Cameras are prohibited and pictures will get you fired

[DwayneEMTP]

I took the below picture on scene. It's very old, only the doctor and I saw it. There is no way to tie it to a patient, nor even a specific part of the United States, to the best of my knowledge.

The patient had been cleaned up and her clothes changed before calling 911. When I first looked at the wounds they appeared to be little more than pin pricks, the kind seem many times by most ER docs on pretend suicides. And as I was new at this service I was afraid that I would be unable to convince the docs to take this patient seriously without some idea of what the scene looked like, thus the picture. I believe this pic and her stained clothes were important to her care.

Unfortunately as long as we have yahoos that want to show the world how brave and heroic they are, we will forever have to be cautious of anyone taking pics at a scene. I wasn't questioned by anyone when I took this one..be that good or bad, I don't know.

Also, I agonized over posting even this picture as I didn't want to start a thread of, "Yeah, I took this one and no one knows where it came from either!" I thought that this would be a good example of a way to compliment treatment with a photo, but also think it's a really bad idea to begin a trend of online pic publishing. Just sayin'...

Edit. Pic removed. Though I don't believe that there was anything wrong with posting it, I have left a few coworkers down the road that don't like me very much. Though posted only in the spirit of learning, I can imagine ways that they could perhaps turn it into something that it's not, causing my current, or future employers to question my professional judgement.

For the record, it was a pic of a bloody kitchen floor.

Dwayne

[DFIB]

I took the below picture on scene. It's very old, only the doctor and I saw it. There is no way to tie it to a patient, nor even a specific part of the United States, to the best of my knowledge.

The patient had been cleaned up and her clothes changed before calling 911. When I first looked at the wounds they appeared to be little more than pin pricks, the kind seem many times by most ER docs on pretend suicides. And as I was new at this service I was afraid that I would be unable to convince the docs to take this patient seriously without some idea of what the scene looked like, thus the picture. I believe this pic and her stained clothes were important to her care.

Unfortunately as long as we have yahoos that want to show the world how brave and heroic they are, we will forever have to be cautious of anyone taking pics at a scene. I wasn't questioned by anyone when I took this one..be that good or bad, I don't know.

Also, I agonized over posting even this picture as I didn't want to start a thread of, "Yeah, I took this one and no one knows where it came from either!" I thought that this would be a good example of a way to compliment treatment with a photo, but also think it's a really bad idea to begin a trend of online pic publishing. Just sayin'...

I know where you are coming from. Motivation and intent has a lot to do with picture taking. It makes a huge difference wither I want to show the Dr. evidence for insight or brag to my knuckle dragging buddies. I have quite a few pictures that are similar to this.

I have one picture that almost looks like the same bathroom but I can't seem to find it. In fact your picture sparked the memory.

We were toned out to an attempted suicide. We found a young prostitute in a dirty shag hotel. The wound was insignificant looking but there was lots of blood kind of like pinpricks. She was distraught but denied transport. "No one understands me, you don't know how I feel" she kept repeating. “You are a man, you don't know how I feel" she would repeat. I think we had almost convinced her to go with us when the Police called her pimp to calm her down when we left he was still "counseling" her. It's been a while so she may not even be alive. Of all of the patients I think of her most often. Very sad case.

[basejump]

This is yet another great topic. It has long been the idea that providers taking pics of crash scenes and making statements to the press is some sort of violation of a law that no one can put thier thumb on except to say "HIPAA" or "FOIP". The reality is, to provide pictures of an accident to the recieving Doc is a great asset! I do, and will continue to, snap a pic with my iphone, and email it to the recieving physician at the trauma centre. Now there is a moral/ethical dilemma one must face before spreading said pic to all his friends.... but hey, we are professionals, so that should not be a problem. However, if you do not show a license plate, patient, or give a name.... it is just a smahed up car!

How will a picture alter care in the ER dept?

[DFIB]

How will a picture alter care in the ER dept?

First hand information is always better than second hand knowledge. Even though we train to standardize our reports, there is always the probability that our verbal report will be influenced by our experience and background which will be infinitely different than the experience and background of the doctor

An image can give a more accurate account of the MOI than a verbal description. A verbal description will only refer to the numbers. Depth of intrusion into the cab, deformity to the car, broken seat mounts, deformed steering wheel etc. A picture allows the doctor to make his own assessment of the MOI.

Imagine that you are working at the receiving hospital The EMT brings you a patient and reports that the steering wheel was deformed. What would be the first image that would come to mind? It would most likely be the exact image of a deformed steering wheel that you have seen before. What are the odds that your mental image is different from the current collision?

Lets say a patient falls 10 feet to the bottom of a cliff. A picture of the surface he landed on would surely be different than what the Doc. could imagine from a verbal description.

An image can give a more accurate account of the NOI than a verbal description. Let’s say there is a significant hemorrhage. You estimate that it is 500ml. A picture will allow the doctor to make his own estimate of the lost blood and adjust his treatment.

The example that Dwaine posted is a good example. His patients failed suicide attempt may not have seemed like a serious attempt to the hospital on the basis that the patients wounds did not look like a serious attempt. The picture of the blood on the floor would indicate otherwise. It could be the difference between the patient getting the psychological treatment she needs and being discharged as a faker.

There are many ways a picture can alter care in the ER.

This said, patient confidentiality is the law. Pictures that can identify the patient, situation, place, time or incident should be guarded with utmost secrecy and care. If an EMT post pictures of his "exploits" in EMS or passes gory photos around to his friends he is looking for trouble. Patients have rights.

I would like to hear one of the Docs opinion on this thread.

[JPINFV]

First hand information is always better than second hand knowledge. Even though we train to standardize our reports, there is always the probability that our verbal report will be influenced by our experience and background which will be infinitely different than the experience and background of the doctor

Why is being different a bad thing? Why shouldn't education and experience change how care and transfer of care is performed?

[DFIB]

Why is being different a bad thing? Why shouldn't education and experience change how care and transfer of care is performed?

Different in what way? I am not sure what you are trying to say?

[JPINFV]

Correct me if I'm wrong, but you're saying that you train to standardize your reports, thus attempting to remove any individuality from the reports. You even imply that you attempt to remove letting personal experience and expertise impact the verbal report. What I'm trying to figure out is why letting experience and expertise affect the verbal report would be a bad thing.

[azemt2007]

This may anger some of you and may ring true with others but my opinion is this: First, if you have enough time to take pictures of the patient while on scene, you need to go to journalism school and forget ems since you are not there doing what you are supposed to be doing. Second, I've never met an ER doc that asked to see pics of the scene or the patient's condition. Even if it was an extended transport, neither he nor I have time to mess around with taking pics and sending them. Third, do you think it's respectful to the patient aside from all the HIPPA bullshit and would you want some EMT/medic photographing you or your family when they are injured? Aside from all that, once the scene has been wrapped up and all that's left is the vehicles or the charred out house, pictures are ok to show severity of the scene as reference for later education or information for litigation/insurance. Most scenes require too much focus to be taking away from it by worrying about picture taking.

[DFIB]

Correct me if I'm wrong, but you're saying that you train to standardize your reports, thus attempting to remove any individuality from the reports. You even imply that you attempt to remove letting personal experience and expertise impact the verbal report. What I'm trying to figure out is why letting experience and expertise affect the verbal report would be a bad thing.

I think you are right. I think job related experience and expertise are crucial to the reporting process. I also think that we all come from different backgrounds, social context, socio-economic status, education levels, culture, and so on. I was thinking of this when I referred to experience. Life experience.

The life experience of a doctor I would think to be quite different from an EMT. So what one may say might not be understood in the context it was meant to. This thread is a pretty good example. I meant to communicate one thing and you possibly understood another. I had to clarify my statements. Or maybe not. This is where standardization comes in.

Professional experience and job related expertise on the other hand, I would think, go hand in hand with concise accurate reporting. I might be over thinking communication and I might be wrong but it is something I have pondered.

This may anger some of you and may ring true with others but my opinion is this: First, if you have enough time to take pictures of the patient while on scene, you need to go to journalism school and forget ems since you are not there doing what you are supposed to be doing. .

Agreed, I don't think any one has posted advocating taking pictures of the patient. Quite the the contrary.

Second, I've never met an ER doc that asked to see pics of the scene or the patient's condition. Even if it was an extended transport, neither he nor I have time to mess around with taking pics and sending them.

The doc can see the patient’s condition for himself and any photographic evidence of this nature would in my opinion be redundant and useless. As far as sending a picture, I have never seen it done or heard of anyone doing it except I think someone mentioned it here. Then again, I haven’t had a lot of contact with a wide variety of medics or systems. Every MVC I have worked the ER doc wants to know what the car looked like. He may not ask for a picture but might benefit from one. They never have to ask because we include that information in our verbal reports.

Third, do you think it's respectful to the patient aside from all the HIPPA bullshit and would you want some EMT/medic photographing you or your family when they are injured?

Is there any way of knowing what one person would consider disrespectful as opposed to the next? Possibly someone would advocate taking pictures of the patients but not me in particular. I can only think of one instance where it might be useful and would probably never happen because it is one of those time restricted moments of a call.

Good points all amigo for a side discussion of the thread. Good things to consider.

Aside from all that, once the scene has been wrapped up and all that's left is the vehicles or the charred out house, pictures are ok to show severity of the scene as reference for later education or information for litigation/insurance. Most scenes require too much focus to be taking away from it by worrying about picture taking.

Why wouldn't this same information be important while treatment is still in progress? Why wouldn’t the definitive care provider benefit from this information before the treatment is complete?

Check out Newgard, Martens & Lyons studies and see for yourself the difference it makes.

Edited November 1, 2011 by DFIB

[Happiness]

No pics, no time. Our cell phone dosn't take pics or do texting. I cant really see the point as I am suppose to be able to tell the ER staff the condition of the scene and they should be treating the patient not the pictures.