Does anyone have any information/policies/guidelines on the following issue:

When your EKG monitor is on, monitoring a stable patient in the back of the ambulance, but it is set up to record all audio input at all times. This is for a routine patient, hemodynamically stable and the patient is unaware. Is this legal, should this be occurring, is it fair to the patient or provider. Should an organization/provider allow this,etc.

Does anyone have any input, direct knowledge of this, or ideas/thoughts

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Our organization doesn't have any P&Ps on this topic, but it has been discussed about in the past. The big thing about this is that you do have clear policies in place on how they are used. If you use this purely as a QI tool, without being used punitively, then you should be good.

You will definitely want to make this peer-review related in your policies and thus not discoverable in court. As for the patient I would say this should be kept confidential just like any other type of protected health information.

This sounds a lot like the video/audio that police carry, it more often than not exonerates them if accused by a citizen, but can also be used in the courtroom.

So my rambling equates to... hopefully someone else with Esq at the end of their name chimes in with some thoughts.

 

Garrett Hedeen BS, MHA

Paramedic, Instructor  

If its a routine patient who is stable why would you call for continuous monitoring?

I'd switch it on every 5-10 minutes to do a set of vital signs, unless it is a cardiac or critically unwell patient I really see no need for continuous ECG monitoring...you unnecessarily stick dots on a patient which hurt like hell when they come off and you waste the battery. 

I can think of one additional good that could come out of it. If you are working a cardiac arrest or have a critical run, you can use it to help with documentation of times and treatments (if your machines' times are synched). You can go through the audio and here for someone saying "pushing" another epi 1:10,000" etc..

Though this wont be necessary in 5-10 years when we have integrated electronic patient care reports that have the ability to dictate with voice recognition software. It may go something like this...

Medic: EPCR

ePCR: Yes Dave

Medic: Input Intervention, drug, epinephrine, 1 to 10:000 concentration, 1 mg

ePCR: 1 mg epinephrine 1:10,000, confirm

Medic: Correct

ePCR: *ding* 

Medic: Exit dictation

ePCR: *dong*

Could be too syfy, but who knows...

Thanks

My concern is that the 90 % usage of the monitor is unfairly being recorded for no purpose, in the past it has been recording anytime you would place the monitor in the paced/shock area for critical and cardiac arrest calls. We routine speak into the monitor for those purposes, this is for everyday use, to monitor capnography,BP etc.

The other concern is: what are your state's wiretapping laws? Do they require consent of both parties? This probably isn't an issue if you're actively using it to dictate (any more than tracking your code using a hand-held recorder would) but might be for those calls where you're not using it for that purpose.

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