Duty to Act
We’ve all seen the video. We have seen the knee on the neck, and we’ve definitely seen the aftermath.
For the second time in three short months, we are thrown into an environment as clinicians that we didn’t train for; and didn’t plan to have happen.
It’s not a virus; but it is a pathogen. And it’s one we’ve known deep in our hearts that has existed in some way, shape or form for a long time.
The months ahead are going to be gut-wrenching. Police agencies all over the United States are going to be dealing with a hard reckoning. Almost 30 years after a TV camera caught police savagely beating Rodney King on a motor vehicle stop; we’re in the same place with George Floyd, Philando Castile, Freddie Gray, Michael Brown, Eric Garner, and Breonna Taylor, herself trained as an EMT.
There are more. Many more. And I don’t envy the journey that police all over the USA will be taking sooner or later. But let’s be honest: It has to happen. Now.
By all accounts, the paramedics who were summoned to the scene of George Floyd’s death did their job. They initiated care, started to attempt resuscitation; and made a decision to move to the hospital quickly. Armchair quarterbacks can argue evidence and the relative merits of “what I would have done…”, but the hard facts are we weren’t there. We cannot use our perch to question the actions of EMS on this call. It’s just not fair.
In Minneapolis, EMS appears to have gotten on scene after George Floyd had become unresponsive. A pulse was checked, then Mr. Floyd was moved to the ambulance where resuscitation was initiated. The chief of Hennepin EMS spoke to EMS1.com and gave a recap of the paramedic care provided and the ED care at transfer.
Again, I don’t want to dissect the actions of EMS at this scene. By all accounts, the damage was done before paramedics even arrived. I truly believe, unless clear evidence to the contrary; that the providers on that call conducted themselves honorably and did the best they could.
But others will. They will most likely not be experts in evidence-based medicine, be licensed to provide patient care, or have ever been in that role. And in a world where optics matter, and everyone on the street has a professional-quality camera in their hands, we suddenly again have to think on our feet and deal with a rapidly changing environment with little to no guidance or precedent. This combination of circumstances creates a minefield for EMS clinicians that we’re going to have to learn to navigate.
As clinicians, we have a duty to act. We learn this early in training, But in the real world, it gets a little more dicey; when passions and tempers flare and lines can blur.
What if they had gotten there earlier? What if the ambulance got on scene 4 minutes into the video? What then? What would you have done?
How do we as clinicians and agencies treat and care (yes, care) for individuals under arrest or prisoners? What if we see excessive force being used in our presence? What are our ethical and moral obligations to that arrestee, and to the officers on scene?
Emotion and adrenaline can overpower training and sometimes discipline. So as I sit here at the computer, and watching what is happening right now in this country, how do we in EMS do better?
First, we need to interact and engage our cops. Be the ones who teach bleeding control, CPR, and the skills officers need to save lives. It doesn’t matter if their department responds to medical calls. This is officer survival. As important as defensive tactics and firearms. If your shop isn’t doing this; find out why. And offer to do it.
It gives you an advantage because you become a subject matter expert to the police you work with every day. They know you. They see you in a non-stressful environment, and you become part of the team, so to speak.
Second, when you respond to these calls involving arrestees, prisoners, or violence involving police, remember your priority is the patient. First, foremost, and always. You ARE being recorded. You ARE being judged in the court of public opinion; and sometimes in the mob. That’s fine. As professionals, we shouldn’t have any problem with that.
If someone is recording you; don’t engage. As Bill Belichick posted in the New England Patriots locker room: DO YOUR JOB. What do you have to lose by a video showing that you’re doing your job effectively and well?
Don’t be dismissive of your patient. You’re not the jury, you’re not charging them with a crime. Not your job. You won’t score points with the cops; and at worst, you’ll miss something that will come back to bite you, hard. Assess, treat, transport. When we get out of that mindset, things can and do go wrong.
And yes, we probably need to take this opportunity to petition our employers to stop putting us in uniforms that look like we’re patrol officers. Rioters don’t take the time to look at a patch before they throw a brick. We need to move more toward a European and Canadian model of uniform with a lot of high visibility. What we don’t need is looking like cops. Especially in neighborhoods that look as cops as potential dangers to their lives.
Don’t be the one that antagonizes or “torques up” the patient. He or she may be a poor example of a human. They may be unpleasant. They may be agitated. There may be a crowd that’s not happy about things. Don’t make it worse. People read body language, read facial expressions. They will surmise you’re not there to make things better.
Do your job. That’s why you’re a professional. A moment of unprofessional behavior can blow back on you for years to come. And for most of you; you’re not municipal or county employees, in which case you’re not indemnified by your agency against civil liability.
Think about that for a minute. I’ve followed the same Internet discussions that you all do; and read regularly about how little you feel your agencies care for or protect you. If they won’t give you protective equipment or vehicles in good repair; do you really think they will get you a lawyer or pay for the lawsuit? You may win; but it’s going to cost thousands of dollars and a long time. Think about if you could weather that storm.
If you’re one of those providers that have made a comment on social media that your response to a potentially violent patient or crowd is to return violence, remember that in any incident, you will be identified, your social media posts will be reported, and it will go viral. Your Internet Tough Guy moment that sounded so cool on that Facebook page will be used against you as an example of your professionalism and prejudices if and when you’re involved in an incident.
Finally, you need to think what you’re going to do when you get on scene and see a George Floyd or Eric Garner on the ground. It may happen, and how are you going to respond?
I feel that the time has passed for us to turn our heads and pretend we didn’t see excessive police violence. In the changing culture of the USA, and it is changing; turning a blind eye to it will be not only dangerous for the patients, but for the officers involved, as well as for our colleagues in EMS. We need to be seen by the public as the ones to look for in a time of trouble.
We need to consider being the voice of reason in these situations. We know physiology and pathophysiology, we know sick versus not sick, and we need to communicate this to the cops we work with.
The PACE format may be a good tool to communicate to cops in a non-threatening way that there’s a problem and we need to help.
PROBE: “Hey, do you guys want us go get him up onto the stretcher?”
ALERT: “Guys, he’s quiet and not moving. Can we check and make sure he’s OK?”
CHALLENGE: “Hey, take your knee off his neck. He may not be breathing.”
EMERGENCY: “He’s not breathing/bleeding to death/is dying. We need to get in there.”
I’m not saying to jump in and directly confront cops in this situation. That may not work out the way you think. But, I think we need to consider that as clinicians, we must incorporate this into our practice and documentation. We have a duty to protect our patients. We have an obligation to protect ourselves. And, we may be able to protect officers as well.
We have to change.
