# stabbing at a local high school



## firecoins (Nov 16, 2007)

This was my call


> Girl injured in stabbing at North Rockland High School
> 
> By RANDI WEINER
> STAFF WRITER
> ...




I never saw any securty guards who "got treated at the scene" unless the school nurse treated them. :unsure:

We were dispatched along with an ALS unit. Lots of pd were sent to the school. It sounded like a large fight was in progress with a stabbing. We got there 2 girls were involved. 1 was in custondy, 17. The other was in the nurse's office. 

ALS had beat us there and were already treating the female patient. There were 2 stab wounds. Neither serious, both superficial. The most serious of the 2 was between the 3 and 4 inercostal rib, in the area of her breast. The female medic already taped it up. lung sounds were clear and equal. We transported BLS with mother.

Mother was an ER RN from a major trauma center in NYC. Mother was talking lawsuit the whole time. Not unusal for this situation. What was unusal was she didn't want to let her daughter tell me what happaned. I explained I am not a cop and HIPPA applies here as well as nurses in an ER situation. 5 minutes later while still enroute, the daughter told her mother what happened. Okay. Mother didn't seem to care as much.


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## Asclepius (Nov 16, 2007)

firecoins said:


> This was my call
> 
> I never saw any securty guards who "got treated at the scene"  unless the school nurse treated them. :unsure:
> 
> We were dispatched along with an ALS unit.  Lots of pd were sent to the school.  It sounded like a large fight was in progress with a stabbing.  We got there 2 girls were involved.  1 was in custondy, 17.  The other was in the nurse's office.



Are you implying that the press got this wrong? That's a steep accusation. I wonder how that is even possible. Do you think it's possible that people get unfairly demonized because the "real" story isn't told accurately? {My comments are PURE sarcasm related to another thread on this site.}


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## OreoThief (Nov 16, 2007)

asclepius.... 

I know what you mean..... I TOTALLY know what you mean.


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## firecoins (Nov 17, 2007)

The original link has expired. 

The Journal News put out the blob you read in my OP. That is the entirety of the post. A longer article will be in today's punlished edition. The online version is a pay version which I won't do. 


The medics had wrapped the wounds prior to my seeing them because they had been on scene first and one of the medics was a female working on a female patient. Wounds were minor.


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## firecoins (Nov 18, 2007)

Look what I found:
http://www.nyjournalnews.com/apps/pbcs.dll/article?AID=/20071117/NEWS03/711170366

Of course Haverstraw Ambulance is not mentioned in the article.  We transported the patient to the hospital but the ALS rig got mentioned for treating the patient.


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## Onceamedic (Nov 18, 2007)

Be careful firecoins.  I was involved as a care provider in a very prominant double homicide here in my relatively small town.  It was and continues to be widely reported.  There have been several other situations where someone who's mug is on the front page of the paper is on my cot.  I can't and don't talk about it with individuals not directly involved in care and as far as posting about them - only in the most general terms.  This was stressed in my educational program and continues to be stressed in the hospital.  Don't divulge details that only direct care providers would know or that can identify the individuals involved.  It can bite you in a$$.


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## Asclepius (Nov 18, 2007)

Kaisu said:


> Be careful firecoins.  I was involved as a care provider in a very prominant double homicide here in my relatively small town.  It was and continues to be widely reported.  There have been several other situations where someone who's mug is on the front page of the paper is on my cot.  I can't and don't talk about it with individuals not directly involved in care and as far as posting about them - only in the most general terms.  This was stressed in my educational program and continues to be stressed in the hospital.  Don't divulge details that only direct care providers would know or that can identify the individuals involved.  It can bite you in a$$.


I was kind of thinking the same thing after the last post from Firecoins. If one did enough checking, I am sure with the level of description we've received already we could easily narrow down the agency and possible who was onscene from that agency. Just be careful not to include specifics....HIPPA and all.


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## firecoins (Nov 18, 2007)

Its my call I am pretty sure you could narrow down that I was on scene. The mere location of the event pretty much set in motion who responded via publically available information.    My rig was filmed departing the school.  Radio freqencies are monitored by the genral public, recorded by the police and tapes probably available via the freedom of information requests since we 

As for the specifin information on the call, I think your right.  Could post 4 be deleted by a moderator just in case?


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## Chimpie (Nov 19, 2007)

I edited the post to protect our member. 

*Warning to all: Please take a moment and review your posts before clicking on 'Reply'.  This is not something that I, nor the rest of the Community Leaders, want to get into the habit of.*


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## jmaccauley (Nov 19, 2007)

firecoins said:


> This was my call
> [/I][/B]
> 
> I never saw any securty guards who "got treated at the scene" unless the school nurse treated them. :unsure:
> ...



The police had already responded and the girl was already taped up. What did you need her to tell you about the incident? Obviously Mom was going to sue somebody, but since you are BLS, what more did you need to know? Or were you just curious? HIPPA or not, you are injecting yourself into a criminal investigation of which you may be issued a subpoena to testify to.


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## firecoins (Nov 19, 2007)

jmaccauley said:


> The police had already responded and the girl was already taped up. What did you need her to tell you about the incident? Obviously Mom was going to sue somebody, but since you are BLS, what more did you need to know? Or were you just curious? HIPPA or not, you are injecting yourself into a criminal investigation of which you may be issued a subpoena to testify to.



She was my patient.  I am required to fill out paperwork by law.  how do you suppose I do this if I can't ask her questions?  I left psychic pcrs at home that day. 

The ALS unit did not transport nor did they necessarily need to treat. If I beat them to the scene I would done all treatment. I had to document their treatment because its my report that was submitted to the hospital. My file is the one that will be brought up in both criminal and civil court.


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## Ridryder911 (Nov 19, 2007)

firecoins said:


> This was my call
> [/I][/B]
> 
> I never saw any securty guards who "got treated at the scene" unless the school nurse treated them. :unsure:
> ...



Couple of things. It appeared as some calls, there was mayhem. Attempt to control the call, not let the call control you. Yes, easier said than done. I personally, would not have let mother ride with the patient. Sorry, ER nurse or not.. if she was going to take over, then she could take her herself to the ED. Either my way or the highway in most circumstances. 

As a provider of the patient, you are supposed to obtain as much history as possible about the occurrence, and if any other potential injuries occurred. The mother being an ER nurse, realizes this much as well. If there is an event or injury missed, you are just as responsible for the treatment or missed treatment. 

HIPAA is poorly understood by most EMT's. Unless, you really know the laws, then I would not make any comments. Most do not really understand it only pertains to those that bill electronically, privacy and HIPAA is separate offenses, as well as public information that can be or not be reported, etc.
If ALS performed the treatment, then they should had documented such, or documented ...._"bandaged pta, wound described as"_. ...

Sorry, on hostage, rape, domestic, I may not want exact details or descriptions, but I sure want a detailed examination and to find out if there is further physical and yes, even psychological injuries. 

R/r 911


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## jmaccauley (Nov 20, 2007)

firecoins said:


> She was my patient.  I am required to fill out paperwork by law.  how do you suppose I do this if I can't ask her questions?  I left psychic pcrs at home that day.
> 
> The ALS unit did not transport nor did they necessarily need to treat. If I beat them to the scene I would done all treatment. I had to document their treatment because its my report that was submitted to the hospital. My file is the one that will be brought up in both criminal and civil court.



Relax, I merely asked a question. If the ALS provider told you she was stabbed and taped her up, you needed to complete your report, I get it. Can you understand why the mother may not want her asnswering questions about the event though? I'm sure mom gave you the pertinent info about the patient.


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## firecoins (Nov 20, 2007)

jmaccauley said:


> Relax, I merely asked a question. If the ALS provider told you she was stabbed and taped her up, you needed to complete your report, I get it. Can you understand why the mother may not want her asnswering questions about the event though? I'm sure mom gave you the pertinent info about the patient.



Yes I understood why the mother was worried about who her daughter talked to.  The daughter said something stupid in front of cops and her mother. the medics and myself made it a point to tell the daughter to not say such things in front of the cops.  Its irrelevant that her mom said anything.

Mom gave the pertinent medical history.  Given her backround, she knew more than most mothers.  

I asked what happaned to get the basic idea of her injuries that I couldn't see at that point.  Her ability to recall gives me an idea of l.o.c. which was my follow up question.Later I saw the injuries.


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## jmaccauley (Nov 21, 2007)

Don't get defensive, but this what I have seen on the job. For those who don't know, I am a police officer as well as a BLS instructor. I have seen EMT's and Medics getting overly involved in police investigations, mainly because they are genuinely caring people. However, it may give the pstient/suspect an opportunity to "try out" their story on a neutral party. I have even witnessed medics press the patient for names of others who may have been involved. HIPPA laws are specific, but limited in their scope. My concern has been that a well meaning, but naive, EMT may inject themselves into a criminal investigation. That is not their role and often causes a serious moral, as well as legal, conflicts. Just my viewpoint and others may have a different perspective they might be willing to share.


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## OreoThief (Nov 21, 2007)

jmaccauley said:


> Don't get defensive, but this what I have seen on the job. For those who don't know, I am a police officer as well as a BLS instructor. I have seen EMT's and Medics getting overly involved in police investigations, mainly because they are genuinely caring people. However, it may give the pstient/suspect an opportunity to "try out" their story on a neutral party. I have even witnessed medics press the patient for names of others who may have been involved. HIPPA laws are specific, but limited in their scope. My concern has been that a well meaning, but naive, EMT may inject themselves into a criminal investigation. That is not their role and often causes a serious moral, as well as legal, conflicts. Just my viewpoint and others may have a different perspective they might be willing to share.



Thank you for that insight, I appreciate it. So, when we are given "the story" during our assessment, what do you advise us to do? Or even better, what do you advise us NOT to do to keep ourselves away from a situation like this?


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## jmaccauley (Nov 21, 2007)

OreoThief said:


> Thank you for that insight, I appreciate it. So, when we are given "the story" during our assessment, what do you advise us to do? Or even better, what do you advise us NOT to do to keep ourselves away from a situation like this?


Perhaps, as Firecoins stated, advise them that you are there to treat any injuries and are not interested in the other details. It's an interesting and probably touchy delemma. However, Suggesting that they may wish to share their story with the police may get them to stop.


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## firecoins (Nov 21, 2007)

I don't care specifically about criminal investigations. I am not to trying to work against the PD but I need info related to a patient's condition. The patient need to be able to answer my questions without legal repurcussions.   My job is take care of the patient first. Its that simple. It is what the job requires.  I am not trying to solve crimes, file charges or write tickets.


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## jmaccauley (Nov 22, 2007)

Again, as an EMT, you do need specific information. Just remember that much of what you ask is probably not medically expediant and probably more for your own curiousity than actual necessity. Try not to think of yourself as someone outside the realm of police investigations because, as I said, you may find yourself right in the middle. You do not enjoy doctor/patient priviledges.


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## firecoins (Nov 22, 2007)

jmaccauley said:


> Again, as an EMT, you do need specific information. Just remember that much of what you ask is probably not medically expediant and probably more for your own curiousity than actual necessity. Try not to think of yourself as someone outside the realm of police investigations because, as I said, you may find yourself right in the middle. You do not enjoy doctor/patient priviledges.



actually Ido enjoy doctor/patient priveldges.  I work as an extension of medical control...a medical doctor.  I ask because I am on a need to know basis.


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## VentMedic (Nov 22, 2007)

firecoins said:


> actually Ido enjoy doctor/patient priveldges.  I work as an extension of medical control...a medical doctor.  I ask because I am on a need to know basis.



No, actually you don't have doctor-patient privileges. 

Legal privilege involves the right to withhold evidence from discovery and/or the right to refrain from disclosing or divulging information gained within the context of a doctor-patient relationship.

You may be called as an EMT at any time to testify or give a statement.  You may also be questioned about how you obtained your information or your motives for obtaining such information.


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## firecoins (Nov 22, 2007)

VentMedic said:


> No, actually you don't have doctor-patient privileges.
> 
> Legal privilege involves the right to withhold evidence from discovery and/or the right to refrain from disclosing or divulging information gained within the context of a doctor-patient relationship.
> 
> You may be called as an EMT at any time to testify or give a statement.  You may also be questioned about how you obtained your information or your motives for obtaining such information.



without a subpeona, I have no obligation to provide information to the police. I have to be subpoenaed to tesify.  Even doctors can also be suboenaed to testify.


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## VentMedic (Nov 22, 2007)

firecoins said:


> without a subpeona, I have no obligation to provide information to the police. I have to be subpoenaed to tesify.  Even doctors can also be suboenaed to testify.



And yes, you will have to divulge what you have been told.  The doctor does not necessarily have to give up that information. If you tell the patient or represent yourself as having the same legal privileges, you are doing both you and the patient an injustice. 

*Legal privilege involves the right to withhold evidence from discovery and/or the right to refrain from disclosing or divulging information gained within the context of a doctor-patient relationship.*


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## firecoins (Nov 22, 2007)

VentMedic said:


> And yes, you will have to divulge what you have been told.  The doctor does not necessarily have to give up that information. If you tell the patient or represent yourself as having the same legal privileges, you are doing both you and the patient an injustice.
> 
> *Legal privilege involves the right to withhold evidence from discovery and/or the right to refrain from disclosing or divulging information gained within the context of a doctor-patient relationship.*



I am obtaining information from patient for their medical treatment exactly like a doctor does.  I often report to a nurse or doctor at the ER and give them the information I obtain. Cops are not entitled to that information simply because they are conducting an investigation.  I will refer a cop to either speak to the doctor at the ER and/or the public information officer of my organization.  In this specific case, the cops did not come to me nor did they need to come to me.  If they need something, the patient and parents were cooperating with the cops.  I have rarely had a problem with the cops. They know what they are doing.


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## jmaccauley (Nov 26, 2007)

From what I have seen here, Firecoins, you actually do have a problem with the police. When you become licensed as a doctor and admitted to the AMA, you may have Doctor/patient confidentiality protection. As an EMT, you do not. Referring the police to the ER docs or nurse in most cases would only delay the inevitible: the subpoena. My suggestion is that you limit your questions to those that are medically necessary and not the other details that are more anecdotal than required for your paperwork. Unless you are ALS, how much time do you think you will have to spend with the patient anyway?


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## firecoins (Nov 26, 2007)

jmaccauley said:


> From what I have seen here, Firecoins, you actually do have a problem with the police. When you become licensed as a doctor and admitted to the AMA, you may have Doctor/patient confidentiality protection. As an EMT, you do not. Referring the police to the ER docs or nurse in most cases would only delay the inevitible: the subpoena. My suggestion is that you limit your questions to those that are medically necessary and not the other details that are more anecdotal than required for your paperwork. Unless you are ALS, how much time do you think you will have to spend with the patient anyway?



umm no.  I do not have a problem with the police. 

The police will not receive patient information just because they ask. I have no problem testifying under a subpoena.  No doctor has the power to fight a subpoena either.  My question are already limited to whats medically relevant as been mentioned several times already.  I need information from the patient and its needs to be done in such a fashion that their words will not be used against them .  If the police have a problem with that, they can go to a judge and get a warrent. The D.A. can subpoena me.  That is fine.  Thats what the legal process is for.


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## jrm818 (Nov 26, 2007)

The discussion of "special relationships" between patient and dr/care provider are actually highly variable by state.  The federal standard is pretty wishy-washy and just makes references to common law and generally accepted practice in terms of a physician privilege.  

NY apparently has a fairly broad privilege - covering not only "those licensed to practice medicine" but also nurses and dentists.  A quick perusal of a couple of court cases from that state suggest to me that an EMT would be considered a "medical professional" (the repeatedly used language of the court here: http://64.233.169.104/search?q=cach..._0113.htm+CPLR+§4504&hl=en&ct=clnk&cd=1&gl=us ) and be be covered by privilege.

Of course that applies only to medically relevant information - but the court also took a fairly broad look at that in the case above.

I have never been able to find any really good case law regarding privilege with prehospital care providers - my suspicion is that that is more due to a lack of ambulance-types challenging subpoenas.  

The issue just doesn’t seem to have been addressed by the courts, and the possibility of extending the privilege to EMT's etc. seems to have been ignored by most legislatures, which makes asserting either that there is or is not privilege for EMT's very shaky.


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## Ridryder911 (Nov 26, 2007)

Like has been stated before, an EMT does not have "Doctor patient privileges"; yes, we represent physicians but we are not licensed as a physician and are only covered by him by delegated practice and authority. 

The patient initial contract of care was the EMT, not the physician even though by proxy. 

Sure, one can refuse to give information because of privacy regulations in which all health care providers should be performing. There are certain information I will give or general information, that is required for safety and public information. This supersedes patient confidentiality. 

R/r 911


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## jmaccauley (Nov 26, 2007)

firecoins said:


> umm no.  I do not have a problem with the police.
> 
> The police will not receive patient information just because they ask. I have no problem testifying under a subpoena.  No doctor has the power to fight a subpoena either.  My question are already limited to whats medically relevant as been mentioned several times already.  I need information from the patient and its needs to be done in such a fashion that their words will not be used against them .  If the police have a problem with that, they can go to a judge and get a warrent. The D.A. can subpoena me.  That is fine.  Thats what the legal process is for.



So, given that you would (as if you had a choice) testify at a depo under subpoena, why would you withhold information from a police officer? If you were treating a patient for a gunshot or knife wound and they told you that the guy next door did it, you would keep that information to yourself unless compelled by a court order? I'm trying to understand your objections, since you are part of the investigation just by being on the scene. Do you feel that you would be violating HIPPA laws, or doctor/patient confidentiality?


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## firecoins (Nov 26, 2007)

jmaccauley said:


> So, given that you would (as if you had a choice) testify at a depo under subpoena, why would you withhold information from a police officer? If you were treating a patient for a gunshot or knife wound and they told you that the guy next door did it, you would keep that information to yourself unless compelled by a court order? I'm trying to understand your objections, since you are part of the investigation just by being on the scene. Do you feel that you would be violating HIPPA laws, or doctor/patient confidentiality?



If the suspect is my patient, I would not turn over information to cop if he simply asked.  The cop would need to go through proper channels to get information.  The reason being that in aquiring relevant patient information, the patient may reveal incriminating information but is necessary for medical treatment.  The exception being that the information reveals a threat to the health and well being of other people.   

If the victim of a crime told me information about the suspect and it was clear the victim would not be charged in a crime,  that is a different scenario.  You advise her to tell the cops.  If the cops are not already on the scene, you can have them meet you at the hospital so the patient herself can tell the cops herself. (Cops are dispatched to all 911 calls in my area.) You as an EMT may be called as a witness in this case so you probably will get subpoeaned anyway. 

Its my understanding there are  mandatory reporting laws that require that all assaults be reported by the ER. 

In the the scenario in the original post, the suspect had already been in custody.  It was not clear if the victim would be charged with anything herself.  She did not reveal anything incriminating about herself to me anyway. The victim did fully cooperate with the police with her mother's permission.  She was not charged with a crime.


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## jmaccauley (Nov 27, 2007)

Sometimes I think you have an inflated sense of your responsibilities. You would make the police jump through hoops rather than just cooperate. Are you protecting your patient or exercising some imagined power that you, as an EMT, believe you are afforded? Why should you care whether or not the victim may be charged with a crime? You're there to plug up holes and get them to a real doctor. Just as time is important in administering medical treatment, it plays a big role in solving crimes.


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## firecoins (Nov 27, 2007)

jmaccauley said:


> Sometimes I think you have an inflated sense of your responsibilities. You would make the police jump through hoops rather than just cooperate. Are you protecting your patient or exercising some imagined power that you, as an EMT, believe you are afforded? Why should you care whether or not the victim may be charged with a crime? You're there to plug up holes and get them to a real doctor. Just as time is important in administering medical treatment, it plays a big role in solving crimes.




What hoopes are the cops jumping through?  

First, the name of a suspect is not something I would even ask because it isn't relevant to her treatment.  I am not a cop.  I am not solving crimes. Clearly *I DONT* have an inflated sense of responsibilities. I ask only medically relevant information. I ask what happaned so I knwo the injuries. I get nice little summary and I move on from there.     

Second, if a victim can ID her attacker to me, 99.9% of the time, she already told cops.  Therefore I don't need to tell them a second time. I am called after the fact by the cops more times than not. In the *unlikely event* she IDs an attacker to me and for some reason not to the cops, I would alert cops that she has identified a suspect under the assumption such a person is a threat to the general public.  

If I am responding to a violent criminal event, I let the cops arrive first.  If this event is in the past, the cops are already there.  There going to have more information than I have to begin with and usually will se most of my assesment.  Its unlikely I will find something out they don't already know. 

Third, If I have a patient that is a suspect in a crime, its not my job to interrogate him.  That is the job of police.  Its my job to treat him.  I have certain information I need to collect to do that.  I am not interested in anything not medically relevant.  If he says some incriminating that does not put my safety or that of the public in danger, it doesn't warrent calling the cops.  

What is it that I am going to find out that the cops aren't going to find out though normal investigations?  Not much.


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## firecoins (Nov 27, 2007)

let try and be clearer I find I am repeating myself. 

I need to know what happaned.  I don't need to who did it and why they did it.  Too much info.  The cops are 99.9% of the time dispatched to the same scene I am.  They are already asking those questions.  My inital assessmen usually occurs in plain view of the officer. As I said, there is very little the cop is not going to know.  Inside the confine of the rig I will ask the same question a second time to make sure I got accurate information.  People may not tell the truth in front of the cops.  People rarely talk about personal drug use in front of cops yet this is relevant information if anyone want to give medications to the patient.  

I am not a cop.  I am not conducting a criminal investigation.  Rarely will I know something a cop doesn't already know. In the event that I do, my giving the PD info depends soley on the circumstances.  

The call in the OP. Dispatch said the fight/stabbing was in progress. We let the cops get their first.  The cops already had the suspect in custody. I am not sure anything I found out in the process of assessing my patient would have made any difference in any criminal investigation BUT I wanted the patient to be able to speak freely without fear that what she said would get her arrested.  This way I could get all relevant information without fear.  I was able to do this.  Nothing mentioned on the call was incriminating as far I could tell.  The news article mentions everything I found out.


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## jmaccauley (Nov 28, 2007)

Much better explanation this time around. Plus, it's sounds more reasonable than the "I won't tell the cops anything unless subpoenaed."


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## eggshen (Dec 3, 2007)

We are lucky here. One time rides in on all penetrating trauma and most other assault type calls where they may need to sort out who is who and what happened. If a pt. hits me up with something I think the cops may like I relay it. As long as it is not in the HIPAA realm I feel free. I hate bad guys as much as the next guy right?

Also...how much does one need to ask on that type of call anyway. Not a lot.

Egg


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## thowle (Dec 16, 2007)

Wow, that's just insane.  People need to just "chill" with the drama, especially in the high-school setting/environment.  It doesn't take much for someone to get worked up just because someone called their mom ugly, or some crazy stuff like that.

This also shows that a need for security, or police presence at the school during times of dismissal is needed as well, not just during regular "school hours".


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## jmaccauley (Dec 16, 2007)

Someone correct me if I'm wrong please. HIPPA rules restrict the release of medical records. Does that mean it covers all of details surrounding an injury or assault? I don't think so, but I have had nurses and even some doctors (who appear as confused as me) reluctant to share anything about the patient. At any rate, my issue is when a first responder decides that they want to be the "good guy" in the eyes of a victim and show that they aren't "the man." Plug up the leaks, get them breathing and take them to the hospital. If you hear something that the police might be interested in, share it before someone else gets hurt.


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## ffemt8978 (Dec 16, 2007)

jmaccauley said:


> Someone correct me if I'm wrong please. HIPPA rules restrict the release of medical records. Does that mean it covers all of details surrounding an injury or assault? I don't think so, but I have had nurses and even some doctors (who appear as confused as me) reluctant to share anything about the patient. At any rate, my issue is when a first responder decides that they want to be the "good guy" in the eyes of a victim and show that they aren't "the man." Plug up the leaks, get them breathing and take them to the hospital. If you hear something that the police might be interested in, share it before someone else gets hurt.



Considering that there are specific exemptions in HIPAA covering the release of PHI to law enforcement as it pertains to the victim or suspect of a crime, you are correct.  I don't see where people are still having a problem with this.  After all, mandatory reporting is something that is exempted from HIPAA also.


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