cameras in trucks?

S

Simusid

Forum Captain
Messages
336
Reaction score
0
Points
16
I had an MVA friday night, car vs tree. Two 19 YOF with unknown etoh on board. Both had verbal response, I believe both were unrestrained. Significant shortening of car, airbags deployed, windshield shattered, had to pop the door but they weren't entrapped. Once in the truck the medic started the assessment and started a line while I got a bp and put on a 3 lead. The senior medic came aboard and I had to drive so I didn't see the rest of the assessment (nor could I finish vitals and I'm kicking myself for that now).

Anyway, we got to our local Level 1 trauma facility. Senior was talking to the triage nurse while a second triage nurse was with the patient. She said "where do you hurt?", patient response "my haaaaaand" "which one?" "the one with the IV!", and the nurse scoweled a little bit. She palped abdomen finding nothing and made a bit of a "no big deal" comment. Last she said "do you hurt anywhere else ?" Patient response "my lip" which was quite bruised and swollen with some facial abrasion.

Right about this time the senior had completed briefing the triage nurse and pulled out his cell with two pictures of the vehicle. Not 3 seconds later, and I think based mainly on the photo she called for a level 2 surgical team and we found the next day that she had a head bleed.

On the trip home, the senior said he was at least thinking about a TBI because of the mechanism as well as her repetitive questioning (I guess beyond what you would expect due to etoh/disorientation).

Second patient (went to diff hospital) was a similar story, showed pictures, called for team rather than wait in triage. She had a ruptured spleen.

So my takeaway is that sometimes you can't just paint a picture. You really have to show it. And now I want to put cameras on both of our trucks. Does anyone carry cameras on their trucks?
 
Nope. No pictures are to be taken at an accident site. Company policy.
 
Agreed. There is a huge HIPAA risk that goes along with cameras. I've seen some tremendously stupid pictures that staff have shown me and that I've seen on facebook. I'm no HIPAA lawyer but I believe that a photo of just the vehicle (possibly obscuring the lic plate) would be compliant.

Firefite, you did answer the only question I asked, but I'll follow that up. Do you think cameras could be useful?


firefite said:
Nope. No pictures are to be taken at an accident site. Company policy.
Click to expand...
 
We've got dash cams. A few years ago a company attempted a pilot project of a dash mounted video camera broadcasting a signal to a computer screen in the trauma centre ED. Then the trauma team could watch the extrication and look over the vehicle.

It fell by the wayside though because the trauma team was usually busy doing other things and couldn't take the time to watch the show.
 
I've taken my fair share of photos to show at the er. None with license plates.

Had an MVC with rollover. The patients that refused were in the messed up car while the transported one was in the clean car. Pics taken of both and shown to doc as saying "no damage" wouldn't have told the whole story.
 
If the camera is issued by the department or company and is part of the vehicle's equipment inventory, and is to be used for this specific purpose, then I see no HIPAA violation. Information can be communicated if it serves a purpose as part of patient care, and in the OP's story, that's exactly what the pictures did.
 
We used to carry great big digital cams on our rigs and we would take the photos during the event. Once we got to our trauma center we would pull the floppy disc out of the cam and stick it into the TV monitor for all the docs to see. It was actually an ongoing trauma study for many years at Harborview. We eventually DC'd it and now most of us have super phones so we may snap a few photos for the doc if we have a chance. I think it can be helpful but make sure you resist the urge to plaster it on Facebook.
 
Simusid said:
Agreed. There is a huge HIPAA risk that goes along with cameras. I've seen some tremendously stupid pictures that staff have shown me and that I've seen on facebook. I'm no HIPAA lawyer but I believe that a photo of just the vehicle (possibly obscuring the lic plate) would be compliant.

Firefite, you did answer the only question I asked, but I'll follow that up. Do you think cameras could be useful?
Click to expand...

Yes I think they could be very useful. It's pretty hard giving an accurate description of the extent of damage without visual pictures.

Our hospitals were talking a while ago about having a system where we send pictures in right after we give the radio report but the talks never lead anywhere.
 
Of course the important question is, "Does it change care in a meaningful way?" Just because the triage nurse freaks out over the pretty pictures doesn't mean that the scan wouldn't have happened anyways.
 
Last edited by a moderator:
There was a long thread on this many years ago and my answer was this:

Many years ago, we used to carry cameras on every ambulance. We would snap our pictures for the trauma center so they could see the damage.

However, after a few years of this practice, the trauma surgeons and our medical director ordered us to stop.

1. A picture absolutely does NOT tell you what is wrong with a patient...only an assessment does.

2. A picture could "tunnel vision" that assessment as you will pursue what you believe the injuries should be based on what you see.

It is much better for them if you do a thorough exam, use diagnostic equipment and interpret all your findings appropriately.

A picture from a camera will NEVER change the level of care which needs to be done. It WILL increase the odds of patient privacy violation.

I have seen people walk away from some of the most horrific rollovers ever...and then I have seen people with critical injuries in vehicles with very minor damage.

In conclusion, you have no justification for carrying a camera.
 
akflightmedic said:
There was a long thread on this many years ago and my answer was this:

Many years ago, we used to carry cameras on every ambulance. We would snap our pictures for the trauma center so they could see the damage.

However, after a few years of this practice, the trauma surgeons and our medical director ordered us to stop.

1. A picture absolutely does NOT tell you what is wrong with a patient...only an assessment does.

2. A picture could "tunnel vision" that assessment as you will pursue what you believe the injuries should be based on what you see.

It is much better for them if you do a thorough exam, use diagnostic equipment and interpret all your findings appropriately.

A picture from a camera will NEVER change the level of care which needs to be done. It WILL increase the odds of patient privacy violation.

I have seen people walk away from some of the most horrific rollovers ever...and then I have seen people with critical injuries in vehicles with very minor damage.

In conclusion, you have no justification for carrying a camera.
Click to expand...

Well I can't really disagree with anything you listed. Everything you say is 100% true. I'll just add that I was 2 feet away from a nurse making her own assessment and judgement call that I really do feel was trumped based on the picture we provided.
 
So it was the nurse's lack of knowledge, experience or training as a picture would make no difference.

I only point this out to clearly demonstrate where the issue was...it never should have boiled down to a picture.
 
Simusid said:
I had an MVA friday night, car vs tree. Two 19 YOF with unknown etoh on board. Both had verbal response, I believe both were unrestrained. Significant shortening of car, airbags deployed, windshield shattered, had to pop the door but they weren't entrapped. Once in the truck the medic started the assessment and started a line while I got a bp and put on a 3 lead. The senior medic came aboard and I had to drive so I didn't see the rest of the assessment (nor could I finish vitals and I'm kicking myself for that now).

Anyway, we got to our local Level 1 trauma facility. Senior was talking to the triage nurse while a second triage nurse was with the patient. She said "where do you hurt?", patient response "my haaaaaand" "which one?" "the one with the IV!", and the nurse scoweled a little bit. She palped abdomen finding nothing and made a bit of a "no big deal" comment. Last she said "do you hurt anywhere else ?" Patient response "my lip" which was quite bruised and swollen with some facial abrasion.

Right about this time the senior had completed briefing the triage nurse and pulled out his cell with two pictures of the vehicle. Not 3 seconds later, and I think based mainly on the photo she called for a level 2 surgical team and we found the next day that she had a head bleed.

On the trip home, the senior said he was at least thinking about a TBI because of the mechanism as well as her repetitive questioning (I guess beyond what you would expect due to etoh/disorientation).

Second patient (went to diff hospital) was a similar story, showed pictures, called for team rather than wait in triage. She had a ruptured spleen.

So my takeaway is that sometimes you can't just paint a picture. You really have to show it. And now I want to put cameras on both of our trucks. Does anyone carry cameras on their trucks?
Click to expand...
Digital cameras or not, drunk or not, when your patient engages in repetitive questioning even after you orient the patient to their current situation... is a big red flag for TBI. About all that the cameras are good for is showing the potential for energy transfer to the patient. In short, it shows mechanism. A good assessment will show what actually did occur, energy-transfer wise. Remember, you can not have an injury without a positive MOI, but you can have very positive MOI and no injury.

Oh, and one more thing... with repetitive questioning, the info is new to the patient. Every time. Even if they've been asking the same question for the past 6 hours. It's interesting to watch, to say the least. When you get that, start asking about the last thing they remember. You might find that their amnesia starts to extend to times well before the incident. One time they'll remember that they were driving down the road, the next time you ask, they remember waking up in the morning but not what they had for breakfast.
 
firefite said:
Nope. No pictures are to be taken at an accident site. Company policy.
Click to expand...

this may be what your supervisor has told you, but it is false.

here is an excerpt from the latest Employee Handpook (2009 non-union)

"The use of any photographic device, still or video cameras, to copy confidential or proprietary information, or to unknowingly, or unwillingly photograph other individuals, or areas in the workplace, is also not allowed and may be in violation of HIPAA regulations." section 2.12

AMR will allow you to take pictures of patients or accident scenes provided that the patient is not identifiable. you may get authorization to take pictures of patients using the photograph release form found on "portal" found in the "employee resources" section under the heading "Communication/ media documents" you may need a release from the "Compliance officer" if you are non-union. if you are union as I am, I am provided that right in my CBA.

with that said I keep my Nikon D5000 with me at all times, for "the purpose of training and retrospective case review..."

pm me if you want more information on corporate policy.
 
Photos from MVAs probably have more potential for harm than good i.e idiots sending them to their friends/facebook/
 
Counsel for the Plantiff: So, Paramedic XYZ, why were you and or your partner taking pictures while my client suffered? Would your time not have been better served, and my client for that matter, examining and treat my client?
 
There is nothing wrong with taking a pic and showing it to ER staff. At one point I was on a dept that had cameras on all the trucks and was a standard to take pics of major accidents to show to the ER. There are no hippa issues if it is for documentation. And with our current PCR program we can upload and attach pics to the PCR. It would be like saying writing down the pts DOB, address, ect are hippa violations. If people post on facebook with things that can identify the pt thats a seperate issue
 
DESERTDOC said:
Counsel for the Plantiff: So, Paramedic XYZ, why were you and or your partner taking pictures while my client suffered? Would your time not have been better served, and my client for that matter, examining and treat my client?
Click to expand...

I dont make Pt contact until extrication is complete. I let the fire-medics do their job until then. on of the perks of having an ALS FD.
 
the_negro_puppy said:
Photos from MVAs probably have more potential for harm than good i.e idiots sending them to their friends/facebook/
Click to expand...

Which is why we have only Polaroid cameras on our rigs, and we have to log every photo we take. They're then turned into the hospital as part of the patient's medical report.
 
DESERTDOC said:
Counsel for the Plantiff: So, Paramedic XYZ, why were you and or your partner taking pictures while my client suffered? Would your time not have been better served, and my client for that matter, examining and treat my client?
Click to expand...

I have my partner snap the photos while I stay with the patient. Nothing lost.
 
You must log in or register to reply here.
Back
Top