Reynolds One
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I'm a licensed EMT/BLS instructor, and I work in investigations for a large county medical examiner's office. Aside from investigating death scenes in the field, one of the more critical things we do is subpoena medical records for decedents. If the death occurred in a hospital, those records would often include the EMS run reports, too.
I think it goes without saying that most EMS providers understand the role of run reports in the continuity of care and as clear documentation for what they did (not to mention legal protection for themselves). But I wanted to pass along how important run reports, specifically good narratives, are to the work of medicolegal death investigators and forensic pathologists.
Despite what some people think, it's not always easy to determine a cause of death, even after autopsy and toxicology tests. Good scene descriptions are particularly relevant in cases of infants when there is no trauma, no known underlying medical condition, or no environmental cause. In cases like this, it's critical that we understand the circumstances surrounding the death and the scene itself.
Why? Well let's be very blunt, a parent could intentionally place a 5-month old on a bed in a potentially dangerous position with some blankets, walk away, and given that most infants that young are unable to move themselves, the baby could very easily die of asphyxiation. Who can definitively prove that it was an accident or intentional, i.e. - is this an "accident" or a "homicide?" All we have to go on is the parent's word.
So, using this scenario, the parents call 911, EMS arrives, and if the infant is not "dead dead," they begin treatment and rapid transport to an ER. EMS leaves. The baby dies. The nurse contacts law enforcement and a detective arrives. The detective interviews the nurse and family (if they're there). And when the detective completes his/her investigation, he/she (or the nurse) contacts the medical examiner's office. We arrive, do our investigation, transport the body back to our facility, a complete autopsy is performed, and so on.
Now, again hypothetically speaking, what if this was intentional? All those involved do their best to get as much detailed information as possible, but the one thing that's missing is eyes on the scene. Except there were, actually - the EMS crew. They saw the scene in it's most untouched. After the fact, we'll contact the family or caregiver who was with the infant and ask if they're willing to do a doll reenactment, which helps us get a better understanding of the circumstances surrounding the death. But still, this is long after the fact. And by now plenty of things could have changed. The scene may not be what it was when the infant died. And again, in a hypothetical foul play scenario made to look like an accident, plenty of time has passed for the parents or caregivers to cover things up.
All the infant deaths I've done (unsafe sleeping or co-sleeping situations) have been terrible accidents (sometimes thanks in some part to poor judgment on the part of the parent/s). But we wouldn't be doing our jobs if we weren't as thorough in our investigations as possible. Most of the run reports I've read in cases like these offer little to nothing in the narratives as to the scene itself - more often than not there are just a few lines of abbreviated notes on the treatments provided. Rarely do I see anything written about the scene or circumstances.
Of course, I understand that patient care is the number one priority. I wouldn't suggest that EMS providers forego care to focus on other things. And I don't know what everyone's rules and guidelines are to writing their run reports based on what agency they work for what media they use. I'm just saying that a good EMS narrative can make a lot of difference in some cases, because despite everything else we've done, the circumstances of the scene, untouched, might hold the biggest clue as to what happened. And the people that are best capable of relaying that information are those first on the scene, and that's typically EMS.
I think it goes without saying that most EMS providers understand the role of run reports in the continuity of care and as clear documentation for what they did (not to mention legal protection for themselves). But I wanted to pass along how important run reports, specifically good narratives, are to the work of medicolegal death investigators and forensic pathologists.
Despite what some people think, it's not always easy to determine a cause of death, even after autopsy and toxicology tests. Good scene descriptions are particularly relevant in cases of infants when there is no trauma, no known underlying medical condition, or no environmental cause. In cases like this, it's critical that we understand the circumstances surrounding the death and the scene itself.
Why? Well let's be very blunt, a parent could intentionally place a 5-month old on a bed in a potentially dangerous position with some blankets, walk away, and given that most infants that young are unable to move themselves, the baby could very easily die of asphyxiation. Who can definitively prove that it was an accident or intentional, i.e. - is this an "accident" or a "homicide?" All we have to go on is the parent's word.
So, using this scenario, the parents call 911, EMS arrives, and if the infant is not "dead dead," they begin treatment and rapid transport to an ER. EMS leaves. The baby dies. The nurse contacts law enforcement and a detective arrives. The detective interviews the nurse and family (if they're there). And when the detective completes his/her investigation, he/she (or the nurse) contacts the medical examiner's office. We arrive, do our investigation, transport the body back to our facility, a complete autopsy is performed, and so on.
Now, again hypothetically speaking, what if this was intentional? All those involved do their best to get as much detailed information as possible, but the one thing that's missing is eyes on the scene. Except there were, actually - the EMS crew. They saw the scene in it's most untouched. After the fact, we'll contact the family or caregiver who was with the infant and ask if they're willing to do a doll reenactment, which helps us get a better understanding of the circumstances surrounding the death. But still, this is long after the fact. And by now plenty of things could have changed. The scene may not be what it was when the infant died. And again, in a hypothetical foul play scenario made to look like an accident, plenty of time has passed for the parents or caregivers to cover things up.
All the infant deaths I've done (unsafe sleeping or co-sleeping situations) have been terrible accidents (sometimes thanks in some part to poor judgment on the part of the parent/s). But we wouldn't be doing our jobs if we weren't as thorough in our investigations as possible. Most of the run reports I've read in cases like these offer little to nothing in the narratives as to the scene itself - more often than not there are just a few lines of abbreviated notes on the treatments provided. Rarely do I see anything written about the scene or circumstances.
Of course, I understand that patient care is the number one priority. I wouldn't suggest that EMS providers forego care to focus on other things. And I don't know what everyone's rules and guidelines are to writing their run reports based on what agency they work for what media they use. I'm just saying that a good EMS narrative can make a lot of difference in some cases, because despite everything else we've done, the circumstances of the scene, untouched, might hold the biggest clue as to what happened. And the people that are best capable of relaying that information are those first on the scene, and that's typically EMS.
