The Research

Lynne EG, Gifford EJ, Evans KE, et al. Barriers to reporting child maltreatment: Do emergency medical services professionals fully understand their role as mandatory reporters? N C Med J. 2015;76(1):13–18.


The Science

In this study, the authors conducted an anonymous online survey of EMS providers in North Carolina to determine if and how well they knew their service’s policy on child abuse reporting. It also sought to determine the reasons an EMS provider might not report suspected abuse.

A total of 740 EMS agencies received the survey and were asked to disseminate it to their employees; 444 (60%) surveys were completed. Of those, 90% of the respondents were frontline staff and over half had more than 10 years of EMS experience, with a quarter of the respondents having more than 20.

When asked whether or not their service had an abuse reporting policy, nearly two-thirds (61.9%) of respondents said yes, 18.7% responded no, and 19.4% responded that they didn’t know if there was a written protocol.

Of the EMS providers who believed their agency had a written policy, 75% correctly stated it was the responsibility of the person with firsthand knowledge to make the report. The remaining 25% believed it was the responsibility of the provider’s supervisor or another agency such as law enforcement or the hospital.

The authors concluded that EMS providers should be provided additional education in child abuse reporting.

Medic Wesley Comments

According to data from the National Child Abuse and Neglect Data System (NCANDS), an estimated 1,520 children died from abuse and neglect in 2013. How is it possible that we in EMS may have missed opportunities to prevent many of these deaths or at least stop suffering in those who survived? This study depicts the result when EMS education fails to address important medical-legal issues. It demonstrates how a lack of understanding of the law may be wrongly translated during training and education, and how providers may misinterpret it.

We stepped up our education on pediatrics years ago when it was clear EMS was mistakenly treating children like small adults. With child abuse and neglect, the patient is often a silent victim unable to share their complaints of pain and suffering. Most often the history is provided by parents or caregivers who may be the perpetrators of these crimes.

Additional hours of training are needed to engrain the responsibility we have toward our most vulnerable patients. Most of all, maybe it’s time states develop rigid instructor training in the legal aspects of EMS. Or, maybe it’s time to have the legal experts provide all of this type of training to providers.

Either way, we have to change the statistic of 4–5 children dying each day of abuse or neglect.

Doc Wesley Comments

Some may criticize this study as only being applicable to North Carolina, and you might be right. However, I’ve had the opportunity to travel across the U.S. and ask questions similar to those in this survey and found that a significant percentage of our providers are either not aware of their state’s mandated reporting law or have misunderstood who is to report what to whom.

The agency responsible for taking reports is clearly stated in every state’s law and is almost always the Department of Social Services. Law enforcement should be contacted in cases where there’s a suspected immediate life threat. Far too many providers believe telling the hospital staff of their concern meets their legal obligation. Unfortunately, this information may not always be acted upon and the case simply falls through the cracks. Every EMS agency should have a clear step-by-step process for reporting your suspicions.

The most common reason providers don’t report is because they’re not confident in recognizing abuse or they wrongly believe they must be certain of the abuse. Detecting abuse, both adult and child, has been incorporated into EMS education delivered in classes such as prehospital trauma life support (PHTLS) and geriatric education for EMS (GEMS). Additional education can usually be obtained from county social service workers

Some are concerned about the civil liability if they wrongly accuse someone of abuse despite the universal provision of immunity in state reporting laws. I hope each of you will review your state’s law and agency policy to ensure it addresses the concerns raised by this study.