Best Practices, Exclusives, Operations

Can You See Me Now? Body-Worn Cameras in EMS

North Channel EMS has been using body-worn cameras since 2016. All still images in this manuscript are taken off the the department’s Wolfcom Vision body camera.

The use of body-worn cameras in EMS has been a controversial topic in EMS for several years. Despite this controversy, North Channel EMS, located in Texas, took a calculated leap and fully implemented body cameras for all crew members in April 2016.

North Channel EMS is located in East Harris County, Texas and covers a 9.9 square mile service area. The daytime population is 50,000. The North Channel EMS system handles 5,100 responses annually with three full time ALS units and one peak time unit

All crew members wear Wolfcom body cameras on all incidents and all interactions in the patient care area on the medic units are recorded via a system purchased from Data 911 products.

Medic unit patient compartment video uploads automatically when the crews return to the station. The individual body-worn camera video is uploaded manually at the end of each shift. The deputy director is the gatekeeper for all video. 

Cardiac arrests, STEMI’s, rapid sequence intubations and major trauma incidents are all reviewed along with randomly selected incidents. Patient care reports are reviewed daily. Either review process can initiate a formal QA/QI review requiring one or more of the crew member’s involvement.

North Channel EMS found a group review of critical incidents by use of body-worn video is effective in improving patient care.

Patient Compartment Recording

Utilizing video is not a new concept for North Channel EMS. We began utilizing in-unit (patient compartment) video recording in our ambulances in 2007. Video recording in our patient care compartment was initially met with distrust from our crew members.

Crews were initially concerned about “Big Brother” watching over everything. After we used video from the patient compartment to disprove libelous allegations against one of our crew members—all crews realized the benefit of video.

You would think that after using patient compartment video for eight years, adding body cameras would be accepted easily by front line medics. You would be wrong. We initially had the same resistance with the implementation of body cameras. Again, it took video evidence to disprove blatantly false allegations against a few medics for the body cameras to be accepted.

Body Cameras are Effective Tools

Body camera video has been used successfully to disprove accusations of assault, rude behavior, theft, lost items and treatment/therapy issues at North Channel EMS.

The combination of in-unit and individual body camera videos have proven to be effective tools for North Channel EMS. Our crew members wear body cameras on all calls and do not hesitate to inform administration of incidents that should be reviewed.

Body camera video has been used successfully to disprove accusations such as assault, rude behavior, theft, lost items, and treatment/therapy issues. As such, the body-worn camera have proven to be a nearly definitive tool for dispute resolution.

In addition, body-worn cameras have provided a valuable feedback system for improving care. The goal of any EMS agency should be to provide the best patient care possible. EMS is a data-driven industry. Everything we document should be used to improve patient care, patient outcomes and emergency medical services. By implementing body cameras, we discovered a treasure trove of information that assists us in building a better service.

Prior to body-worn cameras, we relied on electronic or paper documentation to collect this data, knowing that it’s next to impossible for a paramedic or EMT to document an entire encounter. It is even more difficult to properly document bystander and family interaction.

Watch the body cam footage below to see an ambulance crew respond to an incident.

The addition of body-worn cameras provides another method for collecting data which can be used to augment the information captured by the Paramedic/EMT. This additional data is reviewed with an eye toward improving the processes we use for delivering the best care possible.

Using body cameras is like having an electronic supervisor on location for every call and provides critical oversight. The demeanor of most of our crew members has been affected in a positive way since the implementation of body-worn cameras. Human nature does still kick in and some performance and customer services issues will be brought to your immediate attention by the body-worn cameras.

Beware, you may not like everything you see. Be prepared to have that “We are not who we thought we were” moment. Fortunately, system administrators and medical directors get a real-time look into their organization to improve any shortcomings.

It’s important to be honest with ourselves that no agency or work place is perfect. North Channel EMS has identified several areas that we feel need to be addressed. Most of these should not surprise anyone. We need more training on dealing with combative patients, the homeless, those who are detained and intoxicated patients.

Multiple equipment issues have also been identified through use of the body-worn cameras. For example, we learned that our mechanical CPR device prohibited the proper use of video laryngoscopy on certain patients. Therefore, policies, procedures and even protocols are being improved or modified due to our use of body camera and in-unit video.

We view an incident from the moment a unit pulls out of the station until they arrive at the emergency department doors.

Using body cameras is like having an electronic supervisor on location for every call and provides critical oversight.

Our interaction with the patient is recorded on at least two body cameras. We review cardiac arrests, STEMI’s, RSI’s, critical trauma and randomly selected videos as part of our QA/QI program. Group review of critical incidents by use of body-worn camera video is effective in improving patient care.

Video is uploaded to the department server at the end of each shift and all videos are viewed with the deputy director or the clinical coordinator. Crew members have no access to view video before or after it is uploaded. They only review video when one of their recordings has been identified for QA/QI.

We have discovered our crew members are not hesitant to critique what they review. They point out areas where time could be saved or a task completed more efficiently. Using video allows EMS to verify CPR start/stop times; BVM rate/volume; administered medication and its effect time; exact intubation time/intubation technique/IV technique; mechanical CPR device placement and time to initiate; adherence to protocols and teamwork.

Our medical director and North Channel EMS staff review recordings to evaluate employee performance. We have identified tendencies: strengths and weaknesses of our crew members, how they handle combative or argumentative patients, how they deal with stress and how our providers interact with the public.

Because of all the metrics we record, we can now measure crew performance and enable them to perform better, management to perform better, the system to work more efficiently—all toward the goal of providing better patient care.

We have also used our video program in the precepting of new paramedics and EMTs. We no longer rely on paper documentation only to evaluate the progress of our new hires because we can use video to review all patient assessments and skills performed by new EMTs and paramedics.

We have chosen not to use recorded video to assist in documenting the patient care report. Crew members are not allowed to view recorded video for documentation purposes. The use of in-unit video and body cameras in EMS is new and controversial in our industry. A HIPAA/patient confidentiality breach could be detrimental to its use. It is for this reason that the HIPAA policy we have implemented puts tighter restrictions on access/use of video.

Time management is also a concern; if your agency is busy, your crews may never be able to view all their video in between calls. In addition, using video to assist with documenting treatment and therapies increases the amount of time it takes to write the report and extends the time that you need to archive each video, therefore increasing the cost of storage and delay in getting the unit back in service.1 We use our QA/QI process to identify and correct any discrepancies that may be identified between the patient care report and the video that is captured.

Recorded video is not considered part of the patient record and is therefore excluded as part of the patient care report data set. Body camera and patient compartment video is archived for 90 days. Recordings are automatically deleted when they reach the 90-day creation date. That being said, all videos are discoverable while archived. If a patient, law enforcement agency or attorney requests a copy of a video that has not reached its 90 archive period, it will be supplied with any required or needed redactions. The same applies for any subpoenas. Our crew members can also use our Video Incident Report form to identify incidents that they feel may need to be archived for a longer period.

Video captured can contain information that can assist you in building a better department.

Agencies deciding to use body-worn cameras need to be cognizant of video quality. If you are anticipating Hollywood movie-type video, you will be disappointed. And remember, this video is completely unedited and there is no motion stability featured in the body worn cameras. Some of it is difficult to watch because of movement issues, crew member positioning and patient placement. (You may get a little seasick).

An article written by Stephen R. Wirth, Esq., for JEMS in 2015 is a very good reference for anyone looking to start a body camera program because he covers HIPAA issues very well.2 There is nothing in HIPAA that prohibits the recording of our encounter with patients.

HIPAA is also not a problem if video is treated as a patient care report would be treated. Most patient care records are stored electronically already, and the only time a crew member will ever view their patient care report after they have completed it is if they are called in to review it for QA/QI reasons.

North Channel uses a single gatekeeper for all video access. To comply with HIPAA, we treat access to video the same as a patient care report.

You do need to know and understand the laws and regulations in your state that govern audio and video recordings. Texas is a one-party consent state, meaning only one person in the conversation needs to consent to be recorded. There are 38 states that have the one-party consent law, but that means there are 12 other states that have different regulations.3 Research your local laws before implementing any sort of recording. Your crew members also need to be well versed and understand what a “private place” is.

In Texas, anywhere someone would have the reasonable expectation of privacy is a private place. Examples include a patient’s home, a bathroom, locker room, or a changing area in a retail store. In the event an individual/patient in a “private place” asks our crew members to stop recording, they must comply.

North Channel EMS has a legal road map that we followed to create our video policy: Chapter 1701, Occupations Code, Subchapter N “Body Worn Camera Program.”4 The “Body Worn Camera” Act was passed into law in 2015 and was written specifically for Texas law enforcement to assist them in qualifying for grants to purchase body cameras. One of the requirements is to have a body worn camera policy. Even though this law does not specifically apply to EMS agencies, it still contains information that can be utilized to assist in creating a good video policy for EMS agencies.

The “Body Worn Camera” Act lists what must be included in a body worn camera policy, when to activate/deactivate cameras, archive period, crew member access and how video is released.

Search your local laws for something analogous. Like NCEMS, services need to have a clear and straight- forward body camera policy, that aligns with regulations in their service area, in place prior to implementing a body camera program.

North Channel has been using body cameras for over three years. During this time, we have not had a reported issue with the public or any patient we have encountered. No patient or family member has requested that we turn off a body camera.

We did adjust policy to accommodate emergency department requests for recording to not take place within their facility. Therefore, our crews shut off their body-worn cameras when they enter an emergency department.

It is important to listen to and address the concerns of emergency departments because HIPAA requires hospitals to put in place appropriate safeguards to protect the privacy of personal health information.5 If they have a no camera policy, then we are obligated to follow that policy. North Channel has each crew member deactivate their body-worn cameras prior to entering the emergency departments.

Conclusion

Be smart with your video. Treat access to video as you would your patient care reports and have a good video policy. The video you capture can contain information that can assist you in building a better department. Body worn cameras and patient compartment video are a wonderful tool that can help protect your agency, improve your service and possibly create advancements in emergency medicine for EMS. It is possible to use body-worn cameras and patient compartment video in EMS safely. North Channel EMS has been doing it successfully for years. A copy of the North Channel EMS Vehicle Unit/Body Camera Policy can be obtained by clicking here.

References

  1. Texas Penal Code: 18 USC 2511 (2) d “One Party Consent.”
  2. Chapter 1701, Occupations Code, Subchapter N “Body Worn Camera Program.”
  3. Wirth, S., “Body Cameras in EMS” 2015. Available from: https://www.jems.com/2015/09/08/body-cameras-in-ems/.
  4. Wylie, D., “Body-worn cameras: 5 key considerations for EMS leaders” 2017.
  5. Carter, C. “Legal Implications of video recording devices in hospitals.”

Special Acknowledgment: The author would like to acknowledge C. J. Winckler MD, LP, for his assistance with this submission.