Ride-along programs are often utilized to provide valuable, real-life training and exposure to EMS for students, elected officials, trainees and others who are interested in learning more about our profession. However, legal liability can arise and ride-along programs need to be properly structured to reduce the chances of exposing your agency to litigation or other legal action. There are several considerations an EMS agency should take into account when setting up its ride-along program.
First, it’s important to determine the precise goals and objectives of your program. For instance, if your program exists primarily for EMS students or preceptorship opportunities, your program will be dealing primarily with EMS types who have at least a basic level of understanding of EMS operations, and your training and orientation requirements may not be as substantial. On the other hand, if your program includes members of the public, elected officials, or others who have little or no direct knowledge or experience about EMS, your needs will be different, and you’ll have to undergo much more preparation to make your program safe and successful.
One of your primary considerations must be safety. Ensure the ride-along participant receives strict instructions about what they are and are not permitted to do, and the places they are and are not permitted to be, during EMS operations. Untrained observers must be kept from dangers they aren’t prepared to handle, and they can’t be exposed to situations that would pose undue risks to a layperson. Ensure your expectations in this regard are clearly written in easy-to-understand, plain English policies shared with ride-along participants.
Of course, patient privacy is another paramount concern. We covered the HIPAA implications of ride-along programs in a full-length feature article in the January 2006 issue of JEMS (“Do EMS Ride-Along Programs Violate Patient Privacy? How to ensure your program measures up to HIPAA’s privacy rule”). Consult that article for an extensive discussion of HIPAA issues in the context of ride-along programs. In brief, however, HIPAA leaves it to each covered entity to determine who the members of its “workforce” are, and an EMS agency’s workforce can include students, ride-along participants and trainees who are performing work for the agency in the course of the ride-along program. The agency, as a covered entity, is then required to ensure that all members of its workforce, including ride-along participants, receive appropriate HIPAA training specific to their role with the agency. Ride-along participants, for instance, must receive prior training with regard to their obligations to strictly protect the privacy of all protected health information (PHI). In addition, it would be advisable to specifically prohibit taking pictures or using personal cell phones, texting, e-mailing, or posting any information to social media or other outlets with regard to any PHI.
It’s worth noting that if a ride-along participant commits a privacy breach, it’s still your agency, as the HIPAA-covered entity, that will have to answer for that breach. Therefore, it’s incumbent upon your agency to ensure all ride-along participants are trained and fully aware of their responsibilities to strictly maintain patient privacy.
It’s also advisable to utilize a well-worded release/acknowledgment form that each ride-along participant reads and signs prior to engaging in any activities with your agency. This should include a release from liability in favor of your agency, an acknowledgment of your agency’s privacy policies and other key information. Such a form could also require ride-along participants to indemnify the agency in the event they engage in any act or omission that would create liability for the agency. Keep in mind, however, that most individual ride-along participants would probably lack the financial resources to pay your agency’s legal fees, jury verdicts or settlements out of their own pockets, so an indemnification provision may not offer much true protection. Of course, if the ride-along has personal liability coverage (such as a rider on their homeowner’s policy or similar coverage), there may be some insurance available for a negligent act or omission on the observer’s part (this is unlikely, in our view). Also, if the ride-along is part of a formal training or education program (such as an EMT/medic student), or an employee of some other agency or organization, then it’s worth checking to see whether the training institute where the student is enrolled–or the other agency or organization with which they’re affiliated–might have liability coverage that extends to the ride-along activities.
Finally, prior to implementing a ride-along program, become acquainted with the provisions of your various insurance policies, such as automobile, workers compensation and liability. Work with your agency’s insurance agent/broker, or your agency’s legal counsel, to make sure your policies are clear in terms of available coverage for liability that may arise on account of the acts or omissions of a ride-along. Your state law may vary on some of these issues: for instance, on whether a ride-along participant would be included in your workers’ compensation coverage obligations in the event of a work-related injury.
It’s unlikely that an EMS agency can completely protect itself from the liability that inevitably would arise in the event of a negligent act or omission by a ride-along participant that results in harm or injury to a patient or to another person. However, some careful forethought and advance planning, along with clear-cut policies and training, can reduce that liability and lead to a valuable and enriching ride-along experience for all involved.