New Frontier

They said she was vomiting and nauseous and having seizures. I asked what the seizures looked like and the patient’s friend who had witnessed them, said the patient shook all over with her arms and legs out. It didn’t sound like a seizure. She said they had done all kinds of tests, but hadn’t been able to diagnose anything. In the ambulance, I was putting in an IV when all of a sudden her head goes to the left, her arms and legs go out straight and she starts shaking. I am not impressed. “Knock it off,” I say. She stops. She is fully coherent. There is no postictal state. She didn’t pee herself or bite her tongue. She demonstrated complete control of her muscles in the way she was flapping. “What were you thinking about what just now?” I ask. “I wasn’t thinking about anything,” she says. “Why were you shaking?” “I don’t know.” “Is that what happened to you before when you had your seizures?” “Yes,” she says.

I have seen many seizures over the years and many fake seizures. I remember when I was a new medic and how this girl had arched her back and started shaking and foaming at the mouth, and how I told them breathlessly at the hospital triage how she had seized. The nurse looked at me like I was an idiot and told me to take her to the waiting room. She was a regular – always looking to fool new medics and new doctors into giving her valium, which is what we gave in those days. Some people fake seizures for drugs, others for attention, others I don’t know why.

I get an idea then. I reach into my backpack and take out my small digital camera. I use it at traffic accident scenes to take a picture to show mechanism of injury at the hospital. The trauma team loves seeing the pictures. The camera is so small it fits right into my pocket. Often I don’t even know I am carrying it. There is a motion picture feature on it. I think if she has another one of her fits, I can record it to show the doctors. Maybe then they won’t need to do any more expensive tests.

But then I think, hold on. There might be some patient privacy rights going on here. I am almost certain there is a rule about filming patients. Probably even if filming their seizure might be of great benefit to the doctor’s. I put the camera away.

The next day I get called for a woman with vaginal bleeding. There is blood all over the floor, in the bathroom, in the bedroom. I see some big clumps that look like maybe they might hold a tiny fetus. I need to focus my attention on the patient and not the clumps. She says all her periods have been regular and there is no way she is pregnant. I’m thinking miscarriage. I have my camera in my pocket. I could snap a few quick shots of the gore – to show them at the hospital. It would tell a better story than my just saying, it was really bloody there. Still, this is new territory and I am not really certain I want to be on the end of “Report at once to the Supervisor” pages.

I seem to remember getting some type of memo about digital cameras, but I can’t remember exactly what was in it. I know it was don’t do the obvious wrong stuff, but I don’t know if it covered the grey areas. I don’t want to chance it.

It is new territory, maybe territory that needs some addressing. There surely is a possibility for abuse, but also a possibility for some good. Cops videotape all their encounters on traffic stops. I’ve heard talk of cameras being put in the back of ambulances. How will this all shake out in the future? I wonder.


  • Eric says:

    The company I work for has a policy banning “electronic recording devices”, which includes cameras. So far, I have gotten away with having and using one, as long as it doesn’t end up on my blog (which some did – none showing patients, BTW). I take photos, share then with the ED doc, and then they go away. Well, some of them end up as training material.I did take a photo of a humongus blood clot that a patient vomited. We showed it to the doc, and then when my Paramedic Student Intern chose that call to present to her class, it ended up in a Powerpoint presentation. But, it was for education. In fact, the patient allowed her to use his information for the presentation. It’s my personal belief, HIPAA fairy be damned, that as long as you use the data for patient care and never never never publish it without permission, you should be all right.

  • Anonymous says:

    The irony is that the persistence and potentially privacy damning ability of a picture is FAR less than digital patient records. Yet these are not only commonplace, but the only form of patient record in many places.We routinely transfer patients who have their CT scans and films on CDs and DVDs that the hospital has burned. Not only are they easy to leave in the clipboard requiring a return trip to the recieving facility, but I could quite easily duplicate the records on my own laptop. It would be nice if there was a way and a written policy to allow pictures of goop, smears, blobs, and splatters to become part of a patients record. If a 12-lead can get stapled to their report, why not a color print? Paramedic does after all mean beside the doctor. Photos seem like one more way to effectively communicate what the small round blob floating in the toilet looked like, or what “a lot of blood on scene” really was.