A new study of how EMS personnel could use body-worn cameras to overcome memory errors when making reports has significant implications for law enforcement officers as well.
While the research does not focus on policing, the findings suggest that officers should be routinely incorporating a review of BWC video in their documentation of notable events to enhance accuracy.
Currently, body cams are not widely used by emergency medical services. As has been traditional in law enforcement, after-action reports of EMS calls typically rely “heavily on short-term memory of what has just occurred,” the study notes.
But memory “is a re-constructional event that is influenced by many factors,” including fatigue, stress, and multi-tasking, which “can negatively affect cognition, decrease attention to detail, and prevent accurate recall,” the researchers explain. “Especially under stressful circumstances, memory is often inaccurate.”
Consequently, the researchers hypothesized in launching the study, “significant error” is likely occurring in the EMS reporting process, and BWCs might provide a practical tool for setting the record straight.
A team of physicians headed by two well-known emergency medicine specialists, Drs. Jeffrey Ho and Donald Dawes, designed a first-of-its-kind pilot study that was reported recently in the peer-reviewed journal Prehospital Emergency Care. (Ho and Dawes are professionally affiliated with TASER International, Inc., which manufactures a BWC; the six other MDs on their team are not.)
INTENSE ENCOUNTER
One at a time, 10 advanced life support paramedics with a busy EMS operation in Minneapolis responded to an intense 911 scenario in a medical simulation lab while wearing a head-mounted TASER AXON Flex BWC. The volunteer subjects were 22 to 43 years old, two were female, and their experience ranged from two months to 20 years.
The staged “apartment” each entered was a drug den, dressed with “mattresses on the floor, discarded syringes, dim lighting, open alcohol containers, discarded condoms, 3 firearms, 2 baggies of simulated marijuana and cocaine,” and empty pill bottles in plain view. Four role-playing bystanders, including two minors, were costumed as “commercial sex workers,” and the “patient” was an apparent OD victim in need of naloxone, with a tourniquet on her arm and a syringe lying next to her.
As the scenario progressed, the paramedics had to deal with a profusion of complications, including a combative patient they had to place in restraints, a firefighter first responder who attempting to ventilate the patient, a cop who argued about procedures, an “excited” relative who revealed that the patient had an “underlying HIV infection,” the discovery of a knife on the patient, a simulated ambulance ride during which the “very upset” patient threatened suicide and offered bribes of sex and drugs to get released, and the eventual arrival at a simulated ER where a verbal description of the situation had to be given in order to “hand off” the case to a nurse.
MEMORY VS. BODY CAM
After that, the paramedics used a desktop electronic template to report from raw memory on the call as they normally would on a portable device on the job.
That completed, they were allowed to view their BWC recording and to “make any changes to their initial report that they believed were important and necessary,” based on what the video showed. No time limits were imposed, and they could review their video any number of times and in any fashion, including jumping “to target specific areas,” pausing the action, and watching the images “slowly frame-by-frame.”
Finally, Ho and Dawes assessed the errors that the paramedics corrected. These were categorized as: minor (“generally inaccuracies such as time sequence or misquoted statements”); moderate (“generally errors in medications, dosing amounts, or issues of elevated liability”); and major (“generally issues of personal safety”).
ERROR ANALYSIS
In all, the paramedics made 71 changes in their original reports after the camera review: “7 minor, 51 moderate, 13 major.” Subjects with more experience tended to make fewer changes, “but all paramedics had some changes,” the researchers found.
One paramedic alone accounted for most of the minor errors, but all corrected moderate errors and all but two changed errors judged to be major. In the moderate category, all made mistakes regarding the patient’s vital signs and all but one erred regarding patient medications; some of the errors, Ho writes, were “clinically significant.” Most common among major errors were mistakes relating to the patient’s methadone use, suicidal threats, and need for restraints.
Ho writes that “the natural bias that people have to fill in the gaps of memory” with speculation about what happened rather than what they actually remembered was evident.
Eight of the 10 participants indicated that they “had an increased confidence in the accuracy of their reports after using the BWC recording.”
Interestingly, there was a profusion of errors that persisted even after the body cam review. In other words, some “errors that were clearly seen on the BWC recording and could have been corrected…were not.”
This number ranged from eight to 16 across the paramedics, but all missed or failed to change mistakes in each of the three categories. Persistent errors related, among other things, to living conditions and other parties present at the scene, patient medications, the ambulance-ride bribe offers, endangered juveniles, the knife found on the patient, and firearms.
IN REAL LIFE
“Obviously, some inaccuracies are more concerning than others but any inaccuracy can lead to an increase in poor outcomes and liability,” Ho writes.
What’s more, the researchers point out, the level of memory error in real life is likely higher than was demonstrated in the laboratory. The participating volunteers were all rested at the time of testing, so fatigue was not a factor in the experiment. Likewise, although “some of the paramedics were visibly shaken by the scenario,” physical and mental stress did not likely reach real-world levels either.
Wider use of BWCs, the team concludes, not only is a “reasonable” means for increasing report accuracy but also for “decreasing frivolous complaints, protecting EMS personnel from false accusation, and promoting better behavior by both EMS and the public.”
A full report on the study, titled “Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study,” can be accessed for a fee by clicking here. An abstract of the findings is available free at that site.
Dr. Ho as lead author can be contacted at: jeffrey.ho@hcmed.org.
Our thanks to Atty. Michael Brave, national and international counsel for TASER International, Inc., for helping to facilitate our body cam reports.