Security of the Emergency Medical Service System (EMSS) Radio Network

Two paramedics radio to the hospital that they are bringing in a 54-year-old man with chronic lung disease. They state that he is on "10 or 20" medications, but he does not have them all with him, and he does not know what they are. He has been a patient at that hospital in the past, and his records are there. It will take the paramedics about 20 minutes to transport the patient to the hospital.

This will give the emergency physician time to obtain and review the patient's medical records before he arrives. Should the emergency physician request the patient's name? Should the paramedics transmit it if asked?


Comment: While this would expedite treatment, it raises a question of protecting patient privacy. Emergency medical service (EMS) frequencies are monitored by many people in the community with scanners (radios that scan many frequencies and automatically lock onto frequencies where there is radio traffic).

Occasionally, information about patients being transported to the hospital has been used to burglarize their homes, and the medical condition of well-known individuals has been released to the press. Thus there are good reasons for keeping the information conveyed over the radio to a minimum and for not stating the patient's name. But if only his hospital ID number is given, there will not be a cross-check that the correct chart is being obtained.

Commentary

In this case, the issue centers on whether or not private patient information should be transmitted over the radio from the ambulance to the base station hospital. It is well-known that radio frequencies are monitored, and private patient information is made accessible to those monitoring the airwaves.


The breach of confidentiality may be to the detriment of the individual patient by making private information available about him, or allowing his home to be burglarized, or allowing unwanted details to be made available to the public at large.

In one sense, this is a decision that centers on an analysis of weighing the extent to which transmitting the patient's name over the airwaves in order to gain access to information at the hospital will benefit the patient from the health care perspective, against the risk of violating the patient's privacy or rendering him vulnerable to the commission of a crime.

Both the base station emergency physician and the paramedic are expected to deal with the patient beneficently, that is, to undertake those actions which on the whole will benefit the patient, despite the possibility of some risk to him. The straightforward medical benefit of having greater access to information about a patient might yield a situation in which drug therapy could be administered more appropriately, and in which the patient's therapy would be more precisely guided, yielding a considerably better medical outcome.


An estimate of the extent to which additional information is necessary in order to better guide therapy can be made on the basis of the paramedic's observations about a patient, and a consequent medical determination by the physician who is in medical control.

The risks of loss of the patient's privacy are in many ways highly conjectural, while the risks of not having sufficient information about a patient in order to appropriately gauge medical therapy are very real and have a very profound immediate impact on a patient's life and outcome. Nevertheless, the long-term effects of a loss of a patient's privacy — for example, allowing his home to be burglarized — may have a detrimental effect on the patient's ultimate outcome.

While in many ways the determination of the extent of the risk of not transmitting vital medical information rests with the paramedic and the medically controlling phy­sician, it is conceivable that the patient may be brought into the decision. In the case of a patient with minimal illness, the decision may be relatively straightforward; the need for information will be less pressing.


If consulted, the patient may contribute to making the decision and, in effect, negate the hospital's or paramedic's request for transmittal of information over the airwaves. If the patient is not able to make a decision, the paramedic and base station physician will have to act somewhat more paternalistically in determining whether or not the information is of such paramount importance that a certain amount of risk should be taken in transmitting it over the airwaves.

I believe the turning point in the discussion rests on the criticality of the patient. If the patient is moribund, the decision to gain any information about the patient which will help save his life seems in order. If the patient is modestly ill only, it seems appropriate either to wait to gain additional information until the patient arrives at the hospital or to consult with the patient about the decision while still en route to the emergency facility.


Both the paramedic and the base station physician may facilitate the decision making in this regard by putting themselves in the position of the patient. If they then conclude that transmittal of the information over the airwaves is of benefit to them; that is, they would want it done were they the patient, they should so proceed.

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