*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*
Naturally, when you receive a call reporting an assault, sexual assault, shooting, or stabbing incident, the priorities of victim and responder safety take center stage. You focus on the criminal nature of the assault while gathering victim location, suspect description information, potential for weapons, medical assistance needs, and other scene safety elements critical for a response.
The interrogation pathways on Protocol 106: Assault/Sexual Assault/Shooting/Stabbing do an excellent job of covering each of these priorities. Each recorded detail feels that much closer to apprehending the suspect within an expiring window, especially for in-progress or just-occurred incidents.
Yet when a hospital or healthcare facility reports a victim of one of these crimes, you may wonder why the interrogation pathway is designed as oddly generic and concise. In fact, most questions are designated as purple Jurisdictionally Approved Questions (JAQs), turned on or off according to local preferences.
If the victim has been hospitalized due to a criminal act (and medical needs are being met), shouldn’t suspect apprehension be a priority?
It’s a fair question for an Emergency Police Dispatcher (EPD) who is used to typing suspect Description Essentials (DEs) with justice in their fingers, but this interrogation pathway on Protocol 106 is carefully designed to address a complex issue.
Patient privacy matters
The Police Priority Dispatch System™ (PPDS®) hospital reporting interrogation is both brief and mostly optional due to legal restrictions (both federal and varying by state) that hospital staff must observe when providing private health information (PHI) to law enforcement personnel.
The U.S. government’s Health Insurance Portability and Accountability Act (HIPAA) of 1996 prohibits hospitals and health systems from releasing patient information without authorization from the patient, except in specific situations.1
However, hospitals may, at times, provide disclosures to law enforcement officials (often documented) for the purposes of identification and location of a suspect.2
In extended application of HIPAA regulations, the Office for Civil Rights (OCR) references the “Privacy Rule,” which attempts to balance permitting important uses of information (such as informing law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime) while “protecting the privacy of people who seek care and healing.”3
In this vein, hospital personnel may be legally required to report specific incidents to police such as gunshot or stab wounds or incidents involving child abuse or neglect, regardless of patient or parent/guardian agreement.4
KarDasaty Davis, Emergency Telecommunicator Supervisor at Public Safety Communications, understands this fine line. Hospitals in her service area of Marion County, Florida (USA), are mandated to report incidents of child abuse, sexual assault, and abuse of vulnerable adults regardless of patient desire.
Not only do HIPAA regulations vary by state, but individual agencies can create policies and procedures for processing these types of calls. “Hospital staff sometimes know little of what happened to the patient,” Davis said. “Understandably, they don’t press for more information than what is needed for the patient’s care. Our agency just accepts the information they are able to provide, and deputies will gather more details (e.g., incident severity, time frame, weapons, and suspect information) when they make contact.”
In general, the streamlined “Hospital/Healthcare facility reporting” interrogation pathway on Protocol 106 reduces questions for hospital staff who may not be able to answer due to lack of knowledge or privacy concerns.
Kimberly Dames, EPD Quality Assurance Officer at Public Safety Communications Division in Miami Beach, Florida (USA), has seen some of these careful calls play out. “It is important for EPDs to understand that reports from the hospital may not be clear or produce loads of information,” she said. “The EPD should always try to gather as much as possible from the caller and remain patient with the hospital employee.”
Reporting protocol pathways
Though the regulations for hospital reporting may be complex, the Protocol 106 “Hospital/Healthcare facility reporting” pathway is simple.
First, the EPD must enter the Chief Complaint description by selecting the pathway that best fits the situation (e.g., “Hospital (healthcare facility) report of SHOOTING”). This selection not only populates the appropriate Key Questions for the interrogation but mainly directs the Determinant Code selection as well (e.g., 106-B-1, PAST SHOOTING), with a suffix “H” to indicate “Hospital (healthcare facility) reporting.”
The only Key Question the EPD is required to ask (regardless of JAQs) is “What is the patient’s name and age?”. If the patient’s age qualifies as a CHILD by local definition, that response will alter the Determinant Code selection in cases of SEXUAL ASSAULT/VIOLENCE incidents only.
Of course, in general, the EPD should review the definitions on each Chief Complaint Protocol to ensure that each selection or pathway is appropriate and consistent with the definitions listed in the Additional Information section (i.e., SHOOTING, STABBING, ASSAULT, SEXUAL ASSAULT, SEXUAL VIOLENCE, CHILD vs ADULT Age Ranges, DRIVE-BY SHOOTING).
The remaining JAQs address the patient’s current condition, the patient’s location, the incident location, the patient’s support (“Did anyone else arrive with the patient?”), and additional information for officers. (Please note while collecting this information that the person arriving with the patient is not considered a suspect unless any evidence exists to suggest that connection.)
After completing Key Questions, the EPD will send the appropriate Determinant Code and provide the following Post-Dispatch Instruction: “An officer will be dispatched as soon as possible. Call us back if anything changes or you have any further information.”
The EPD will be prompted by the Critical EPD Information (CEI) to “Do computer check,” though agencies can choose to overwrite CEI items to specifically list any additional actions the EPD should take or consider for these situations.
Finally, the EPD can close out the call with the Dispatch Life Support (DLS) Link “Hospital Reporting – Close case” with no further instructions necessary for hospital personnel.
Additional considerations
In conjunction with the HIPAA regulations that govern hospital reporting on Protocol 106, patient privacy is a consideration on other Chief Complaint Protocols as well. For instance, there are similar guidelines governing hospital personnel’s reports of the death of an individual if there is suspicion that the death may have been caused by criminal conduct.5
Dave Warner, IAED™ Police Protocol, Academics, and Standards Expert, hopes to implement a change in Protocol 112: Deceased Person in the next version update of the PPDS to address these reports specifically.
The EPD should also be aware that hospitals have established procedures for dealing with crimes that occur during a response, such as a patient assaulting a crew member.6 The hospital may initiate an emergency lockdown if the crime happens near the facility, if the victim is pushed out of a car at the entrance, or if the subject is outside or may have followed the victim. Obtaining Description Essentials for the person, any weapons, vehicle details (CYMBALS), and direction of travel could be critical steps to prevent further harm.
Conclusion
Handling hospital/healthcare facility reports can be one of the quickest calls at the console, but it’s important to understand the hospital personnel’s perspective and respect for patient privacy to ensure EPDs project professionalism in their communication and
cooperation with every incident.
Sources
1. “Guidelines for Releasing Patient Information to Law Enforcement.” American Hospital Association and National Association of Police Organizations. 2018; March 8. aha.org/system/files/2018-03/guidelinesreleasinginfo.pdf (accessed Aug. 28, 2024).
2. See note 1.
3. “Summary of the HIPAA Privacy Rules.” U.S. Department of Health and Human Services. 2022. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html (accessed Aug. 28, 2024).
4. See note 3.
5. See note 1.
6. “HIPAA BASICS FOR EMS PRACTITIONERS.” NEMSIS and Page Wolfberg & Wirth. pwwemslaw.com/sites/default/files/forms/hipaa-resources/pww-nemsis-hipaa-resource-practitioners.pdf (accessed Sept. 5, 2024).
