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Michael Petrie is the administrator of the City and County of San Francisco Emergency Medical Services Agency. He is responsible for EMS systems development, planning, regulation, homeland security and disaster preparedness. Petrie also serves on the faculty at the Center for Homeland Defense and Security at the Naval Postgraduate School, and is an advisor to the East Bay Terrorism Early Warning Group. He has been a licensed paramedic for 25 years and holds master's degrees in Business Administration and Homeland Security and Defense.
In the September 2007 issue of the journal Homeland Security Affairs (www.hsaj.org), Petrie advanced the controversial hypothesis of utilizing EMS personnel as "intelligence sensors." Petrie feels that EMS providers are in the unique position to observe signs of terrorist activity or affiliations and report them to appropriate authorities. For this reason, Petrie argues, EMS providers could be used as information collectors to support terrorism early warning groups and other intelligence fusion centers. This is currently not being done due to concerns about medical confidentiality, EMS professional issues and societal expectations of medical personnel. Taking these issues into account, Petrie's article presented a model EMS information collection protocol. While the ability to use EMS personnel as intelligence collectors will vary from state to state based on laws protecting patient privacy, Petrie argues that the access these personnel have to information regarding potential terrorists could be invaluable to terrorism prevention efforts.
For this month's column, I had the opportunity to speak with Michael Petrie about the article he wrote titled The Use of EMS Personnel as Intelligence Sensors: Critical Issues and Recommended Practices.
Can you explain your hypothesis of utilizing EMS personnel as intelligence sensors?
EMS providers enter thousands of residences and workplaces daily, across all demographic and geographic areas. Because EMS providers respond rapidly and are not considered law enforcement agents, the reporting party may not consider or may not be able to "clean the scene" of indicators of terrorist ideology, planning or operations.
EMS personnel, working as part of an EMS provider-approved collection program, could be trained to recognize indicators of terrorism that may be present on emergency scenes. Trained personnel could report incident-based and behavioral-based indicators of terrorism. Incident-based indicators of terrorism are based upon what a person observes, hears or otherwise senses. Examples of incident indicators include pictures of known terrorists or unusual chemicals or explosives in a residence. Behavioral indicators are based upon an individual's activities or conduct, such as friends of the patient acting especially nervous during a low-acuity EMS call. EMS personnel should not report trait-based indicators of terrorism. Trait-based indicators of terrorism are based on an individual's race, religion, ethnicity or national origin. This is commonly called racial profiling. EMS personnel should also not report confidential or protected medical information.
Information should be reported by EMS field personnel through an EMS provider terrorism liaison officer (TLO) to a designated terrorism early warning group (TEWG) or other intelligence fusion center using an established protocol. The protocols should be developed by the EMS provider and the TEWG following review by legal counsel. Terrorism liaison officers, who serve as the conduit for information flow, should also receive special training.
EMS personnel should be given the opportunity to opt into an information collection program rather than being compelled. EMS personnel should also not individually report suspicious activities unless it is sanctioned by their employer, because lacking training or a formal reporting structure, the report may violate medical confidentiality laws, exposing the employee, the employer and the fusion center to civil and criminal penalties.
Have you received any backlash about this idea?
This idea is controversial. Using EMS personnel as intelligence sensors raises legitimate questions about the role of prehospital providers and first responders in the post 9/11 era. EMS personnel serving as information collectors may identify and report indicators of terrorism that could prevent a terrorist attack. Conversely, collecting terrorism-related information may interfere with EMS' traditional medical mission. Poorly designed collection programs that encourage EMS personnel to report protected medical information may have two detrimental outcomes: 1) Members of the public may not trust EMS providers to maintain the confidentiality of their medical information, resulting in decreased use of EMS and healthcare services and increased morbidity and mortality. This consequence would be utterly unacceptable and would require immediate termination of the collection program; 2) Using EMS personnel and other professions such as fire service, utilities, etc., to collect information may be strategically counterproductive if the public believes they are not trusted by the government. When individuals or communities perceive they are not trusted or are otherwise alienated, they may be less likely to report suspicious activity to authorities, reducing the aggregate amount of terrorism-information received.
In the last three months, there have been several editorials in newspapers throughout the nation discussing whether urban fire departments should establish programs to report indicators of terrorism. Unfortunately, these editorials missed an important point. Many fire department first responders are EMTs or paramedics, and during their interactions with patients, they are privy to confidential medical information. The characteristics of the EMS-patient interaction creates complex issues governed by HIPAA and state confidentiality of medical information acts. These legal issues should be carefully examined and are worthy of an informed debate.
In regards to backlash about using EMS personnel as intelligence sensors, following a November 2006 lecture on this topic to the San Francisco Paramedic Association, about 25% of the EMTs and paramedics in attendance indicated they would not participate in such a program because they did not believe the information collection function is consistent with the role of a paramedic.
How do you see EMS and homeland security interacting in the future?
At the local and state level, I do not consider homeland security a distinct profession. Rather, homeland security is an overlay of additional functions that are placed on existing disciplines such as EMS, fire suppression, rescue, law enforcement, public health, emergency management and the armed forces. EMS as the provider of prehospital medical care will continue to play a pivotal role in the preparedness and response components of homeland security.
In many areas throughout the nation, vetted EMS personnel receive intelligence reports and warnings. These documents provide important information on potential threats, which allow EMS personnel to better understand our environment and thus function more safely.
There are also opportunities for EMS personnel to assume a more active role in the terrorism-prevention mission of homeland security. As noted in this interview, field-based EMS personnel and other medical personnel may play key roles as the eyes and ears of terrorism early warning groups and other fusion centers, reporting incident-based indicators of terrorism. EMS personnel may also fill important roles with intelligence fusion centers. In these capacities, properly trained and vetted EMS personnel can provide linkages to EMS and other field providers, interpret medical and health related information, conduct vulnerability assessments and function as trainers or outreach specialists.
Raphael M. Barishansky, MPH, EMT-B, is executive director of the Hudson Valley Regional EMS Council in Newburgh, NY, and a member of EMS Magazine's editorial advisory board. He can be reached at rbarishansky@gmail.com.
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author: By Raphael M. Barishansky, MPH, EMT-B