Is ICE as Simple as It Sounds?

A Guarded Yes, but Do It Right
By Norm Rooker

As a paramedic and chief of a county EMS service, I was inundated over the summer with questions and suggestions about ICE. It started the week after the July 7 bombings in London with e-mails from medic acquaintances in New Zealand and Canada. Both began with, “Norm, have you heard about this new program in the United Kingdom? It’s called ICE.”

ICE is the brainchild of Bob Brotchie, a paramedic with the East Anglian Ambulance NHS Trust. An acronym for “In Case of Emergency,” it is a designation that can be affixed to the name of the person in your cell phone’s phone book whom you want called if something happens to you. This emergency point of contact can be accessed by responders for everything from personal data to critical health information. Brotchie developed the concept more than a year ago, but it didn’t catch on until after July 7.

Of course, there’s more to this process than just creating an emergency point of contact. You also have to brief that person with all your pertinent information. To that end, you could create emergency information cards to give to all your designated contacts (ICE 1, ICE 2, ICE 3, etc.).

So now folks want to know 1) if they should designate one or more ICE contacts on their cell phone or PDA, and 2) if I or any other EMS provider will actually look for an ICE listing on their electronic device of choice.

These are tougher questions than they seem. ICE, like most good ideas, runs into problems not in concept, but in implementation. I personally don’t look at a patient’s cell phone or other electronic device. If a patient is well enough, they’ll provide us with that information. If they’re not, odds are, we’re too busy attempting to save them to spend the time. Doing more than a quick scan of a patient’s wallet or purse for ID falls into the purview of law enforcement or the folks at the receiving hospital.

Additionally, if I were a terrorist, one of the easiest ways I could think of to take out emergency responders and spread additional shock and fear is to seed an emergency scene I’ve just created with a few “special” cell phones wired with small explosive charges that would be set off when someone activated the phone in search of ICE information.

If you’re concerned enough to create emergency information cards for accident contacts, why not just create an extra one, laminate it and carry it in your purse or wallet? (The Oklahoma Emergency Medical Services Authority, which has come out strongly in favor of the ICE program, has created a template for this that can be filled out online and printed on your computer. See www.emsaonline.com/iceadvice.)

In answer to the question “To ICE or not to ICE?” this medic and chief answers with a guarded “Yes, but do it right.” Time on scene is best spent taking care of the patient—leave looking through the electronic devices to law enforcement or folks at the hospital.

Norm Rooker has been involved in EMS since 1973. He is currently a paramedic and chief of Ouray County EMS in southwestern Colorado.

No, It Could Compromise Provider Safety
By Shai Jaskoll

“In Case of Emergency” seems like a logical, simple and beneficial concept, and many in the emergency-services community have come out in support of it. But does it truly benefit EMS personnel and their patients?

Many feel the ability of a police officer or a paramedic to identify a patient’s next of kin is a critical component in the overall care of that patient. It could provide quick access to medical history, including medications, allergies and mental-status information. Being able to notify a family member or friend of a medical or traumatic emergency would allow for continuity of care and a high level of customer service. And when a cell phone is located and transported to the hospital with the patient, staff there can obtain patient records, learn of past hospitalizations and notify next of kin just by calling an ICE contact. It could help save a patient’s life.

However, while many within our industry support ICE, some are having a hard time warming up to it. Those with backgrounds in military or terror medicine question the efficiency of focusing on ICE. Could it compromise the mission of the first responder? Will it affect the level of patient care or the safety of operations? Consider the following scenario:

You and your partner are responding as mutual aid to a train derailment in a neighboring town. Arriving on scene, you’re assigned the role of triage group supervisor. As you enter the area of the train, you’re met with a strong odor of burned flesh. You can see amputated body limbs and blood. Inside the train, you see multiple unconscious and deceased patients. As you enter the chaos, what are you thinking? Is your focus on scene safety, patient care and triage, or locating cell phones for ICE information?

Some things to consider while evaluating ICE are:

Scene safety—Whether the incident is a bombing or a simple motor vehicle accident, the potential of it being motivated by terrorism should never be overlooked. Terrorism continues to flourish, with new threats recorded daily. Responders must keep a focus on scene safety. The slightest compromise of scene safety can lead to dead or injured first responders.

Responders entering a scene must be wary of secondary or undetonated primary devices. The time it takes to locate a cell phone by moving a patient or looking at his belongings may be just what is required to discharge the bomb. Always err on the side of caution and minimize your exposure to the scene and any potential hazards.

Patient care—Information that could be provided by an ICE contact has no bearing on initial patient care or treatment. The principles of providing the best care for the most people prevail. A patient’s allergies or past medical history are not considered during a large-scale incident. The chaos of these incidents, regardless of how controlled, makes chasing ICE contacts impractical. As students of history and terrorism know, items such as cell phones have been used as secondary devices or detonators of concealed primary devices. One experienced terror-responding EMS agency now goes so far as to leave personal effects from victims of potential terrorist events on the scene. This allows law enforcement and bomb squad teams to properly clear the incident location of additional devices. If EMS transports patients’ personal effects and a secondary device detonates at the local ED, EMS becomes guilty of aiding the terrorists.

All that said, most of the calls we respond to are things like chest pain, difficulty breathing and fender-benders—why shouldn’t we activate ICE in those cases?

As with any EMS protocol, the things we train to do, we do in the field. Once we start digging for cell phones at simple MVAs and searching through purses at chest-pain emergencies, it will become second nature to us. This will ultimately add to the risk of triggering a secondary device if a call ever truly is terrorism.

In concept, ICE seems an effective tool to assist first responders, but it’s plagued by the realities of the world we live in. Until the forces of terrorism are defeated, ICE implementation would present a potential compromise to emergency responders. For that reason, we should advocate the melting of ICE.

For more information on ICE, see www.eastanglianambulance.com/content/news/newsdetail.asp?newsID=646104183.

Shai Jaskoll is manager of the Regional Emergency Medical Communication System Division at University Hospital-Emergency Medical Services in Newark, NJ. He has more than 13 years of local and international experience and lectures extensively on terrorism response for EMS. He can be reached at shai.jaskoll@umdnj.edu.