Body Cams Help New Orleans EMS Protect Providers While Prioritizing Patient Safety

Emergency medical workers in New Orleans have become among the first in the United States to adopt body cameras on a large scale.  

Bill Salmeron, chief of New Orleans EMS, says body cameras will become increasingly common in EMS.   

“Body cameras have been in law enforcement for a long time, it was introduced in the fire service and it’s just a matter of time [before] we see more agencies do it on the EMS side,” he adds. “We wanted to be ahead of the game, have the opportunity to vet it with our staff, and then socialize it in the community.”

Deploying Body Cams in New Orleans

New Orleans EMS embarked on a soft launch of body cameras in late 2022 to determine if staff wanted them and to calculate costs. The first deployment was 15 cameras, which recently increased to 30 more. 

The body camera use in New Orleans EMS also serves as part of a bigger approach to make a medic’s job safer, such as the use of new trucks and LUCAS devices, Salmeron says. 

Salmeron says initial staff apprehension regarding camera usage was addressed through clear guidelines emphasizing the cameras' role in enhancing, rather than monitoring, performance, reiterating the video cannot be accessed without a viable reason. 

Medics are already used to having cameras in the ambulances when they’re driving, he adds. 

Most staff are fine with the camera’s use, Salmeron says, adding there is now a waiting list to use them.  

Salmeron says body cameras are part of a larger environment in which cameras are practically everywhere, be it CCTV, cell phones, or other uses.

Rising Rates of Assaults

New Orleans EMS is quite active with its fleet of 45 ambulances of which 21 trucks are in service each day. The department has 145 employees, with a budget for 176 staff members. There also are 100 volunteer EMTs, advanced EMTs, and paramedics. 

The department responds to an average of 70,000 calls annually. It serves a population of 376,000 people, a number that can swell to 19 million during peak tourist seasons such as Mardi Gras. 

“We have seen an increase in (verbal and physical) assaults on staff over the past few years and wanted to try to deter/assist with prosecution,” says Salmeron, adding those assaults are compounded by prevalent mental illness and substance abuse in the community. We want to be able to see exactly what happened with raw footage to determine what happened or to be able to defend ourselves if we have to do that and tell our story.” 

Salmeron points out there have been mixed attitudes toward the public in recent years and EMS is feeling the brunt of that as well because workers are in uniform and at times work closely with police.     

“We are often the first thing people see when they wake up from something and they're confused,"  says Salmeron. "They may not know what's going on, so we have to find a way to deter it by letting people know they may potentially be on camera and hopefully that will help them make a better decision on how they act.” 

If something does happen, the camera footage helps determine what happened and New Orleans EMS can work with law enforcement on any charges or legal proceedings around that.

City Leadership Backs Body Cams 

Salmeron says there was buy-in from city leadership and elected officials in purchasing the cameras. 

“We’ve hopefully addressed their concerns and realize as we roll this program out more, we may have additional concerns and will address them in real-time if something comes up,” he says. “It’s definitely an ongoing effort to keep people feeling comfortable about the program” 

Cost considerations extend beyond initial procurement to encompass ongoing expenses related to storage. Since starting the program, New Orleans EMS has invested $46,000 in the cameras. 

One of the body camera requirements is medics on field training rides wear a camera so they can look back on calls on which they are working and the field training officer can work through a call with the medic in terms of what was done, whether it was done correctly and if something should have been done differently. 

While participation remains voluntary for field staff, supervisory personnel, and senior medics are mandated to use them during critical interventions such as cardiac arrests and pre-hospital blood administration to ensure the procedures required at that level of care are being monitored. 

“We’ve given over 200 patients blood since we started the program. We use that to show how we're doing great with blood and then cardiac arrest care and those critical patients we have,” says Salmeron.

Choosing Axon

New Orleans EMS chose Axon as the camera vendor because of the company’s secure HIPAA-compliant video storage and transmission platform.  

“Fortunately for us, the New Orleans Police Department has used Axon for many years. The sheriff’s offices and a lot of other departments around here use Axon. People see the cameras on law enforcement already, so they're used to it,” says Salmeron.  

“We’re also able to share video if we get subpoenas through the Axon system. It’s a good integrated setup.” 

Salmeron says the body cameras are user-friendly. The staff is trained in its use.

“It’s a normal body camera size," he explains. "It has a magnetic clip on it that you're able to clip onto your shirt and its mid-torso to where you can see anything that's going on and know you’re doing it right.”

When the medic wearing a body camera arrives on the scene, they press a button to activate it and press the button again to turn it off. 

“We’re not supposed to have it recording if we're in an emergency room or hospital setting,” Salmeron says. “We also honor with individuals who when they see a body camera say they don’t want to be on camera. The medic can press the button and turn it off. 

“If something critical happens, they can press that button. It’s going to record so many seconds back of whatever that interaction was that caused you to press that button and we’ll be able to capture that interaction if we need to, but it's not recording constantly. It only records when you press that button.”

Protocols for Patient Safety

Despite regulatory nuances, such as Louisiana's one-consent state status, the department prioritizes patient autonomy in recording decisions, with established protocols respecting patients' confidentiality and preferences regarding camera usage.  

“When I was first told about the program, I wanted to make sure our patients feel comfortable telling us anything,” Salmeron says. “I don't want there to be any barriers to patient care. I don’t want people to feel uncomfortable at all about calling 911.  

“I want them to be able to feel that what they tell us is confidential, private, and it's going to be kept that way and that we want them to continue to trust us and that this camera is just one more tool in our toolbox we have to treat them and protect ourselves.” 

With HIPPA, a file or medical record cannot be accessed without a business reason to do so, Salmeron notes.   

“We don't access camera footage unless we have to if there's a complaint or if we have to look at a call for a clinical reason or if there’s a call that we can learn from that we can bring up videos and look at calls to see how we did,” he says.  

“We take privacy very seriously, limit access to videos, and don’t release anything unless presented with a legal subpoena. We can't use footage unless it's fully redacted. We have to remove audio and video of any identifying pieces of information, whether it be names, tattoos, or identifying marks.” 

For agencies considering a similar initiative, Salmeron notes agencies should plan not only for initial costs but multi-year investment.  

“Understand your medical records retention policy both locally and at the state level, or if there are any federal requirements that you have to retain records and how do those video records apply to that,” Salmeron says, adding that helps determine how much storage has to be purchased to keep those videos.  

“We have to keep medical records like a paper medical record or EPCR for 10 years,” he says. “The video footage is not considered part of the medical record. However, we consider it part of the medical record because it contains HIPPA information – patient care, treatments."

“Instead of keeping that video for 10 years, I only have to keep it for in most cases right over a year after the statute of limitations runs out. If it’s a criminal matter, I keep it longer so that we’re able to access it for some reason like a criminal proceeding, a shooting or stabbing, or something later down the road. The price is dependent on how long you have to keep those videos.” 

It’s also important to understand the reasons why an EMS agency would make an investment in cameras, be it for workplace safety, training, or clinical reasons, he adds. 

“The reason shouldn't be that you're going to watch your employees all the time and critique every little thing that they do, because you shouldn't be accessing that video unless you really need to,” he says.  

“Address privacy concerns. Socialize it early in the community. Go to your government partners and make sure you get buy-in from them and then have an opportunity for the community to provide feedback as well on what you’re trying to do, why you’re trying to do it, and ask them how they feel about it. That can mitigate any concerns ahead of time."