Today’s correspondent asks:
In an emergency situation where you are treating an unconscious patient or one with an altered level of consciousness, is it permissible to use the patient’s phone and their fingertip or face to unlock it in order to access emergency contact details? Does this protocol differ for a first aider compared to a registered paramedic working for a jurisdictional ambulance service?
I have answered that before, see Accessing the unconscious patient’s phone (December 3, 2016). I revisit it not because I think the law is changed – ‘if you can’t communicate with the patient and your actions are reasonable and in the person’s best interests, they can be justified’ – but I think it’s worth asking whether it is actually reasonable to take the time to do this.
First, you can have no idea whether the patient will have any readily identifiable emergency contact details. If their partner’s number is recorded under their name – Jane or Bill – you won’t be able to identify who out of the many contacts is the emergency contact. Equally if the phone has an entry for ‘mum’ or ‘dad’ you don’t know who is the appropriate person to contact.
If the person is not able to communicate with you then you are probably more concerned with actually treating them – if they are unconscious or with an altered level of consciousness that may mean protecting them and trying to deal with the cause of their illness or injury. Surely trying to access their phone takes away valuable resources and time.
And what are you going to do with the information. In the various times I’ve served with ambulance services it’s never been suggested that we would be ringing relatives from the scene. That is better left to police or hospital staff who will have more information and a quieter place from which to call or the resources to go and knock on the door.
I would also think it would not be reasonable to access the phone to try and get medical information as you cannot have any idea what information the person may or may not have stored on their phone or how to find. All phones are different and perhaps they decided there was a better way than that suggested by apple, or android or nokia, or google or whoever else provides the operating system on their phone. And what do you do with that information? If it tells you their diabetic paramedics have probably already taken a blood sugar level. If it tells you their blood group no-one would seriously believe that but would check before giving a blood transfusion.
In short finding information would be down to ‘sheer, dumb luck’ and even if you could find it, what are you going to do with it? The clinicians who read this blog might like to give information when it would be reasonable, but I cannot really imagine why you would want to bother taking the time trying to unlock their phone.
Does this vary whether it’s a first aider or a paramedic? Only the extent that a first aider has even less need to find the information which they may be hoping to find. If they are treating someone who is unconscious or with an altered level of consciousness they’re going to pass the patient onto a paramedic who is, all things going to plan, hand them onto a hospital. A first aider has even less reason to look for the information that may, or may not, be on the phone than a paramedic so the threshold – that the action was ‘reasonable’- will be harder to reach.
As an aside, on my phone I have a background image on my ‘lock’ screen that says:
This phone
belongs to
Michael Eburn
If found, or in
an emergency
please ring
[Name] on
[Phone number]
That’s worked twice when I’ve left my phone somewhere and someone has rung my partner to tell them where it is, and I’ve been able to recover it. Hopefully it will work in an emergency as that information is right there, without the need to unlock the phone.
(I wrote it on a word processor, took a screen shot and saved it as an image then loaded it on my phone and set it as my lock screen image).
Conclusion
My conclusion to my earlier post was ‘if you can’t communicate with the patient and your actions are reasonable and in the person’s best interests, they can be justified’. I still think that is the case, but I do think it would be very hard for a first aider, and in most circumstances for a paramedic, to show that the action was ‘reasonable’. But if it is – if in the context you can show that it was reasonable – you needed the information and you had reason to believe that information that was vital to the immediate needs of the patient was on the phone and you were going to be able to locate it (not just ‘it might be’) – then it’s probably fine.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
Australian Emergency Law 
As a paramedic the only time we would access the phone is to open the phones built in medical alert app which is available from the Lock Screen of the phone. That does however require the patient to have put their medical details into the phone, which is uncommon to find. We wouldn’t try unlocking the phone to find this though as it would be available from the Lock Screen without a need to unlock it.
Also the only time I would think the information in there would be relevant in the given situation is if the patient needed to be paralysed for intubation as some medications used for paralysis can trigger a rare medical condition that is life threatening and untreatable outside of hospital. That being said I don’t think many if any ambulance services in Australia use the paralysis medication that triggers that medical condition anymore.
So ultimately in the paramedic setting it doesn’t help our treatment of an unconscious person and the only time I’ve used that feature is when the patient has been conscious and given me that information as a summary and list of their medications.
It would be great to see more people using the built-in functionality – which should be on almost all Android and iPhone phones now. I must admit, though, that it was only late last year when I finally set mine up – quite hypocritical I know.
But, honestly, in my experience, I can count on one hand where this information has been needed with any urgency vs being “handy”.
My father collapsed in a public place and didn’t have the lock screen function. As a result, someone was able to access the phone and contact me. My dad was never going to recover but by using his phone to contact me, we were able to spend some extra time with him before he passed. So I have mixed feelings about it – it’s very hard to say, ‘no you shouldn’t’ when I have real experience of the benefits of what happens when someone does.
For the most part, people won’t be looking to mine your information in those circumstances. I think we’ve become very distrusting of our fellow humans sometimes.
For another perspective – I have a metabolic hypersensitivity to morphine and insensitivity to naloxone. I keep this information in my phones built-in medical alert/information system, so it can be accessed without requiring the phone to be unlocked. I also have a line scrolling on my lock screen advising the emergency info button to be clicked in case of an emergency.
Is this even helpful (I.e., will paramedics check it? Is there ever a case where I would be unable to communicate and i might be administered morphine?) or do I need a medical alert bracelet?
I’m not a clinician but I would expect that ti would be rare for paramedics to check your phone. They’d have to find it and take the time to look at it and it would depend what other care you needed. You might be administered morphine if it was indicated by your condition and the treating team were reasonably not aware of the contra-indications. A medic-alert bracelet is something that I suspect clinicians find because they have to do a head to toe exam and will come across it. The clinicians who read this blog may have different or more detailed views.