Once again, debate has been sparked on the topic of social media (SoMe) in the paramedic profession. This is the result of some corporate ambulance service ‘tweeters’ recently having posted identifiable photographs of patients in ambulances. The College of Paramedics (CoP) (2019) has also released a timely document covering the use of SoMe for the profession to add to the current guidance provided by Baron and Townsend (2017).
Over the last few months, individuals and some anonymous Twitter accounts have raised concerns about corporate tweeters and ambulance service accounts tweeting patient-identifiable information. These tweets range from photographs of patients' pets to photographs of patients' faces with details of their medical history. Another growing trend in paramedic SoMe use appears to be live-tweeting from incidents, often with photographs of damaged vehicles, clinicians posing for photographs with ambulance equipment during ongoing incidents and, in some cases, photographs of live scenes from road traffic collisions showing patients still lying in the road, dead or injured.
When considering such tweets, we must be mindful of both the positive and negative impact they may have. In other areas of medical publications (e.g. textbooks, journals and websites), there are clear guidelines surrounding the need to obtain consent for a patient's information to be reproduced and published. It is also recognised that there must be a demonstrable benefit to be gained from this information being shared (usually in the form of valuable learning for colleagues and peers). In such cases, the need to partially breech confidentiality (with consent) is weighed against the intention to benefit the many through medical education. In the case of SoMe posts where there is no clear public health nor educational message, there is zero benefit to the patient, so it is unclear how one could justify breeching confidentiality.
Furthermore, for other forms of publication, we are very careful when gaining consent, which must usually be in writing. In terms of live-tweeting, I suspect written consent has not been acquired in the majority of cases, despite the College's clear guidance (CoP, 2019). It could also be argued that it is not possible to gain informed consent, free from undue pressure or external influence, from a patient or parent for live-tweeting identifiable information from the back of an ambulance, or the scene of an accident. In these cases, a clear power dynamic is present between the requester and the person consenting. Moreover, this is likely to be a stressful life event for the individual in question, making it unlikely that this is an appropriate moment to be seeking consent to publish their personal information.
I would suggest that there is no place for live-tweeting by the paramedic profession, unless this is being done to convey an urgent public health message, and contains no patient-specific information. Furthermore, I would urge individuals and ambulance services to review their use of SoMe in light of the new CoP (2019) guidelines and the existing standards for publication ethics.