Case reports have an important role to play in developing prehospital and paramedicine care and literature, and improving patient care (Maarouf et al, 2017). However, a number of case reports have been published which are ethically questionable, including explicit patient images/video (Durão et al, 2017), details of paediatric patients (McLean et al, 2017), and information which may put the patient's life at risk (Sharif and Alizargar, 2013).
It is important to remember that the patient's story does not belong to us as caregivers, but rather to the individual. All research, including case reports, should comply with established ethical codes and principles such as the Declaration of Helsinki (Cook et al, 2013), where patient rights and autonomy must be respected. Currently, case reports are mostly published without written informed patient consent or review by an ethical review committee (ERC) and this status quo may be considered an ‘ethical blindspot’. Authors and journals have a duty not to publish any content which is ethically questionable even if it is technically possible to do so.
Occasionally, prehospital case reports report that verbal patient consent was obtained. In the typical emergency situation, it would be very difficult if not impossible to ensure valid informed consent under such duress. So, what can be done? The author suggests that ERCs should include case reports in their low/negligible risk review pathways and that, ideally, journals should only publish case reports where there is evidence of ERC approval, and informed, written patient (or carer/guardian where necessary) consent has been provided. Authors should also delay requesting consent until the patient has recovered, wherever possible.
It is best practice to include patients' perspectives in a case report (Gagnier et al, 2013), to support patient-centred care, provide a holistic clinical picture, and help to address the imbalance of power between patients and clinicians. At minimum, case reports should be reviewed by the patients prior to final publication, to ensure removal of any confidential or compromising material (Shevell, 2004).
One barrier to the publication of prehospital care case reports is that most prehospital care is undertaken by clinicians, often paramedics, who are employed by statutory ambulance services. Potential authors may not be able to access patient care records (PCRs) held by the data custodians (e.g. ambulance services) without ERC approval, so the dissemination of knowledge is slowed or stopped in our discipline when it is increasingly needed. Data custodians would do well to implement a policy allowing clinicians to access PCRs to request informed, written patient consent. Seen by many as the most trusted profession, we must do all we can to retain and improve that trust—while also developing our professional knowledge base.