Failure to Train Applies to Bike Medics, Too

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By Wren Nealy, IPMBA President

In October 2017, I exhibited at the EMS WORLD EXPO and fielded lots of questions about EMS bike teams and how we use bike medics at Cypress Creek EMS. Board Member Tom Harris was there working the IPMBA booth, and he had a similar experience. We were both taken aback at the number of agencies that apparently do NOT provide formal bike training for their personnel. I cannot tell you how many times I heard people say they were just given the bike and uniform and told to ride. According to the attendees, when they asked to attend formal training, they were told it was not necessary because everyone knows how to ride a bike.

Canton v. Harris is a landmark Supreme Court case that should make every public safety training coordinator and administrator cringe. It was originally used in a law enforcement case but is now being applied to medical cases. It has two parts that work hand-in-hand: Failure to Train and Deliberate Indifference.

City of Canton v. Harris, 489 U.S. 378 (1989)

Geraldine Harris was brought to the Canton (OH) Police Department after having been pulled over for speeding. During the traffic stop, Ms. Harris became uncooperative and was arrested. She was transported to the police department in a police wagon. When they arrived, she was sitting on the floor of the wagon. She looked unsteady on her feet, and officers asked if she required medical assistance, to which she gave an unintelligible answer.

While the officers were processing her, she slumped to the floor twice. The second time, the officers left her on the floor to keep her from falling again and injuring herself. It took about an hour to process her in, during which time no medical assistance was acquired for her. Police then released her from custody to a hospital, and she was transported there via ambulance. Ms. Harris was diagnosed with emotional issues and admitted to the hospital for a week. She subsequently received therapy for her issue for a year.

Later, Ms. Harris filed a §1983 action against the police department, stating that her Fourteenth Amendment rights were violated, specifically the due process clause, because the police department did not seek immediate medical care.

Applying this to Bike Medics

Can medics ride bikes at a special event without any problems? The answer is, “maybe, maybe not!” The risk of injury and the liability an administrator assumes are HUGE! It is a roll of the dice every time, even when those personnel are highly trained. When they’re not, the risk increases exponentially. I ask, “Why are you accepting the job assignment without the training? Would you let someone drive your fire truck or run as the lead paramedic on your ambulance without formal training?” The answer is NO, absolutely not! So, why is there a double standard when it comes to working on a bike? It is a well-known fact that if you ride a bike with two wheels, it is not a matter of if you will fall, but when and who will see you. The reality of that situation is that you can be injured as a result of the fall, sometimes requiring you to miss work. If your injury prohibits you from working, how this will be handled in your department? Will workers’ compensation insurance pay your claim, or will they challenge it and ask for your training records?

Some departments, especially municipalities, run their own “in-house” training courses. That is better than nothing at all, but when litigation occurs, the training needs to have the substance and credibility to stand on its own. That is why most accredited agencies prefer certification courses. In-house training is not a certification course. A key factor in Failure to Train is if the “Deliberate Indifference” standard can be applied.

The “Deliberate Indifference” Standard

It is possible to discern three closely related requirements that must be met before a failure to train will constitute deliberate indifference to the constitutional rights of citizens. First, the plaintiff must show that policymakers know to a moral certainty that their employees will confront a given situation as opposed to rare or unforeseen events. Second, the plaintiff must show that the situation either presents the employee with a difficult exercise of judgment that training will make less difficult, or that there is a history of employees mishandling the situation. There must be awareness of a problem that is susceptible to improvement through training. Third, the plaintiff must show that the wrong choice by the employee is likely to cause the deprivation of a citizen’s constitutional rights. Training resources may appropriately be concentrated on those situations where an error in judgment by an officer is likely to result in a constitutional violation. Where a plaintiff can establish all three elements, then it can be said that the policymaker should have known that inadequate training was “so likely to result in the violation of constitutional rights, that the policymakers ... can reasonably be said to have been deliberately indifferent to the need.”

In all 50 states, the bicycle is considered a vehicle, subject to the laws that govern the use of that vehicle. There is an established standard through which public safety cyclists receive formal training and certification in operating this type of vehicle, just like any other emergency vehicle. When an administrator chooses to deviate from this standard and does not provide training for their personnel to operate these vehicles, it will not be difficult to apply the three requirements described above to this example.

Canton v. Harris has been successfully applied to law enforcement cases for several years. It is now being applied to medical cases, such as in those involving wrongful death claims. It can be applied to cases involving property damage, personal injury, or death. If you are an agency administrator, stop rolling the dice! Choose wisely, and provide your people with an accredited public safety cyclist training program. It will protect your personnel and the agency, and enhance the credibility of the job we do as public safety cyclists. If you are a public safety cyclist in need of training, don’t let your agency put you at risk. Visit http://www.ipmba.org to locate a course and/or instructor in your area today.

February 15, 2018

Hey Wren,

I really liked your President’s Column in the Fall 2017 newsletter. It took me five years to find a certification course that was even remotely close to me. I’ve worked as a certified bike medic for four years now and have worked more than 80 events. I mainly work at sporting events such as 5/10Ks, half marathons and marathons. I work for three different agencies and as an independent contractor.

Your column struck a chord with me. With one agency, I was assigned to work an event with another bike medic. When I asked if they were certified, their response was “We’ve had no complaints.” Another event, their response was, “J. says he’s okay.” Needless to say, I don’t sign up for any of their events. If they ever ask me why, I’ll send them a copy of your column, if that’s all right with you.

At another event, I got paired up with a clown that had a garage sale bike and had always wanted to be a bike medic. She left me so she could trail the leader of the race while I was in the back of the pack treating patients. I was at a cardiac arrest call a few months later, and she was nowhere to be found. She was booted out of that agency.

One national agency once told my partner that the race promoter only wanted one bike medic, so he asked why the race promoter was making decisions about how the medical team was staffed. He explained that I carry all the oxygen equipment and he carries the AED. Splitting us up made no sense. He received no answer. I signed up for another event, and that national agency said they only wanted one bike medic. I no longer respond to their calls.

It would seem that I’m surrounded by knuckleheads everywhere, but my buddy took the certification course together with me and we work as a team. We are both in different fire departments but work outside our departments independently. We are on Facebook with 5000 friends from fire and EMS agencies from all over the world.

Thanks again for a great column and I hope it wakes people up.

—Steve R. Jackson