The problem with consent as paperwork
In most emergency departments consent exists as a signed form filed somewhere, referenced rarely and audited almost never. Whether a specific clinician had authority to access a specific record on a specific day is, in practice, unanswerable.
BAEMS treats consent as a first-class system event. It is captured with scope, timestamped, anchored to the ledger, enforced automatically at every access, and revocable by the patient at any time — with the full history retained so that revocation does not erase the record that access once occurred.
Emergency exceptions are recorded, not hidden
Emergency medicine cannot always wait for consent. An unconscious patient cannot grant it, and the alternative to acting is often worse than the privacy cost of acting.
The system therefore provides emergency access paths — and makes every use of them a recorded, reviewable event with a named clinician and a stated clinical justification. The exception exists; it is simply not invisible.
The patient controls access to their health data and participates in decisions about it. That is meaningful only if withdrawal is as easy as granting, and if the record of what was accessed survives the withdrawal.