Informed Consent Form for Interview Participants
  • Study Name: "Hundred Days After" study; "Mike" group
  • Principal Investigator: Anna Grace Keller, member of Katuah Medics. Phone (504) 710-1604, email moc.liamy|rellekrecarg#moc.liamy|rellekrecarg.
  • Local Supervisors: Andrea and Marta, members of Gateway Region Action Medics (GRAM). Email moc.liamg|scidem.lts#moc.liamg|scidem.lts.
  • Project Website:


Participation in this study is voluntary, and you have the right to withdraw at any time, without prejudice, should you object to the nature of the research. You are entitled to ask questions and to receive explanations.

I. Description of the Study

This study is an investigation of the practical politics of street medics. Methods include analyzing documents and interviewing medics and others. This phase focuses on Ferguson and Saint Louis during the hundred days after Michael Brown was killed. The second phase will focus on New York City after Hurricane Sandy.

II. Nature of Participation

You will participate in a recorded one-session, one-hour interview by phone or webchat. Interview questions will ask what street medics did, and about political impacts of the actions of street medics.

III. Purpose of the Study

To better understand: (a) what medics did in militarized crisis, (b) how medics formed political alliances, (c) political impacts of medics. We are only interested in an evaluation of these variables, and how they are related to one another. We are NOT interested in any specific individual.

IV. Possible Risks

a) Emotional risks — Talking in a group for an hour about the intense days of last summer and fall may be healing or distressing. We do not expect it to be more distressing than situations and conversations routinely encountered in everyday life. In case the interview brings up unresolved situations or emotions, we provided you with information about how to reach counseling and support.

b) Risk of police or legal harassment — Research data is not legally protected communication. The following precautions are intended to decrease the risk of prosecution or harassment to interview participants and others: (1) You may choose to be a named participant, but we encourage anonymous participation. (2) Do not share potentially incriminating information with us. Lie if necessary. We won't transcribe or archive anything we consider incriminating. (3) If we learn that interview data may have been accessed by police or anyone other than us, we will notify you and all interviewees immediately.

V. Possible Benefits

a) Personal benefits to interview participants include the opportunity to share stories, reflect on their experiences, and listen to the stories of others.

b) This research will benefit activists by adding to knowledge about the practices and political impacts of street medics at militarized political protests. Benefits to participants and the general public include open access to archived transcripts as well as presentations and papers by the researchers.

VI. Compensation for your Time

There is no financial compensation of participants in this study, because we have no funding for this project.

VII. Confidentiality

a) We will not share interview recordings with anyone (the researchers will personally transcribe all recordings). Your transcript will be anonymized unless you ask us to use your real name. We will not share your transcript with anyone unless you ask us to archive it with Washington University in Saint Louis.

b) We will not use recordings or transcripts for activity besides this research project. We will keep recordings and transcripts until we complete the project (no later than June, 2016). Then recordings will be destroyed, as will non-archived transcripts.

c) We will use words, ideas, and passages from interview transcripts in drafts, presentations, and published articles. We will only use passages from interviews in which participants consented to the study and to the use of the interviews. We will not use identifying information unless you want your identity known.

VIII. Opportunities to Question

a) Any technical questions about this research may be directed to: Anna Grace Keller (principal investigator), member of Katuah Medics. Phone (504) 710-1604, email moc.liamy|rellekrecarg#moc.liamy|rellekrecarg.

b) Any questions regarding your rights as a research participant or research-related complaints may be directed to: Andrea and Marta (local supervisors), members of Gateway Region Action Medics (GRAM). Email moc.liamg|scidem.lts#moc.liamg|scidem.lts.

IX. Opportunities to Withdraw at will

If you decide now or at any point to withdraw this consent or stop participating, you are free to do so at no penalty to yourself. You are free to skip specific questions and continue participating at no penalty.

X. Opportunities to be Informed of Results

In all likelihood, the results will be fully available around 1 November, 2015. Preliminary results will be available around 15 June, 2015. If you wish to be told the results of this research, please contact: Anna Grace Keller (principal investigator), member of Katuah Medics. Phone (504) 710-1604, email moc.liamy|rellekrecarg#moc.liamy|rellekrecarg.

She will either meet with you or direct you to where you can read a copy of the results. In addition, there is a chance that the results from this study will be published in a cultural studies or public health journal, which would be available in many libraries.

XI. Consent

a) Do you consent to be interviewed? (Y/N)
b) Do you consent to recording of your interview? (Y/N)
c) Do you prefer a phone interview or a webchat, or is either ok? (phone/chat/either)
d) Do you want to use your real name or be anonymous? (real/anonymous)
e) If anonymous, please pick a nickname or ask us to pick one. (___)
f) Do you want your interview transcripts archived or destroyed? (archived/destroyed)

This document holds us to our word. If we want to make changes after you agree to it, we must renegotiate with you. You can tell us "no," and hold us to this version of the interview procedure. Your signature below indicates that you voluntarily agree to participate in this study.

Dated this __ day of April, 2015

Signature of participant:

Signature or person obtaining consent:


This is version 2 of this form (14 April 2015).

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License