By Drew Fried, EMT-B
In the performance of their duties, paid and volunteer EMTs can be called to the scene of gunshot wounds, stabbings, and other police-related jobs. It is important to remember that each assignment requires a different response but involves one common task: When you are first on the scene, you will need to secure the crime scene.
A crime scene is the area of response that involves the commission of the crime. The crime scene includes any area that leads to or from the scene. Any area that involves physical evidence such as a weapon or blood becomes part of the crime scene.
Many times the ambulance or rescue crews arrive prior to the police. The arriving crews must first determine that the scene is safe to enter. If it is not, the crew should secure the scene and await police response. If the scene is safe to enter, the EMTs should do so carefully. Whenever possible, attempt not to disturb any physical evidence. Remember that patient care comes first. Do not become so involved with the scene that the patient suffers.
When it is necessary to enter the crime scene, be observant to the scene’s surroundings. Make a mental note as to the location of the patient; any blood, weapons, or articles that seem to be out of place; and anything else that seems important.
At times, it may be necessary to move furniture to gain access to the patient. When this is necessary, note where furniture was and to what location it was moved, including the location of physical evidence that may have been moved. You should also note who moved the evidence. If you can describe the evidence, note brand name, size, shape, color, and how the evidence was made. As the first person on the scene, your first observations may be of paramount importance to police, so it might be necessary to make a sketch of the scene.
Securing the Crime Scene
Securing the crime scene is easy; in most cases, all you need to do is close the door. Some services, especially the fire service, carry barrier tape (that says “Do not enter/cross”) that can be used. Remember, do not use anything from the scene.
After you have secured the scene, no one should be allowed to enter the scene until the police. That means your partner, supervisors, and other emergency responders must not enter the secured area.
Working in the Crime Scene
There are many things you as an EMS provider can do to contaminate a crime scene. The first mistake is walking through any body fluids that have collected at the scene. Whenever possible, do not place any equipment in body fluids. Not only does this contaminate the scene it, but it violates bloodborne pathogen procedures.
While working on the patient, you can help protect physical evidence that may be found on the patient. Physical evidence includes the clothing you need to remove to treat the patient. You should red bag the clothing separate from other biohazard waste and, as soon as possible, turn it over to law enforcement.
You can also protect the scene by not smoking or using the ashtrays. The use of the toilet or telephone is also off limits. It is also important not to run any water in the kitchen or bathroom sinks.
Arrival at the Scene
When you arrive at a potential crime scene, do not lose sight that patient care comes first. When you arrive at the scene, make sure the scene is safe. If the scene is safe and you enter, take a moment to look at the scene and form a general impression of the scene and patient. Look at the scene for items such as a weapon, spent shells, odors, and body fluids.
Scene Size-Up and First Impressions
- Ensure scene safety; take body substance isolation and personal protection gear.
- Identify the mechanism of injury.
- Identify the number of patients.
- Determine the need for additional resources.
- Consider C-spine stabilization.
- Form a general first (doorway) impression.
- Provide patient care, following your protocols.
Working at a crime scene can be one of the most difficult for the prehospital provider. You must treat the patient while working to protect physical evidence, if possible. This can put you in a tough position. Remember that the patient comes first. Do not delay care to collect evidence. Collecting evidence is not the job of the prehospital provider.
Drew Fried has been an EMT since 1978; has been a New York State EMT Certified Instructor Coordinator since 1998; and is a retired NYS peace officer from a community police department in the Bronx, NYC, assigned as the commanding officer of the Emergency Service Unit. He currently is the EMS/health services coordinator with an occupational healthcare company in New York specializing in emergency management.