Safety Isn’t An Accident

By Jim Logan

As I thought about topics for this new column on fire-based first response to emergency medical service (EMS) calls, it was easy to choose safety. Safety is one of the very first things drilled in our heads by fire and EMS instructors in the classroom and on the drill field. EMS textbooks do a fantastic job explaining and illustrating standard precautions and body substance isolation (BSI), but when they broach the topic of scene safety, it is usually from an awareness approach. This is understandable, since there is much material to cover during the course and safety is approached in a didactic fashion with no practical application,  except practicing for your skills test for your state or National Registry Exam, i.e. “Is the scene safe and I have applied BSI?”

As an EMS educator, I have found it very difficult to relay the depth and breadth of how safety relates to every aspect of our daily operations just so we can make it home to our families after each shift. You must have operational experience to understand the importance. It’s hard to explainsometimes it’s not always textbook, and some things don’t always turn out as routinely as they start. 

The Call

It’s late in the afternoon on the last day of your tour. It’s been a pretty slow Saturday so far. You just got off the phone with your wife, who took the kids to the zoo because of the great weather. It’s the first weekend after school let out for the summer. The tones go off and alert you that a child has been struck by an automobile about a mile from the station. As usual, you and your crew grab your EMS gear and move a little faster, hearing a call involving a child. As the engine approaches the intersection, the engine operator safely makes the turn onto the street where dispatch has advised you the incident is located. It is a standard procedure with your dispatch center that this alarm will automatically deploy an advanced life support (ALS) ambulance and the police. Sensing that you are approaching the incident, you turn and face forward just as your company officer says, “We’ve got trouble; let’s make a quick assessment and get the kid out of here!”

As you exit the engine and grab your medical gear, you hear your officer telling dispatch to expedite the police and stage a second ambulance two blocks away from this location. Things are unfolding quickly. You look to your left after you reach the front of the cab and see the cause of the urgency and the need for a second ambulance: the driver of the automobile that struck the child is in a seated position in front of his car being repeatedly punched in the face by a bystander who is holding him up by his shirt as he delivers blow after blow to the driver’s head. The man appears unconscious, but the bystander is relentless. Your officer points you and the other emergency medical technician (EMT) in the direction of the crowd and a still figure, which appears to be a four- or five-year-old child. As you move forward, you hear your officer trying to reason with the man assaulting the driver of the car that struck the child.

Knowing that the situation is explosive and the crowd is hostile, you perform a rapid patient assessment–ABCs are good and the patient responds lethargically to verbal stimuli. You rapidly package with appropriate spinal immobilization. The ambulance arrives, followed by a single patrol car. As the paramedic on the ambulance makes his way toward you, he yells, “We’re leaving!” An irritated bystander replies, “Oh hell, you’re not–you’re going to take care of her or I’m going to the house and get my gun!”

The two police officers from the single patrol car are focused on the situation at the automobile and are arresting the bystander, who has beaten the driver unconscious. You motion to your company officer, who runs to your location, seeing the urgency on your face. As the child is loaded into the ambulance, you tell him about the threat made by the bystander. You ask the officer to advise the patrolman of the threat and follow the ambulance with the engine. In the midst of the escalating hostility, you and the paramedic on the ambulance have devised a strategy to quickly load the child and move a few blocks away, out of the view of the crowd to continue your assessment and lifesaving interventions in a safer location.

As you ride in the ambulance to safer ground and assist the ambulance crew, you hear the EMT driver advise dispatch of the situation and request that the ambulance staged for the man beaten unconscious remain stationary until law enforcement secures the scene. Your officer and remaining crew meet you at the ambulance some two blocks away from the original scene. Everyone is safe. Multiple patrol cars have secured the scene and a second ambulance has arrived and its crew treating the other patient.

The child is in critical condition and it is decided that you will ride in and assist with care during transport to the hospital.

After Action

After returning to the station, your officer calls everyone together and begins a “hot wash.” He asks, “Could we have done anything differently?” As you and the others replay the call in your minds, the engineer/driver shakes his head and says, “I don’t think so, boss. This started out as a pedestrian struck by an automobile and turned into a mob scene.” One of the other crew interjects, “We could have stopped in the middle of the road and backed up, but when we turned the corner, we were committed.” Unnoticed, the paramedic and EMT from the ambulance have slipped in the side door to tell you that they had returned your equipment. Startling the crew, the paramedic says, “I’m sure going to watch what I say from now on. I guess that guy took me wrong when I said we were leaving. All I meant was that I could tell when we pulled up that you guys had your hands full and we needed to get both us and the patient to safety.” Your officer smiles and takes another sip of coffee, saying, “I’m proud of all of you for keeping the safety of your crew and patient first and foremost.” We all took away a lesson from this one: it’s not only live wires, weather conditions, fuel spills, or hazardous materials that create safety issues; sometimes it’s the human condition that produces emotions that can turn a scene violent and unsafe. Textbooks can’t teach you the human condition, but I think your instructors would agree that their constant harping on safety, coupled with your experience today, has made you a better responder. Both patients benefited from your quick thinking and actions this afternoon.” 

Tips for a Safer Scene

  • The nature of the call can help you determine the type of precautions to take.
  • Dispatchers will not always have complete or accurate details about an incident. Often, those who report an emergency are excited, nervous, and confused. They also may deliberately not give the call taker complete information.
  • Become familiar with your response area and the typical types of calls so you can be prepared for both the expected and unexpected.
  • When deciding where to position your apparatus, consider that placement must provide for access to equipment, efficient and rapid loading of the patient, and continued traffic flow when possible.
  • Don’t develop tunnel vision. Observe your surroundings, look around for hazards, and listen for the noises in the areais it unusually quiet? Is there yelling?
There is no such thing as a routine call. Your safety is paramount. The objective when you arrive at work each shift is to protect life and property. EMS has become a large part of our daily duties; just as with fire suppression, scenes can become unsafe in a blink of an eye. The goal when you arrive at work for every shift has to be safe practices that allow you to return home just as you left–safe and sound. 

J. Harold “Jim” Logan, BS, EMT-P/IC is a 27-year veteran of fire-based EMS and serves as a lieutenant firefighter/paramedic for the Memphis (TN) Fire Department. As an EMS administrator, he specializes in EMS consequence management, quality improvement, and education. He is a widely published author. Logan is an EMS instructor coordinator and fire instructor for the Memphis Fire Department and the state of Tennessee. He holds a bachelor’s degree in health and safety. For more than a decade, he has also served as a rescue/medical specialist and a medical coordinator for FEMA’s Tennessee Task Force One Urban Search and Rescue Team (TN-TF1).

References 

1.      J. David Bergeron/ Chris Le Baudour,(2008). First Responder, 8th Edition. Upper Saddle River: Brady.
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