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 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.
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.
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 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 areais it unusually quiet? Is there yelling?
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).