By FRANCIS CALIFANO
It is midway through a relatively slow tour. You and your partner are on the back end of a 12-hour shift, and both of you are ready for a long weekend rest. Your pager goes off, “Ambulance 5611: for the unknown type aided-medical alert at 300 Edwards Street. Additional information: request for a welfare check.”
You acknowledge: “FIRECOM, 5611 responding.” Of all the call types we respond to, these tend to rank among our least favorites. They most often turn into a complex guessing game.
On this run, you arrive on scene; you approach the house; and, at first impression, no one is home. The windows are shut tightly, curtains are drawn, and all doors are securely locked. A ring of the bell and a knock on the door produce no response. You give it another try – only this time, you add the all-important “Fire Department” announcement. Once again, negative results. “FIRECOM, 5611.No response at the door. Can you recall the residence?”
|(1) Outside door. (Photos by author.)|
Thirty seconds later: “5611, FIRECOM: No response on callback.” Now, the ball is in your court. Do you mark it unfounded or take it to the next step?
You decide on the next step. “5611, FIRECOM: Send us an engine to force entry.” The engine acknowledges en route. When the engine arrives, you give it one last try: knock-ring-announce, all with no response. The decision is made to take the door. An irons team takes position at the door. Suddenly, the sound of two strikes on the irons is met with three gunshot rounds through the door. One of the engine crew members is hit and goes down. The game has changed.
How does your department handle cases like this? What do your policies and procedures say about unfounded calls? How do your policies handle “medical alert” calls with no patient contact? What are your guidelines for forced entry? If a forced entry option is decided, do your policies require law enforcement response? What might seem to be a simple call can easily generate more questions than answers. Let’s explore this scenario in more detail.
Scene Safety: First and Foremost
From your first day in the recruit academy, you learn the importance of scene safety. We can all recite the process: Scene safety begins when you first receive the call and progresses through size-up and ongoing assessment throughout the operation. Is the scene safe, and is it going to stay that way? Situational awareness (SA) is a key element of scene safety. It is the ability to identify, process, and comprehend critical elements of information about the environment in which you are operating. SA should be an ongoing action on every call. Complacency is the diametric opposite of SA. It is defined as a feeling of quiet pleasure or security, often while being unaware of some potential danger or defect. Complacency is self-satisfaction or smug satisfaction with an existing situation or condition. Routine everyday calls, such as the opening scenario, are often a breeding ground for complacent behavior. In today’s world, a heightened level of SA must become intrinsic (innate). We must expect the unexpected.
As you approach a location, think about what you are looking for. Is it a residential address, a commercial or an industrial facility, or maybe an apartment complex or high-rise? In our response, we were dealing with a residential home that turned out to be a 21/2-story single-family dwelling – not too daunting. As you approach the front door, are there stairs, a porch, railings, or a vestibule? All of these observations should be habitual. Does the door open to the left or right? Is there clearance on either side (photo 1)? Where do you position yourself and others in respect to the door operation? Does it open out or in? In photo 1, the door opens from the right and out. This photo shows where you should be positioned for optimal protection. Announce your presence: “Fire Department Paramedics” loudly and clearly. When you knock, stand opposite the hinge side, making sure you are not in front of a window that someone inside can see you through. If you find yourself in a dead-end hallway (photo 2) or tight quarters such as vestibules (photos 3-4), do not stack up your crew. Use caution with entrances that are below grade (photo 5) or have angled patios or stairs (photo 6); they limit your means of escape. Be aware that more than one door may give access to the apartment or office. If things go bad, where are your escape routes?
Ensure that any adverse conditions noted during size-up are corrected. Is the scene still safe, and is it going to remain safe? Do dispatch and other responding units know your exact location? You may be at the proper address, but what floor, how far into the building, and what specific location? Do you continue to have radio communications, or are you in a dead spot? As you enter the premises, check behind the door. Look for other entry points, and make sure they are clear. Look for alternate escape routes, and ensure the way you came in stays clear if it is the only way out. Don’t allow anyone to come between you and your exit route no matter how harmless they may appear.
Patient or No Patient
Has patient contact been made? If so, it may be straightforward. You can treat the patient. Problems arise when you discover there is no patient. How do you document your findings? Do you verify the information with dispatch (proper address, apartment number, calling party)? Do you ask for a callback to see if you hear the phone ringing at your location? Do you notify the police (if it has not been done already) that you have made forced entry and now have an unsecured property? Address all of these considerations in your standard operating guidelines (SOGs).
Some Talking Points
Consider legal complications and local and state laws. What laws authorize you and your agency to enter a premises, especially private property? Most often, such laws have been long standing when it comes to police or fire department authority. These laws may be broad in scope and may not include the same authority when responding to medical emergencies. It is wise to clarify local and state laws and regulations for your specific authority as they pertain to medical emergencies.
Duty to Act
Duty to act refers to the duty of a party to take necessary action to prevent harm to another party or the general public. Emergency medical services (EMS) providers have a duty to act as would any “reasonable and prudent EMS provider with the same level of training, in the same community, and under similar circumstances.” In our case, a justification to make entry involved the “duty to act.” Breach of duty to act may make a party liable for damages, depending on the circumstances and relationship between the parties. Leaving the scene without making entry may constitute a breach of duty to act.
Some question cases when fireEMS is called for a welfare check and encounters a locked premise. Would a reasonable and prudent person (emergency medical technician) make every effort to confirm and verify the status of or lack of a patient? A breach of duty could result from failure to confirm or refute the presence of a patient. You must decide to leave the scene with a status of “No patient found,” only after all means have been exhausted and well documented.1
|(5) Below grade.|
Alternative means of entry. If you have the resources (such as an engine company on scene), is there access to an upper-level window that may be reached by ladder? Is there a fire escape? If the location is an apartment building, is there a superintendent? If the location is the residence of a “frequent flyer,” perhaps arrangements can be made for giving the fire department access to the key.
Police response. In the jurisdiction in which I operate, the police are part of our response matrix, especially for welfare checks and any incident that requires forced entry. It is important to have an understanding of how police operations work with and complement your SOGs. A decision of who will assume responsibility for making the call to force entry should be made before the need to make such decisions.
Unlocked or open premises. What happens when you go for a welfare check and encounter an unlocked or open premises? Do not assume the occupants are expecting you. Make your presence well known: Announce yourself loudly, and wait for a response. Make entry with extreme caution, and continue to announce yourself as you make your way through the premises.
Caution is the operative word. Limit the number of personnel until the scene has been established as safe.
What too often are considered “nuisance” calls can have all the trappings of major events with serious consequences. Not only should SOPs for these types of responses be written, but they should also be reinforced through training and monitored for compliance. Vigilance is needed in all of our response activities in today’s increasingly dangerous and ever-changing environment.
1. IL: 911 Call for difficulty breathing. EMS did not make forced entry. Caller died. Lawsuit proceeding. http://www.illinoiscourt.gov/Opinions/SupremeCourt/2016/117952.pdf.
FRANCIS CALIFANO, BS, EMT-P, CHSP, is an emergency management coordinator for Northwell Health, Manhasset, New York. He is a 30-plus-year member of Rescue Hook & Ladder Co. #1 of Roslyn, New York. He serves as emergency management services captain/safety officer. He has a bachelor of science degree in community services/emergency management from State University of New York, Empire State College. Califano is a certified hazardous materials specialist and a certified healthcare safety professional.
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