Scene safery first...always?

[DwayneEMTP]

I'm looking for honest opinions here, not the easy opinions. You'll see what I mean...

Called for a stabbing the other night. Arrive on scene to find approx. 300 people drunk and going nuts. The cops (about 5 or so) are in a semicircle around a girl that is completely covered with blood from her hairline down to her jeans. Cops are pepper spraying the crowd to keep them back. A dozen people writhing on the ground from being sprayed.(The girl is near the entrance to the club, so it’s difficult to tell if they are trying to keep them back from the club, or from the girl)

Do you go to the girl or not?

I’ve come to understand, to my surprise I might add, that I don’t have what it takes to wait for the crowd to be controlled before I help the girl stabbed in the face.

Am I going to take a beating here? Yeah, I’m guessing so. But I’ve been gifted with these tools of medicine, and I couldn’t sit and watch her bleed while I did nothing. This was my decision, my preceptor left it to me, I expected to get my ass kicked afterwards if I chose to go…I just couldn’t do wait. And my preceptor wouldn't have waited either. God bless her for giving me the learning opportunity...but I would have waited by myself in the ambulance.

Enroute to the hospital she goes into shock, begins having seizures. Fluid, heat, diazepam, and all ends well. Would she have been worse off had we waited half an hour…probably not. Maybe so. I don’t know.

Called for a mentally retarded girl. Violent and dangerous. Upon arrival we see her attack her caregiver (pushed her down). The medic (5’ and a little bit) says “Hey now! Easy…..” and goes up to the 40 something year old girl. The girl puts out her arms, as the medic goes towards her I think “NO! She could hit you!” or “ Scratch you!” or whatever…But the damaged girl engulfs the medic in her arms and cries…and cries…It is an amazing, inspiring, and completely inappropriate moment from an EMS point of view. I would do it again in a second.

So is EMS safety absolute? Should Dust be considered less of a medic because he's chosen to work in a war zone? It’s not safe…he knows better…be could become a victim…See what I mean?

Your thoughts/experiences?

Dwayne

To the basics out there. I'm 44 years old. I've been down a road or two. Until you've developed your own sense of safety, and what you're willing to be injured for, you will be considered idiotic, and rightfully so, if you endanger your safety for the safety of others...I'm just sayin'...

[DirtyBlackSocks]

Suppose there are a million and one factors that people could dig up in theory as to why it would be alright to violate the scene safety rule.

Personally, I was trained as a Combat Medic. As a result I'm a little more selfless then I should be, but I'm also trained to be a little more wreckless and size up combat style situations.

If I come up on a patient whose been shot in the leg, is outside of a doorway and the gunman is still inside threatening to shoot anyone that helps them. Then you bet your ass I'm staying away, sorry victim. Another body isn't going to do anything but escalate the situation quickly.

If I come up on a party where some one's been stabbed and they're spurting bright red blood or have obvious chest/abdominal wounds then I'll gladly put myself in harms way - provided I think I've got a fairly good chance of being successful.

You'd have to be pretty nuts to want to head into a lynch mob trying to save the victim without any backup. But like I said, it's all situation dependant.

Having a good judgement comes with age and experience - nobody should be looked down upon for their own personal decisions until they make things worse for everyone else. Be that waiting too long to save a life or risking your own life to save some one else.

Nobody is more of a hero for doing things either way, too.

[akflightmedic]

Good topic Dwayne. Dust isnt the only one from the city making those decisions, so...lol.

Anyways, in the past have I put myself in danger on scenes by determining what risks are acceptable to me at that moment? You betcha! Did I regret them afterwards? You betcha. Were there times I did not regret it and would do it again? You betcha!

I do not believe there is any solid answer to what you have presented. It depends on the day, the call, the weather, my partner, backup support, my mood, my year, so many factors influence what level of risk is acceptable at any given time.

Each situation is unique and must be considered independently with no blanket policy applied to everything.

What I have found is as I become more experienced (older), my acceptable risk level has shrunk considerably. Yes, I have the tools, knowledge and gift of medicine to help others...and yes I am willing to do so, but only when certain factors are in place. I find myself thinking more now and saying it is not worth it.

MA 1 My Ass First!

What good am I to anyone if I am injured or dead due to me determining this one time was an acceptable risk?

Can I sit back and watch someone die or get worse? Yes, I can. I have done it and will do it again.

What you have to remember above all else is this... IT IS NOT YOUR EMERGENCY.

It is their emergency and you will help if you can without injuring or killing yourself in the process. You did not create their emergency, so you should not become part of it.

All the heroes I know are dead. There are many fools still alive but no heroes.

To some this may sound shocking or ghastly but it is the truth. No, I am not burnt out and needing to retire. These are the words of someone speaking honestly about how they feel inside. I have no desire to have a street or park named after me. No one else's life is worth mine with the exception of my children. They are the only people on this planet I would willingly die for.

Does this mode of thinking and operating detract from my level of care or compassion. No it doesn't, as I give the best possible care when it is safe for me to do so. I am very empathetic and at times have become sympathetic, which I always try to stay away from.

As a flight medic for several years, I determined me responding was an acceptable risk. Anyone in the business can tell you how dangerous flight is. Everytime we took off or landed, my stomach was in knots, but I had decided me flying to your emergency was an acceptable risk. However, there were times I cancelled flights as well. In the business it takes 3 people saying yes to fly. The flight can be cancelled at any time by one person saying no.

Dwayne, I once had a 3 year old girl run over by an ATV in remote Alaska. The weather was dangerous but the pilot was feeling brave. My partner was being overly emotional about the call as we were recieving constant reports of the severity of this child and she was wanting to fly. I refused to launch and we stayed on the ground. Air support was/is the only way as there is no road system. The weather did turn and become extremely severe and we would of been caught in it. We were not able to fly until 26 hours later, during which I recieved hourly updates from people in the village telling us the child was unconcious and seizing at times. It was a very long day, I assure you but the risk was not acceptable. We finally made it to the child and flew her to a trauma center 3 hours away (by plane) and left her in critical condition. My partner and pilot later thanked me for being somewhat level headed and refusing to fly as they both admitted they were anxious due to it being a pedi call and the severity. The pilots up there are not full time medevac guys so they do have hero syndrome.

Now I could wrestle with myself for the rest of my life and wonder what if, and beat the call to death in my head, or I can say..it is what it is and leave it at that.

I know that child suffered and was deteriorating due to no care, but it was not worth three lives to help her.

Big risk for big gain...little risk for little gain

This story is just one of the multitude I experienced flying in the arctic. One of the few people who can relate to the experience is Squint (tniuqs). I had to make many, many decisions that affected peoples lives by evaluating whether or not the risk was worth it to me personally and then to my crew.

Ok, I realize I am rambling now and I hope I have made some sense and addressed your question. Feel free to ask any clarifying questions and again thanks for a great topic.

[AnthonyM83]

If PD clears us to enter, we go in. It's often not really safe, but it's a little harder to get in trouble for it if you were cleared.

I'm young and willing to put myself at risk more. I know this will change as I get older and when I have more at stake, like my own family. If we weren't told to stage out and scene is questionable, we'll make a decision and it's based on who my partner is. It's also based on how difficult it would be to disengage/retreat if things got too much (not going into a backroom with an agitated psych patient, but might start talking to him on a busy street corner. We also have the luxury of knowing the FD is always coming to every call, so we'll never be 100% left on our own even if they're a few minutes out.

Who my partner is and retreatability are probably the biggest factors. The latter can be over-rided if police is on-scene and let's us in to a critical patient, b/c even if we get locked in I know they'll be calling for infinite number of backup units. That way there's still risk, but it's not suicide.

[firedoc5]

Way back when...BTLS was first being introduced, in class or testing the first thing you were to do was state "Is the scene safe or secure". We were like, right. Easier said than done. What constitutes a perfectly secure scene?

[Just Plain Ruff]

No scene is ever completely safe. Remember that.

Scene safety has to be a mantra for you and it must be heeded.

Yes you can go in a scene that is unsafe but cleared by PD and still have it turn into a crap fest.

If you feel that you can get in and then get out without suffering injury or harm then you have to live with the consequences good or bad of what actually happens.

Do you have the fortitude to not enter a unsafe scene and have the patient die while waiting for you.

Consider a school shooting. You hear gun shots at one end of the school but there are kids at the other end who are injured. Do you go in?

A stabbing at a local bar - like Dwayne had, you see the angry mob. You have no idea where the assailant is. Do you go in?

A domestic violence call where the husband is still there along with his wife who he smacked around. Is this scene considered safe?

A Scene most of us don't consider unsafe - a mvc on a highway. you have a fire truck blocking the road and your ambulance in front of the truck. The two lanes of a three lane highway are closed by police. Is that scene completely safe?

These are just a few of the examples of scenes that are unsafe or safe to a point.

Go with your gut, if it feels unsafe and you are leery then don't go in.

If you feel it is safe and that you have an egress point then use best judgement.

I recommend to always have a way out. NEVER go into a scene and put the victim between you and the door. Always have someone watching the scene and surroundings. Bad things happen and come out of no-where so you need to be ever vigilent.

If you get put in a unsafe situation and survive it, then it's time to be reviewing your attitude and making that situation a learning experience of what not to do next time.

[captainstandup]

At the end of the day only you can decide if you took unreasonable risks, well I suppose your supervisor may have some degree of input, but it sounds like it worked out ok. As I have said in other threads you have a responsibility to many different people to go home at shifts end.

As far as this forum is concerned you are the only one who was there, you assessed the situation and made a decision to act. Monday morning quarterbacking your decision is counterintuitive. We weren’t there..........

[Richard B the EMT]

IMHO, there is no truly safe scene.

1976, Eastern Parkway, Brooklyn, NY. With lanes closed, blocked by Fire, PD, and traffic cones, a vehicle versus pole incident.

Add a drunk driver who decides all this stuff blocking his way doesn't apply to him. He pulls back into the lane, and pins 2 EMTs who are loading the patient from the previous MVA into their ambulance, between the bumpers of the car and the ambulance.

Result? Original patient banged up, but not really further hurt. EMT Carol Buffa suffered severe damage to her legs, and has almost completely recovered, and is now a Lieutenant. EMT Chris Prescott was killed, becoming the first Line Of Duty Death for the New York City Health and Hospitals Corporation Emergency Medical Service. (This was pre-merger of the EMS into the FDNY)

As for approaching a potentially dangerous individual?

I used to work with a partner, originally from Haiti, and a wonderful EMT. Actually had the Haitian equivalent of a Physician's Assistant, but never went for the NY State re-certifications in this title.

A dangerous or uncooperative patient? This guy would simply open his arms up wide, like he was going to hug them, put this big beaming smile on his face, and almost bellow out "My FRIEND..."

Always seemed to at least disarm the patient, so we could at least talk, even if it was to disagree. Lines of communications were at least opened.

The only time I recall it not working, the ETOH abusing patient took a swing at him. He ducked, and I got hit. I might have referred to it in one of the strings on getting LEO backup in a hurry.

Somewhere on the site, I had mentioned, and again here mention, this one.

At "Pulse Check", the convention of the New York State Volunteer Ambulance and Rescue Association, the action scenario "drill" was 2 persons shot in an open area between two multi-family houses in the time-share area of the Villa Roma Hotel. "PD" and "Security" all saying the scene was safe, and "FD CFRs" on scene for additional hands. All the patients on the stretchers, and about to be loaded.

Suddenly, a guy in camo battle dress uniform, covered in camo paint, bursts out of a door in one of the buildings, and sprays all of the responders, "bystanders", and the patients with an Uzi! I do mean sprayed, the Uzi was a motorized water pistol.

Those who wrote the scenario, and those who score carded it, as far as I am concerned, made their point. This "secure" scene changed almost instantly to an "unsecured" scene, with potential to become a Multiple Casualty Incident.

Going off the deep end here, but can you predict if a meteor might drop into your scene?

Final point? No scene is ever going to be completely secured.