Help me settle a debate

[rock_shoes]

Sorry Wendy I'm not going to budge on this one. If you're dispatched to a known potentially violent scene with the police you always, without exception, allow the police to arrive first. I've been burned learning this the hard way. If the dispatch information is insufficient to recognise a scene is potentially violent it's medics discretion. The way things were worded by the OP it sounds as though the responding crew was aware police had also been dispatched.

[Eydawn]

See, that's what I'm not clear on. Is this a scene where PD was already dispatched to it, or is it a scene where one medic decided he WANTED to have PD clear it and they requested it? What I'm saying is there's not quite enough information here to make a decision from my viewpoint. Obviously, you err on the side of cops before every OD scene, and agree with the OP's partner.

OP- care to clarify?

Wendy

CO EMT-B

[mikeffd]

I'd like to add some clarification. I never argued with my partner before the call about entering the scene. It was only afterwards that we had our discussion. My stance is that an overdose doesnt inherently imply violence. I'm only arguing that if both of us had no objections, then entering the scene before police is acceptable (simply given the potential ramification).

[Eydawn]

Was PD automatically dispatched to this call?

Do you have standing orders to wait for PD clearance if they are automatically dispatched or are you allowed discretion?

Wendy

CO EMT-B

[paramedicmike]

I get what RockShoes is getting at. But Wendy has some valid questions, too.

Scene safety, of course, is paramount to our operations. However, if police weren't dispatched then there are questions that need to be addressed prior to entering.

This is true for every single call we run.

[DFIB]

I get your drift. An OD does not necessarily mean that the bobbies should be called in. It of course could be granny ingesting too many paracetamols but it also could be a serious criminal environment. There is a big difference between being toned out to the nursing home and being toned out to the local brothel or low class shag hotel. Many scenes are neither and not so obvious. They are then evaluated as to the odds of the scene being dangerous.

The EMS personnel are trained to intue a dangerous situation and react accordingly to the environment, condition and energy of the scene. We will pause short of the door or before descending from our unit and verbally say “scene safe” the accompanying EMTs will confirm “scene safe” from their vantage point. Then we move.

I have a little saying I teach our new EMTs. If I have to choose between people weeping at my house and people weeping at theirs ... well scene security comes first for me.

Edited November 19, 2011 by DFIB

[HERBIE1]

I know that scene safety is drilled into our heads since day one of EMT school. I will somewhat part company with folks here.

When I was in the ghetto, if we waited for the police on every OD or call with the potential for violence, we would have rarely gotten out of the rig.

Bottom line- you need to know your area, you need to know your capabilities, and maintain a situational awareness of your surroundings. If you are pulling up to a scene and notice dozens of angry people running around, then yes, it makes sense to wait until the scene is secure. It depends on how much prearrival information you receive, your knowledge of the area, and what the call is dispatched as. Maybe you are familiar with the address and know it's a drug house or gang hangout- then yes, wait for back up. Maybe you know a certain area is "hot"- meaning gang warfare is going on. Wait for back up. This is when experience comes in handy.

If you decide to wait before making patient contact, you damn well had better be able to JUSTIFY your rationale because a lawyer will certainly want some proof later: active shooting, threatening bystanders, warnings from dispatch that the scene is not safe, etc. Simply saying that you did not feel safe is not good enough. In some areas, the whole neighborhood is "unsafe" by the standard definition of the word, but if that's your area, that's part of the deal. Prehospital care is by definition unpredictable, and that is exactly why most of us got into this business. If you want somewhat safe, secure, serene surroundings, a hospital is probably where you need to be.

I'm no cowboy, I am never reckless, nor would I knowingly put myself or my partner in danger. I simply think folks sometimes overstate the dangers we face. The vast majority of times when I felt my safety in jeopardy was in cases that had nothing to do with a violent injury like a GSW or beating- they were from medical or cardiac calls when bystanders and/or family started acting up, or when a domestic dispute broke out while we were on scene.

In my experience, in 99% of our calls, even the goofiest, most angry, violent folks do not direct their anger or ire towards us. As long as you make it clear you are there to do the job someone called you to do, generally they leave you alone. Remember- someone called YOU for help, and you are supposed to be the professional that is there to mitigate a problem.

[Siffaliss]

Me and my partner have been in argument for the last few days. I was wondering if some of you could lend your opinion.

We work on a native reservation in Northern Ontario. We were paged out sometime between 5-6am for a drug overdose. The only other info that I remember was that the patient was 37 and female. My partner insisted that we wait until the police cleared the scene before we went in. I felt comfortable going in without them. He contends that given the fact that we weren't familiar with the residence, as well as the time of day and the nature of the call (potential for hostility), it was unacceptable to enter before the police. I maintained that given the potential seriousness of the call, that decision was at the paramedic's discretion. In short, it's not a black and white, yes/no answer.

Your thoughts?

It sure is black and white, your partner was 100% correct. Who cares how serious the dispatch info is? Half the time it's wrong and even when it's right, it's not YOUR emergency. You won't change the world going into calls, but your world will change if you don't come out.

Live to attend another one ...

Edited November 19, 2011 by Siffaliss

[Chief1C]

If a person, even well known, has a frame of mind where they consider an overdose to be acceptable. Then they aren't in a state where you can trust them. The other factors just bolster the idea that waiting is better. Yes, it's possible that going in, not waiting, and taking the patient could save their life. It's also possible that while waiting, the patient may die. Then, it's also possible they really want to die, and will kill you, to ensure nobody stops that plan. That's the only flaw in the plan of attempted suicide cases, the ones who really don't want to die; many times do die, because help didn't arrive in time. But who are we to judge, by dispatch info, whether a person was serious or not, or if they're dangerous?

Had a case just after I became an EMT. A person shot themselves in the chest, and did not want to die. The spouse called 9-1-1, begging for help. Police arrived, ambulance, helicopter, paramedics all on hand. The patient wouldn't give the gun to police. The patient was conscious, alert, talking, highly intoxicated -- and holding a gun. Until [the pt.] passed out, [the pt.] was waiving the gun around. Maybe [the pt.] didn't understand what was happening, but was the patient able to be trusted? [the pt.] was drunk, and armed. Only one of which, IMO, is required to lose trust. The patient bled to death, with a gun in their hand. I wasn't going to lose my life to find out if [the pt.] was done shooting or not. According to the history, neither alcoholism nor depression were ever issues in the patients life, an apparent one bad day incident. Of course, who knows what the patients side of the story was.

[basejump]

wether you'd like my stereotypical attitude or my nice,common sense knowledge it still boils down to the same answer. PD needs to assess the situation before you gallying on in unless you'd like to get an axe thrown at your head. I don't want to read about you in the paper brother,stay safe out there. cheers