Staging per law enforcement

[Cougar]

I am with a volunteer squad in a VERY rural area (read frontier). After almost 17 years, we know the populace pretty well and have fairly accurate spidey senses for when a call could have safety issues and when it's not a problem. Our area is is used as a training ground for state police and the nearest paid ambulance service has been going through a few years of very heavy turnover so although we know our patients and our district well, they don't. They are forever having us hold for law enforcement to clear scene that we would be comfortable going into becuase we know the folks. Mind you we are a minimu of 40 minutes for them to get up here and sometimes much longer.

Last night we had a call that came out as a 19 year old female who had possibly OD's on prescription antidepression meds. Enroute we hear she has left the house and is heading for the river (no bridges here). We get within a quarter mile of the scene and are told to stage and wait for LE to to arrive and clear the scene. After 20 minutes I am really worried about whether this could be tricyclics and we could end up working a code so I get central on the radio and get them to repeat exactly how the call came in. I ask them if there is ANY reason to suggest this pt has a weapon or iffers any specific threat to my crew. They tell me law enforcement is an estimated 20 minutes out. After hearing what they have to say about no weapons and how the call came in, I have decided we are going to head in anyway when law enforcement comes screaming by (I guess the 20 minutes was the wrong estimate) They clear teh scene immediately because it is a frantic teenager who has had a miscarraige a couple of days ago and is pretty missed up , but dangerous to no one but herself.

My question is, since this keeps happening up here because the staters are all new and shiney and the paid service doesn't know the area and our drunks scare them, should we just listen to our own risk assessment? There are places here we aren't going into without law enforcement. Domestic violence situation with the shooting nutjobs....we aren't crazy....but we have a way better idea than the the law enforcement people and paid service from 40 miles away what situations are threatening and which ones aren't. I don't want to be explaining to a judge and jury someday why I sat on my ass in my comfy warm truck while someone died when I had a pretty good idea my crew would not have been in any danger if we went in promptly when called. Can law enforcement stop us. Who has jurisdiction here?

[Arctickat]

Ultimately, the decision as to whether the scene is safe is yours. If you feel there is no risk to you or your partner, then what are the LEOs going to do if they aren't there to stop you? They can give you a lecture, but you can't be charged with any offence that I'm familiar with. You just have to ask yourself if you're willing to face the repercussions if you make the wrong choice and your partner ends up dead.

[Bieber]

I agree with Arctickat, ultimately the safety of your safety and that of your partner lies with you. You've got to make sound, reasonable decisions based on what you know about the scene and keep in mind that every decision you make regarding scene safety could mean the difference between you two going home and you two going to the morgue. At the end of the day, no one is going to keep you safe but yourselves and while I understand not wanting to risk a patient's life or well being, YOUR life and YOUR well being needs to come first every time.

If you're uncomfortable or uncertain about the safety of a scene, just ask yourself, "Whose lives are more important? Mine and my partner's or our patient's? And if me or my partner go down, can we take care of that patient?" Twenty minutes lost may or may not mean the difference to the patient's life, but it could also mean the difference to you and your partner's lives as well.

Stay safe out there.

[island emt]

Coming from a rural area like you, We do know a lot of the population, and after a few years , you do get to know who can be a problem and those that are perfectly harmless.

It does take a good "spidey sense" to know when to sit and when to go ahead and do your job.

We will often get a call and dispatcher in a bunker 50 miles away will say "Stage" due to the nature of call, thats what their dispatch software tells them to do. It's all about your comfort level and your knowledge of your pt's. If your not comfortable , wait till the blue canaries arrive to clear the scene.

Then again, the scariest scene I was ever on was after four blue suits had entered an apartment and allegedly cleared "scene safe". As we were moving down a hallway towards stabbing victim. Banger pops out of closet with a Mac10 and opens up spraying the walls a few feet over our heads. Luckily there were two cops in front of us and they managed to get the shooter before he pulled the weapon back down.

Had to clean the shorts after that call.

[zmedic]

It's worth noting that there are plenty of people who get killed by people they think they "know." Like psychiatrists who get killed by their patients, you'd think they would know how to read them and figure out that its a dangerous situation.

Sure I've gone into situations that maybe others would wait for the cops, and there are times that I've waited. It's worth keeping in mind that you can run 5 calls on someone who is "just a drunk," and the sixth time they show up with a gun in their hands. What I was taught was that about 40% of suicidal patients are also homicidal.

So if you want to go in go in, but I would keep it in mind when you are approaching the house, where you park the rig, where you stand when you knock, where you stand when you are talking to the patient.

[paramedicmike]

What I'm reading in the OP screams complacency and that scares me a bit. I understand the point the OP is making. I've worked in rural areas where you tend to know more people than you don't and run certain people more than others. It's easy to get used to people, know them and think you understand them.

However, the minute one starts trying to justify cutting corners or forgoing basic safety practices is when one's life comes in serious danger. Just because someone has never been a problem before doesn't mean they aren't a problem this time.

I don't want to be explaining to a judge and jury someday why I sat on my ass in my comfy warm truck while someone died when I had a pretty good idea my crew would not have been in any danger if we went in promptly when called.

Will a "pretty good idea" of the safety of a given scene be enough comfort to your family when they find out you were killed on the job? How about your partner's family? I'd rather explain to a judge and jury why I chose to stage than have my family deal with the mess left over after I was killed for making a bad decision.

Your decision to go in to a scene is yours to make with your partner. You know your employer's policies. You know the risks. You have a better idea of the people and geography involved. Don't kid yourself, though, that just because you know the people involved that your safety is somehow more secure than it might otherwise be.

Also, please don't think that you're endangering your patient by not proceeding in. You're not. The patient is already in danger. You didn't create the situation. You're only responding after the fact. Your safety is paramount as is the safety of your partner. You can't save every one all the time. You certainly can't help others if you're dead or injured. And you're definitely not going to help things by cluttering a scene with your vehicles and wounded or dead bodies when the scene that you had a "pretty good idea" was not going to be a dangerous one blows up in your face.

This raises some interesting questions. Say a crew ignores the dispatch instruction to stage and winds up injured. Would the employer be in a position to recommend a denial of worker's comp benefits in this situation? How about legal protection on behalf of the employer when the crew ignores written policy designed for the benefit and protection of the crews on the road?

edit: spelling error and added an extra thought.

Edited April 29, 2012 by paramedicmike

[Asysin2leads]

I can only reiterate what has been said before. The decision if the scene is safe or not is ultimately yours. The presence or absence of law enforcement isn't necessarily the deciding factor of scene safety or not. In class, we say, call for law enforcement, but of course life is more complicated than that. I've had times law enforcement has been present and said the scene was safe, while I disagreed. This usually came down to "there was a bad guy here, but he's definitely not in the apartment, but he might still be in the building." That might be safe for them, but not necessarily for us.

I would say that if you are told via radio to stage and wait for law enforcement, there had better be a pretty good reason to disobey clear, direct orders, and you need to have a good grasp of what the consequences are of your actions. But again, the decision is ultimately yours.

[Bieber]

That's a good point to make, Asys, with regards to what police considers safe versus what EMS considers safe. Not that the police are invincible with their guns and vests--far from it--but they definitely have an advantage over a stethoscope wielding, non-vested EMT or paramedic, not to mention all of the vast amounts of training that they have in mitigating violent situations.

[Arctickat]

Thing is, most often I've seen people consider the police to be a threat and become belligerent in their presence, we paramedics however are not threatening and usually find ourselves to be ignored and allowed to go about our business.

[Bieber]

Haha, we can hope, Arctickat. I don't know about your service, but where I work there are a lot of very aggressive medics who seem to think they're a lot tougher than what they probably are in actuality.