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Five Steps to Scene Safety
The EMS responder who becomes a victim is no help to anyone. That axiom is the basis of this new column, which will focus on aspects of scene and provider safety, as well as patient safety issues. This month's installment discusses five key scene-safety tenets; for others, see www.emsresponder.com. Please send ideas for future columns to nancy.perry@cygnusb2b.com.
As EMS providers, we must put our own safety at the forefront of our minds on each and every call. We need to use every tool available to us: the radio, to ask dispatch for more details en route; our eyes, to check for signs of danger when we get there; and our intuition, perhaps the most powerful and underused tool of all. Read on for some rules to help make sure you go home safe after every shift.
1. Be prepared
Half of scene safety takes place before you go on shift. In fact, it started in your training, when your instructors drilled the concept home and made it second nature. You also need to be physically ready to run a call. Were you up late last night? Do you make exercise a part of your routine, so you can defend yourself if needed? Are you drinking enough water?
You should also put some thought into what type of uniform you wear. If you can choose between a jumpsuit and a two-piece, they both have safety pitfalls that need to be weighed. The two-piece uniform makes us look more like police officers (especially when wearing a badge), but they're easier to move around in should you need to fight. A jumpsuit is more comfortable, and you look less like PD, but it's harder to wrestle with your patient, and where it goes, you go.
What you carry on that uniform can be just as important. If you carry shears/scissors, do you tuck them in the back of your pants, where anyone can grab them as a weapon? Is your stethoscope around your neck, so it can be grabbed to choke you?
Finally, always carry a flashlight and your handheld radio. Walking into a dark room leaves you vulnerable. So does leaving your radio in the rig. You should also always know your exact location, in case you need fast PD response.
2. Look, listen and feel is not just for breathing
What do you see and hear? How are the cars parked in front of that residence? Are they askew, like someone got there in a hurry? Are there broken windows, as if from a fight? Is there yelling, or is it silent? Are the hairs on the back of your neck standing up? If so, there's probably a reason for it.
Perhaps the most important thing we can do to keep safe is pay attention to our gut. We do it instinctively when it comes to patient care, but those instincts are built over time. We need to do the same with our intuition. Turn up the volume on that inner voice when you're on a call, then listen to what it tells you!
3. Set yourself up for success
As you walk up to the residence, take note of where the hinges on the door are. When you knock, stand on the hinge side, making sure you're not in front of a window. This prevents whomever answers from gaining clear access to you should they have a gun.
As you enter, do a quick scan for other exits. Look for one you could use with a patient (a door) and one just for you if things get hairy (a window). Don't ever let anyone block your exit. Also, do a mental tally of how many people are in the residence. This helps you decide if you can handle a situation with the personnel you have on scene.
4. Be present
Any call can be your last if you don't focus. You need to be fully present in order to tune in to subtle things you may miss if you're preoccupied. People send thousands of messages via their body language. The obvious ones are things like crossed arms and not making eye contact. These are signs of someone who is either angry or not paying you much attention. But there are others, and as much as what people are saying, you need to listen to what they're telling you nonverbally.
Consider the teenager on the couch in his home. Mom called 9-1-1 because he wasn't acting right. Police tried several ways of getting him to open up, but he still wouldn't say a word. All he'd do was look around, eyes darting from one exit to another. The moment PD shifted in the room and the doorway was clear, he bolted, knocking over an EMS crew member. PD caught him several blocks away. But could this have been prevented? Absolutely. The patient was acting like a caged animal: He wasn't speaking, which meant he had no interest in negotiation; he bit his lip and shifted in his seat several times; his eyes were constantly scanning the exits, and the only option he was given was to go to the hospital on a mental-health hold. He felt trapped.
5. Assess your patient threat potential
Who are your potential threats? Certain types of calls lend themselves to common, predictable problems to anticipate. Assault victims generally have bruised egos and may take their frustrations out on you. Some MVA victims are amped up on adrenaline and could be irrational. And with all the road rage on our streets, your patient could still be in a state of anger. Behavioral-emergency calls come with their own problems. Expect the unexpected. These patients often have mood swings and/or paranoia and may become violent. Always approach overdose victims with caution. Restraining them before the Narcan is a good thing; these patients wake up angry and agitated.
Comments
Thanks for the good advice. What is missing from all literature is managing bystanders mostly family and friends who want to be pushy, demanding, tell us what to do on a scene mostly medical. I’m a paramedic working in Sydney and although we have legislation that anyone that hinders or obstructs a paramedic can be charged, it’s still good to have procedures and strategies to manage these people. For me I quickly work out if a bystander will be a problem, it could simply be them telling you to lower your voice even though your we are talking at a normal volume. Eavesdropping on a patient assessment, usually mental Health related. For me I don’t like people acting this way as it demonstrates disrespect and I quickly, firmly ask them to leave the room or scene entirely for risk mitigation and complicating the scene and distracting from assessing the patient. Any thought will be helpful
—Dean Wilmot