Situational Awareness, Scene Safety, and Prayers for Comrades

What a week. Friday a mass shooting in Binghamton, NY, and today three police officers killed in Pittsburgh, PA. Following the week when 8 were murdered in a nursing home in Carthage, NC. Please keep the families of the fallen officers, and our EMS colleagues who had to respond to thesescenes, in our thoughts and prayers.

So - how do we help to prepare ourselves situations like this? And how do we keep ourselves from becoming victims?

We probably need to spend some time, with our colleagues, our staffs, and our students talking about some pretty simple stuff.

1. Stay alert! Oftentimes, responding to a call, we're looking out for traffic, talking with a partner, reading a map, handling a radio and a computer. We're not necessarily observing the scene as we approach. Before you drive up to the front door, look at what's going on. If there are people running away or hiding behind cars, you might want to stop a short distance away, exit your ambulance, and look and listen to the scene. PS - even if dispatch has not mentioned shooting or staging!)

2. Slow down! Give yourself time to look and listen. Remember that while we are obliged (by public perception) to step smartly, we are NOT required to "rush in."

3. Observe the whole scene! As you enter a place, scan the room for signs that violence might erupt, and for things that might be used against you. The patient may be a harmless geriatric, but if there are children about and knives, guns, or things that could be used as impact weapons nearby, one partner should keep an eye on the scene while one keeps eyes and hands on the patient. Law enforcement officers call this "cover and contact" - one partner has contact with the subject, the other covers, remains observant, etc.

4. Learn something about self-protection. It may be nothing more than time-distance-shielding like we learn about radiation events. But, it would be better if we were skilled enough (and physically fit enough) to get out of a choke hold, or to escape from somebody who has jumped on your back (and perhaps applied a choke hold). Better to avoid the situation in the first place, but sometimes that will not be possible. Sometimes trouble will develop after you're "in to " the scene and the call.

5. Develop your incident management and MCI skills. It can happen anywhere! Binghamton NY is a small city - Carthage, NC (the nursing home massacre) is a small town. If there are patients, they will do better if the scene, or at least the medical aspects, are managed effectively. That means you need to know ICS, and particularly the duties of the EMS branch positions - triage, treatment, transportation, hospital destination coordinator. Know where to get additional ambulances immediately.

6. Keep your communications with you! By now, every EMT and paramedic responding to a call should carry a portable radio, and radio systems should allow point-to-point communcations by everybody on the ground.

In short, we need to be prepared on every call. If we approach scenes in a lackidasical manner, drive right to the front door without looking, walk in "fat, dumb, and happy" - well, stand by for the headlines.

Please -- stay safe out there. It is MOST important that you go home to your family, intact, at the end of each shift.

And drive carefully! Wear seatbelts! More of us are hurt in vehicle crashes every year..........


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Comment by Skip Kirkwood on April 6, 2009 at 1:10pm
That would be the state legislature. They control everything dealing with the penal code.

Our legal system is historically unwilling to deal with threats, etc., waiting instead until actions are taken.

Sad, yes?
Comment by kristen on April 6, 2009 at 1:00pm
Skip, I recently saw a "warning poster" placed at DRH. the poster pictured a man who had been arrested after taking shots at people from his apt. building with a rifle. several more weapons were confiscated from his home after he was arrested. he has been released on a $5,000 bond. the poster was to warn police officers and paramedics about the statements that he made concerning shooting anyone in uniform who came near him. How we we keep ourselves safe when our legal system doesn't care enough about us to keep someone making threats against us in jail? Where do we need to lobby first? A great many of these people involved in mass shootings have been openly making threats for years, yet we get dispatched to their homes with no warning. In this age of "transparency" isn't it time that we are able to protect ourselves from people threatening violence.? (public service anouncements and stricter jail time for "communicating threats")
Comment by Lobo on April 6, 2009 at 8:22am
Good advice. I attended a Calibre Press Seminar in Las Vegas in the 1980s. In the seminar a couple of things stuck in my mind. Along with staging, the illumination level of the cab is important. Nothing like lighting up the targets for someone just wanting to shoot a responding unit. Another item was doing a patient 'pat down' for concealed weapons while doing the patient assesment. You do not want the radiologist finding concealed weapons in a hospital setting.
Calibre Press is still training EMS and Police departments. Check out their web site!
Comment by Annette Smith on April 4, 2009 at 10:21pm
I agree....good post
Pittsburg PA....the latest....but I'm quite sure not the last...
Be safe everyone!
Comment by Ben Waller on April 4, 2009 at 10:18pm

Three things I do on every call - learned behaviors from two high-volume urban systems earlier in my career....

1) Staging can save your life. Running into an unsecured scene might occasionally save a patient's life, but if you run into the scene ahead of the cops and get killed or disabled, then you've just removed yourself from the equation of all of the future patient's live that you could otherwise have saved. If in doubt, stage at least a block away, out of line-of-sight from the scene.

2) Don't run lights and sirens right up to the front door. It makes you the center of attention and tends to overload your senses. Even if you don't have an obvious need to stop and stage, cut the lights and sirens at least a block away from the scene.

3) Roll the window down as you approach the scene. If you are buttoned up inside the vehicle, you can use only one of your five senses - vision. If you roll down the window, you add hearing and smell to your size-up sensorium. You can hear gunfire much better if the window is down, the siren is off, and you don't have the MP3 player or FM radio cranked up. You can also smell the natural gas leak from beneath the vehicle that just sheared off the gas meter as it crashed into the house, rather than parking in the gas cloud.

Good post.
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