The Quick & Dirty Guide to Scene Safety
"Is the scene safe?"
A phrase we have uttered numerous times during our training. Scene safety is literally drilled into us throughout our training; then not so much, as our careers take off. Even though we are repeatedly told to observe scene safety, we are taught very little about "how" to ensure it, and "how" to deal with a scene that turns unsafe around us. It is standard training for first-responders of all types to ensure that a scene is safe prior to entering the area. In most training courses, it is easy to pick out which scenarios may be dangerous, and which are safe, from the obvious clues given about the scene. We are simply taught to call for law enforcement before entering an unsafe scene and wait for an "all clear". We then quickly move on to the patient, without anymore thought on scene safety. That would be great if all scenes, were "as bad as it gets" prior to our arrival, but the real world of EMS is a little different. Assault on EMS personnel, injuries from accidents, and injuries/illnesses caused by environmental causes on the job; are all on a steady rise, making it more important than ever to be vigilant about your own personal scene safety.
Scene Safety before the Scene
The proper assessment of any scene starts as we know, begins as we approach the scene. Many times, we are "aware" of potential danger due to the nature of the call. Verbal clues and cues from dispatch can "draw a picture", for first-responders to the potential hazards. This is a best-case scenario; first responders will then have a heightened sense of awareness, prior to arriving in the middle of a bad scene. For example, if you are dispatched to an injury that is secondary to domestic violence situation, you are going to approach with a heightened degree of caution. But truly, any scene can change in the blink of an eye; not all situations are textbook and any call has the potential to become unsafe for EMS professionals, at any given time. Safety should be a major concern for all responding EMS personnel from the time they are dispatched, to the time they clear the call.
As competent EMS professionals, we must put our own safety first on each and every call. We can't help anyone, if we allow ourselves to be injured. The true professional will always use every tool available to ensure their safety:
- Their radio; to ask dispatch for more details en route, or ask for additional resources that help ensure safety
- Their unit; is a safe, somewhat controlled environment from the elements and potential harm
- Their eyes; to check for signs of danger on arrival, as well the potential for danger to arise
- Their gut intuition; perhaps the most powerful and underused tool of all, trust yourself and your training
Always Be Prepared
Once you leave the safety of the station, it is a great idea to remain cautious, yet vigilant on your mission. Being prepared for anything and personal safety, go hand in hand when responding to all calls for help. Be aware of what you hear, what you see, and what you feel, while on any call; no matter how routine.
Responding to the scene:
- Is the unit safe for transporting you, your partner, and your patient?
- Is the unit full of fuel and mechanically sound?
- Is the driver of the unit emotionally in touch? (i.e., adrenaline rush)
- Is the unit being operated safely and by the book?
- Does the driver leave enough room between the unit and traffic to allow for a rapid egress from the area, if the need is to arise?
- Is traffic heavy and responding appropriately to the use of your sirens?
- Does the weather present a potential hazard for personnel or the patient?
Arriving on Scene/ The Scene Size-up
- Is LE or other resources on scene, or are they needed?
- Does the call have circumstances that call for strategic parking?
- i.e., MVA with heavy traffic, house/car fire, escaping gases/liquids, etc.
- Are there any clues that make you feel that something isn't right?
- i.e., broken windows or items strewn about, screaming, crying or overly anxious bystanders/patients, inappropriately silent
- Do you feel like you have seen enough to feel safe?
Make sure that any issues observed during the scene size-up have been address prior to entry and make sure your dispatch knows where you are at all times!
- Did dispatch confirm that you are on scene and its exact location?
- Did you exit the unit with your flashlight , radio, and first out bag?
- Does the portable radio/cell phone get reception?
- Is the unit secured and strategically parked?
- Is there a need to consider cover and concealment, if so law enforcement should be involved!
Hides your body, offering ballistic protection.
Examples include the engine of an ambulance, the corner of a solid structure, a tree.
Hides your body but, Does Not offer ballistic protection.
Examples include the back of your unit, shrubs or interior walls.
Approaching a residence/building
Can the person we are there to help, really want to cause us harm?
As you walk up to the residence, notice what side of the door the hinges are. When you knock, stand opposite the hinge side, making sure you're not in front of the door or a window. This prevents clear access to you should they have a gun. Take a second to note another way to retreat from the area of the entrance, if needed!
As you enter, do a quick scan for any other possible exits, in case the need arises to get out quickly.
Look for a way you could use with your patient, like a door, and one just for you, just in case you have to get out quick, like a window. Don't ever let anyone, at any time block your exit, no matter how "harmless" they may seem. Also, do a mental tally of how many people are in the residence. This helps you decide if you could handle a situation with the personnel you have on scene, if things were to go bad!
- Are there potential threats, certain types of calls have easily predicted problems?
- Assault victims generally have bruised egos and may take their frustrations out on you.
- Some MVA victims are experiencing an adrenaline rush and could be irrational. With all the road rage situations that lead to accidents, your patient could still be in a state of rage.
- 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.
The dynamics of the safety position for superiority remain unchanged, but the standing position gives you a strong base to perform various maneuvers. A standing position is definitely required for the interview of a standing patient, but may also be the wiser choice with a patient who is seated or lying on an elevated surface like a bed or exam table.
A rule of thumb is to utilize 45-degree angles when approaching patients. This way, you present them with the fewest possible vital targets, and make their potential angles of attack more difficult. It also maximizes your view of their extremities, thus increasing your reaction time. Your body should be erect, with hands displayed above the waist in a passive yet effective manner. Your arms should be bent with palms facing out, or one hand placed to the chin and the elbow resting in the palm of the other hand. Both of these positions allow for a quick and effective response against several angles or types of attack.
Establish eye contact promptly and directly to display confidence, but not prolonged as if to challenge the patient. Your demeanor should be calm and caring, assuring the patient you're there to help. Identify yourself by first name and title, then follow with a neutral opening question like,"How may I be of assistance?" Try to avoid using the "why" questions, which tend to put people on the defensive; i.e., "Why are we here?" or "Why did you call for EMS?"
The most important thing you can do to keep safe is be aware of your surroundings at all times, trust in your training, your knowledge, and to pay very close attention to your gut and your guts surroundings. We do it instinctively when it comes to patient care, but those instincts are built over time. Situational awareness saves EMS lives.
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