Scene Safety: What Your Not Taught in School 

     You find yourself working one of your many Over Time shifts for a private ambulance company doing Inter-facility transfers. You’re on the back half of a sixteen hour shift and it’s about 2230. You are looking at the clock and thinking great, just a few more hours and then I’m off. Then your radio crackles and the dispatcher gives you a call from the cities Level 1 Trauma center which also happens to contain the major EMH-Psych unit for the area. The transfer is to another affiliated hospital about 35 minutes away. The patient was to be transported on an emergency protective order to the other facility then to be admitted to their in patient psych floor.  

You and your experienced partner go into the Hosp., greet the staff, and patient, and receive your report. After report you go through the paperwork, ensure the emergency hold order is valid, etc...

  This is the patient who is presented to your care. The patient is a 15yo Male who is experiencing SI/ and requesting detox. assistance as well. The paperwork reveals that this patient was brought to the EMH in PD custody and that he had assaulted the EMS crew who had gone to his house to transport him to the ER, at the request of PD/Family. The patient had barricaded himself in his room after a fight with his girlfriend. His Mom, Dad, and girlfriend are with him and will follow you to the other facility in their own vehicle. After getting through all of the necessary billing, paperwork, etc..You ask the staff whether the patient has been searched for weapons, etc..., and whether there were any issues or triggers which you should be aware of???  

    The staff says that the patient has been cooperative, and searched by their hospital security/police while in their care and has been cooperative; they state that you should expect no issues and that restraints wouldn't be needed. Your partner then looks right at you and says in front of the staff, "What did you ask them that for?? We don't search our patient's....!?!??!"  Remaining calm and collected with the utmost professionalism you say nothing and thank the staff for their help. You decide that it would not be the most career enhancing idea to press the issue and move on to make patient contact. 

     You and your partner package and talk to the patient who is cooperative. In the course of conversation just before you leave you  ask him in front of family if he has any weapons, lighter, etc.. or other items on him, he'd like to provide or get rid of now... The staff is sending you incredulous looks along with your partner; they all stand by as the patient says “no”. The patient’s family agrees, and says they will take the rest of his belongings and meet you there; and that he has nothing he shouldn’t have on him now.  

Next after you  package the patient and have an uneventful transport until you the next hospital. When you arrive there the patient's family meets you outside the ER. The patient turns and asks you, "Will they search me again here?" You reply, " Yes, more than likely they will,"  

     Then he turns on the stretcher looks right at you; smiles, then turns to his girlfriend and says, "Well then can you hold this stuff for me, honey???!!!" You aren’t sure you heard correctly when he reaches into his pocket, and pulls out, a knife, a needle, a razor blade, marijuana, and a small "baggie containing a white powdery substance."  Then tries to give it to her......... At this point you are watching with disbelief as the patient who was supposedly ‘safe’ and had been ‘searched’ hands over weapons and drugs to his family! What do you do in this situation? Are you prepared?

   We were all taught the importance of scene safety in our ‘training programs’ to become EMTs. We all got the continuous mantra of scene safety, scene size up, personal protective equipment and that this applies to every situation we encounter. Next, we came out of school with a sense of pride and accomplishment and looking forward to ‘doing some good calls.” But, in reality, how long did it take you before the realities of the job set in? Did your program really train you in this important skill adequately? I found, as I am sure many of you reading this have at some point as well the answer is NO.  

   EMS often forces us to make extremely difficult choices in very short time frames. By its very nature a lot of what we do is unsafe, and in a potentially untenable environment. As the situation above illustrates you need to be aware of you and all in your surroundings safety at all times. To really perform this task adequately you need to take this a step farther and have ‘situational awareness’. This is truly a merger of the terms you probably heard during your training as the mantra of ‘scene safety, scene size up, personal protective equipment.’  

    You will learn that if you don’t work to develop this ‘skill’ which is essential that the failure to do so could be fatal. Here are a few tips to help you in the future.

1.)             Always be aware of your surroundings and your location on the scene. Take a second and look around and try to notice as many details as possible. Then, be sure that it is safe to approach and continue.

2.)             Be aware of your partner, and their presence at all times. You need to look out for yourself and your partners safety equally. They will be doing the same.

3.)             Always be aware of the location of the best egress routes to safety and to extricate yourself and  others from the scene.

4.)             Be sure that others know your location and your activities so that they will know both where to go should you need help and assistance from public safety entities.

5.)             Be sure to have communication with dispatch and let them know your most current status so that they will be able to get in touch with you and send help if needed.

6.)             Trust no one, patients, family members, staff, bystanders, etc.. They can and will turn on you or be deceitful at any time.

7.)             If there is a Law Enforcement presence with you  have them search the patient and be active participants in helping to be sure that the scene remains safe and secure while you treat your patient.

8.)             In the course of your assessment, and Physical Exam, be cognizant and alert for the presence and potential for concealed weapons or sharp objects.

9.)             Wear body armor to work, and do your best to look out for your partner and patient while doing all of the aforementioned

10.)        Always control your patients access to their belongings and others after you have initiated care, you never know what might happen.

    Above are ten quick tips to help you ensure that you’ll go home at the end of the shift safely. Situational awareness is something we are all taught but aren’t necessarily always careful to ensure. Over time we can if we aren’t careful become complacent with this. No job, patient or amount of political correctness is worth you getting injured, disabled, or killed in the line of duty. SO next time you work, take a few extra seconds, stop, look, listen, and observe. Do everything you can to ensure that you won’t be putting yourself, your partner, or your patient any further into harms way than you already are just by being present in an emergency situation.

Eric Richards, EMT-B with over 10 years of EMS experience in Massachusetts in a variety of settings.