Scene Safety & Patient Care - Administration and Leadership - @

Scene Safety & Patient Care



W. Ann "Winnie" Maggiore, JD, NREMT-P | | Monday, December 6, 2010

A debate recently sparked in Jackson, Miss., over whether EMS providers should enter an unsecured violent crime scene unescorted by law enforcement. The debate requires us to reflect on who we are and what our role is at this type of scene. Apparently, this needs to be said again so all our government officials understand it: EMS providers do not, and should not, enter unsecured violent crime scenes without a “thumbs up” from law enforcement. To do so would be reckless and would unquestionably lead to increased morbidity and mortality. Maybe the debate on this issue is raging in Jackson, but not anywhere else.

The incident began when American Medical Response and the Jackson Fire Department responded to a call for a shooting and, in accordance with their training and service policies, waited for law enforcement to arrive before entering the scene. The result was a barrage of criticism from city councilman Kenneth Stokes, who is quoted by Jackson’s as saying: “Their policy might be to wait for a police officer, but the job is to assume the risk and if they take the job, they must assume the risk to come and aid and help the injured. One second for the injured could be the difference between life and death.” AMR spokesman Jim Pollard says company policy ensures that the unarmed EMS personnel are safe during violent crime incidents. He says, “We don’t know whether a gunman is still there, and must rely on law enforcement to make sure the scene is safe because EMTs are not armed and don’t have arrest powers.”

Stokes’ view, on the other hand, is certainly not the standard in the field of EMS. According to the sixth edition of the well-respected Emergency Care in the Streets text by Nancy Caroline, MD: “If you feel the scene is not safe, contact law enforcement personnel and wait for them to secure the scene. If you rush into a scene and are injured by violence, you become a nuisance to your partner and fellow EMS responders, not a trained care provider.

You must quickly identify potentially dangerous situations and act to remove yourself, your team and if possible, the patient, to a safe place,” she continues. That’s the standard nationwide, and situations involving violent crime scenes are the lone exception to the EMS mandate of putting the patient’s needs first. In short, if we are “taken out” or disabled at a scene, we’re of no assistance to the crime victim, instead becoming an additional problem.
However, Councilman Stokes disagrees. “AMR’s policy needs to change, and if it doesn’t, the city needs to change its ambulance service,” he told Apparently, this was an empty threat. Stokes didn’t even know that it was Hinds County–not the City of Jackson–that contracts with AMR for service. And it’s been that way since 1990–almost 20 years. Further, it would appear that the family of the shooting victim is probably gearing up for a lawsuit and needs someone to say that what EMS did was wrong. They’re unlikely to find that testimony from anyone who knows anything about emergency services. Stokes says providers who are concerned about safety should don a bulletproof vest. Perhaps he also thinks EMS should be armed, be trained in takedowns and have arrest powers.
Stokes is clearly full of political rhetoric without having a clue about how EMS functions. “If you can’t do the job, let someone else do it,” he says.  

In the emergency services “trinity” of fire, EMS and law enforcement, each of us has a role to play in accordance with our training. Stepping outside of that training, and your assigned role, can lead to disaster. It’s clear that EMS–unarmed and unprotected by body armor–shouldn’t enter a violent crime scene without clearance from law enforcement. Although some EMS services may provide body armor for their personnel, those providers remain unarmed and without the training or legal authority to subdue a violent criminal and effect an arrest.

Unless the standard of care changes, the old adage of “home alive at five” is still the way to go. The truth is, the role of EMS has long been defined, and that role at a violent crime scene is to be part of the solution–not part of the problem. Stokes is way out of his league and doesn’t appear to know how EMS actually functions. Although we do assume many risks of the profession–such as blood borne pathogens and back injuries–we try and minimize these risks as much as possible. Trying to “play cop” is not the role of EMS, according to our training, policies and procedures.

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Related Topics: Administration and Leadership, Legal and Ethical

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W. Ann "Winnie" Maggiore, JD, NREMT-PWinnie Maggiore is an attorney and paramedic in Albuquerque. She is a shareholder at the law firm of Butt, Thornton & Baehr, PC where she defends physicians, dentists, oral surgeons, nurses, paramedics and other health care providers, as well as law enforcement officers, against lawsuits and administrative enforcement actions. She is an author of many EMS legal publications, a member of the JEMS editorial board, and holds a volunteer faculty position in the Department of Emergency Medicine at the University of New Mexico.


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