Administration and Leadership, Columns

Pro Bono: Responding to Dangerous Situations

Issue 1 and Volume 40.

The Ferguson situation has renewed the debate over EMS response into so-called dangerous or “hot” situations. EMS liability can take different forms in these situations—for failure to respond to the scene of the incident in a timely basis, as well as for not providing a safe work environment for EMS staff who do respond and are then injured or killed. But potential liability for the EMS agency really comes down to doing what is “reasonable”—asking the question, “What would a reasonable and prudent EMS agency do if faced with a similar situation?” And if a case goes to trial, you’ll ultimately be judged by a jury of average citizens who will look at it through the prism of the current public perception, as seen on the news, Twitter and Facebook feeds. The key then is to use “common sense” in developing policies in handling these potentially dangerous responses, and that means looking at what other EMS agencies are doing in terms of their policies and procedures for response. You don’t want to be the EMS agency that is the “outlier” and doing things differently than everyone else, as it could then be argued that you’re not following the “standard of care” that has now been established.

There’s no cookie-cutter method and the approach may vary from community to community, based on the resources each community has, both in EMS and law enforcement. Response to dangerous situations must be based on an actual assessment of the threat (as opposed to perceived threats), excellent communications between dispatch and the field, and the approach that protecting the EMS responder first is the paramount concern. Keep in mind that what is a reasonable response to a potentially dangerous scene is often based on an evolving public perception, which has changed in recent years as there have been more reported instances of active shooter situations. Twenty years ago, the public fully understood why EMS wouldn’t respond into a warm zone of an active shooter situation. That all changed after Columbine, and the consensus approach and training have evolved to a point that it’s now more acceptable for EMS to take some risk in order to save lives. After all, if these events are happening, the public is saying, why can’t EMS responders be better trained to “get in and get out” quickly in these situations where lives are at risk?

Delaying response into a scene to access, treat and transport a patient injured due to the violent actions of others must also be based on an actual assessment of the potential threat. EMS agencies should not stay out of a particular neighborhood simply because of past incidents of violence there. Or a policy that “we don’t respond into any Section 8 housing project unless police escort us in first” is likely not going to be seen as a “reasonable policy” in 2015. Indeed, there’s been litigation in at least one case where that blanket policy was alleged to have been discriminatory against certain minorities. Given our current state of society (post-Columbine, post-9/11, and post-Ferguson), the public is more likely to expect us to be trained to handle these situations in a safe, swift and professional manner, and not just sit back and wait until the “all clear” signal is transmitted.

EMS agencies should also provide the best possible safety equipment for their staff. Should EMS crews be equipped with body armor? EMS agencies that are likely to respond to violent situations should be prepared and OSHA’s “general duty clause” that requires employers to maintain a “safe” workplace may be enough impetus to have this protective equipment readily available for EMS crews. As we all know, EMS is sometimes a dangerous profession that requires that we expose ourselves to some risk—but there must be a balance, and that risk must be balanced against the potential to save lives.  
The bottom line is to stay up to date in ways to respond to dangerous situations. Develop workable policies and procedures that protect EMS responders to the maximum extent possible while ensuring that the safety of the public (and injured victims) is also met in a reasonable and prudent manner. Encourage the use of clear protocols, checklists and other common sense tools to ensure response decisions are made objectively and not based on the emotions of the moment. Regular tabletop and practical role play and other simulation training on how to respond to these difficult situations that are outside the normal response realm is also essential.