EMS Response in Abandoned Structures

In an era of socioeconomic challenge, an increase in the availability and use of street drugs, have adversely affected the EMS responder. Homeless populations have swelled across the United States. Almost 15 percent of those people are classified as “chronically homeless.” Thus, the past instability of the economy has increased the number of private and commercial properties that have been foreclosed on or abandoned.¹

Cities like Baltimore, Maryland; Detroit, Michigan; and Camden, New Jersey (Figures 1 and 2), have thousands of abandoned structures in their respective cities. Well documented in urban areas, these issues are on the rise in quiet suburban towns across America as well. Coupled with the aforementioned homeless situation, street drugs and the availability of these structures to squat in has become a catalyst for EMS responses into these structures.

EMS responses into these situations comes with a large number of associated hazards. Structural integrity, utility issues, trash, medical, and human waste are just some of the issues responders will encounter. So, how can first responders safely and effectively enter these structures to provide care? Protective equipment for EMS providers is paramount. Helmets, gloves, eye protection, and some type of turn out coat should be standard response gear for these types of calls.

As with all EMS calls, we routinely consider scene safety and body substance isolation (BSI).³ But that means something different in the case of vacant or abandoned structures. In firefighting, it is called a size-up (a 360-degree walk around), to take in the whole picture.⁴ What are you looking for exactly? A different set of questions should automatically enter your thought process for abandoned or vacant structures.

Common aspects of building construction are often taken for granted. Look at the overall structural integrity of the building; are all the required parts there? Offset or juxtaposed doorways and window frames are begging to be noticed. Are the doors and windows boarded up? Will assistance be needed to gain access? Is there anything hanging off the outside structure that could potentially harm a crew or patient? Does the foundation appear to be intact? Are there any utilities present? Once you can actually view the interior, take care to note potentially harmful issues.

Does the structure have floors, walls, ceilings and stairs? Are there holes in the floor or ceiling? Missing floors and walls create major concerns about the structural integrity of the building. These situations may warrant upgrading the response to a structural collapse level, just to locate the patient and make it safe to retrieve them and exit the structure.  

As you prepare to make entry into the structure, you must look for things you can see but more importantly, be alert for those you cannot see. Hidden problems, intentional or unintentional, that will injure a provider, or worse. Cardboard and trash on the floor may be covering up something more than the floor. Debris can be hiding hole in the floor goes directly through to a lower level. Falls of this type can cause serious injury and shift the course of the call to a rescue assignment.

Keep your head on a swivel, watching for things that seem out of place. Recently, a crew in an urban environment was dispatched for an unconscious person on the second floor of an abandoned residence. Bystanders outside advised that the patient was indeed upstairs. Inside the front door, in the hallway, leading to the steps for the second floor, was a piano up against the stairway. After investigating, it was determined the piano was covering a large hole in the floor, allowing for squatters to transverse to the second level as two-thirds of the staircase was missing. If the patient is on the first floor, one may think it more straightforward a removal, however, you must consider more than just your feet’s perspective. You must be aware of holes in the floor and precarious overhead fixed or hanging objects simultaneously. Objects falling from upper floors or those affixed to the ceiling above can, and will, shift and fall on personnel once committed to interior spaces. A technique we can utilize from the fire service is that of “sounding the floor” for stability.⁷ What that means is they use a tool to hit or “sound” the floor to see if it is stable enough to walk on. If the tool cracks, goes through, or compromises the floor, units can steer themselves around problem areas or not commit at all. This procedure is wise to practice in all such structures.

Check for utility issues prior to entry. Always act as if the premise has working electric, water, and gas until you have had the provider or fire department secure them or proven otherwise. Take note whether the meter is missing or present on the exterior. If the meter looks properly removed by a known utility provider, there is a high degree of probability that the building is de-energized. However, nothing should be assumed to be a certainty.

Be mindful of electrical/extension cords coming in from other structures and running into the structure in question. Illegal electrical hookups and portable generators are a fairly common thing squatters/vagrants/homeless utilize in abandoned structures. Often used for light and heat, or addicts seeking shelter to use drugs; a new trend is to use small Sterno-Cans (Ethanol gel fuel cans)⁸ to generate light and heat. Many abandoned structures have burned because of candles or illegal electrical hook-ups.

Control the number of responders using the staircase at any one time in order to limit added weight as much as possible. Ascending or descending the staircase, try to stay to the wall side of the treads as there is typically more structural support. More often than not, the railing, treads, and/or risers are missing or compromised. Consider utilizing a ground ladder from the fire department to help equalize the added live load of EMS personnel. Using the hand rail or banister for support may be ill-advised as there is a good chance it will not support the lateral or impact load.

Always approach these structures with the mindset that they are unsafe and proceed accordingly. Proceed cautiously and watch where you step, sounding the floor as much as possible. Once you have reached upper floors, the same precautions should be utilized throughout these structures.⁹

Following your size-up due diligence, you have now deemed the structure unsafe to enter. When you have received credible reports of an incapacitated patient in the structure, how do you proceed? This is the critical point when the call escalates from a typical medical call, to a medical call with a technical rescue component, which is a whole different level. Medical incidents complicated by unsafe structures, with a technical rescue component, require specialized teams or units to the scene capable of dealing with specific collapse rescue circumstances. This may involve incident management aspects at the unified command level, requiring multi-agency responses over multiple jurisdictions.

These specialized technical rescue units have multiple methods of identifying or confirming that there is indeed a patient located within the structure. These specialized units carry listening devices, technical search equipment, thermal imaging cameras etc. If the structure is boarded up, the boards can be removed and access for a better vantage point or an alternate place where access may be gained. The context of each situation will dictate the level of response need based on observations from your 360 size-up.

If you take away anything from these observations and experiences, please let it be that you and your team are the most important part of any scenario. Utilizing body substance isolation (BSI), scene size up and critical thinking skills for structure evaluation, everyone can clear these scenarios without injury to patients and the rescuers. Sometimes the most appropriate level of response requires coordination of multiple emergency services assets in order to safely complete the mission. The bottom line: It is incumbent on you as the provider to do everything in your power to safely and successfully complete the call. Everyone goes home!

References

1. Homelessness in 2020- World Population review- state rankings/homeless population by state. www.worldpopulationreview.com.
2. Figure 1 and  2- 556 Division St, Camden NJ
3. Body Substance Isolation (BSI)- EMT –Training.org
4. Haigh, C. (2016, 7.1.2016). The 360 Degree Performance Evaluation Tool. Fire Engineering, 169. Retrieved from https://www.fireengineering.com/2016/07/01/304871/the-360-performance-evaluation-tool/
5. Figure 3 and 4- 700 block of Line Street-Camden NJ
6. Figure 5 and 6- 800 block of Line Street-Camden NJ
7. Tactical Tuesday – Sounding the floor. (2015). Retrieved from https://www.facebook.com/ULfirefightersafety/videos/tactical-tuesday-sounding-the-floor-the-use-of-a-tool-to-determine-the-structura/349870831869738/
8. https://www.dictionary.com/browse/sterno Sterno- flammable hydrocarbon jelly packaged in a small can for use as a portable heat source for cooking. 
9. Naum, C. J. (2010). Risk versus Gain: Operations in Vacant or Abandoned Structures. Retrieved from https://www.firehouse.com/operations-training/blog/10459873/risk-versus-gain-operations-in-vacant-or-abandoned-structures

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