EMS Instructors Teach Scene Safety

Situational awareness is usually defined as the need or ability to have a high level of attentiveness to the environment in a dynamic situation, or making the proper decision and acting on it in the most appropriate fashion. Many EMS professionals face the quandary of how to approach scene safety because of the limited information they have at any given moment.

The Theory
The most valuable commodity in any situation is information. The first logical step in the management of an emergency scene is to gather as much information as possible. This phase, the overall scene survey and management, begins with the dispatcher soliciting vital, initial information from the reporting party.

Any unusual or potentially hazardous situations should be identified so the appropriate resources can be dispatched and all known hazardous conditions passed on to the responders.

The nature of emergency response dictates that responders frequently find themselves working at unstable or unsafe scenes. A policy should be in place to stage EMS crews in a safe area away from the scene in cases involving violence, overdose or behavioral emergencies. Crews should not be permitted to enter the scene until scene safety has been verified by law enforcement.

EMS providers should always approach the scene of an emergency with a high degree of suspension and keen attention to obvious or subtle indications of threats to overall scene safety. Standard safety procedures, including the use of body substance isolation (BSI), personal protective equipment (PPE), high-visibility apparel and vehicle placement are all vital elements in the overall scene-safety equation.

During this phase of operations, situational awareness becomes a critical link. Continuous hazard assessment is both prudent and absolutely essential to maintain a safe operating environment.

The Practice
Once the initial information has been received from dispatch and the decision to stage has been made, the next critical decision becomes where to stage your vehicle. Proximity can certainly pose issues for responders. A minimum distance of one mile away from the scene and out of plain view is recommended. One mile is recommended because a bullet may travel up to a mile.

Once cleared to proceed into the scene by law enforcement or other responders, maintaining situational awareness is key. Instructors should give students some of the following key factors to consider:
1. Known hazards on the scene;
2. Combative patients, family or bystanders;
3. Physical indications of a potentially unstable scene, such as drug paraphernalia, weapons and destruction of property or contents;
4. Indications of potentially violent individuals, such as agitation, paranoia, intoxication, erratic or aggressive behavior; and
5. Indicators of potential terrorist activities.

Continually question your situational awareness. Always evaluate the quantity and quality of the information made available to you, the hazards present on the scene and the resources required when handling the emergency. Finally, you must make a judgment about whether the benefits of any action outweigh the risks. You should determine the most appropriate action with the lowest potential risk.

The best opportunity to build situational awareness skills and develop the necessary judgment to make appropriate risk management decisions lies in actual field experience. Often, students and trainees don’t possess enough real-world experience or have sufficient life experience to adequately assess the risks they’ll encounter.

An invaluable tool that can be used to develop these skills is facilitated, scenario-based discussion. A facilitator provides baseline information to participants and guides them through the scenario. The facilitator should lead the discussion with proper techniques and in accordance with local protocol.

The following is an example of an instructor-facilitated scenario. This scenario may be used to evaluate scene safety and take appropriate actions.

Black text = Facilitator information
Green text = Potential student respons

1. Your unit has been dispatched to an assault in a neighborhood that’s known for gang and drug activity. The dispatcher advises your crew to stage away from the scene. The assailant’s location is unknown. Law enforcement has been dispatched but has an extended arrival time. Further information from the calling party indicates the patient is a 45-year-old male who’s unconscious but breathing and bleeding from the head, where he was struck with an unknown object. Ask students where they would stage their unit.

If participants respond that they would stage less than one mile from the scene when they arrive in the area of the call, proceed to 2. If their response is to stage one or more miles away, proceed to 9.

2. Less than one mile from the scene isn’t far enough. In an area known for gang and drug activity, it must be assumed that weapons will also be present on or near the scene. Because many projectiles can be deadly at distances up to one mile away, staging outside this distance would be more appropriate. Additionally, parking farther away reduces the chance the crew will be assaulted by gang members leaving the scene, particularly if the dispatcher is unable to give the crew any vehicle or suspect descriptions.

3. Law enforcement hasn’t arrived on scene. A somewhat frantic woman approaches the passenger side of your unit screaming at you as she approaches.

4. What actions would the crew take?

Your students may indicate that they would roll down the window and talk to the woman.

5. Before opening the window of your unit to converse with the bystander, providers should ensure the security of their doors and look for weapons or potential weapons as she approaches. Lower your window only enough to converse with her.

6. The woman states that her husband was the one who was assaulted. She says “he’s dying” in their house (the dispatched address), and she wants to know why you and your partner are sitting in your unit doing nothing.

Your students may choose to remain in staging and explain to the woman that they’re awaiting law enforcement to ensure scene security for their protection. Take this opportunity to remind the students that the potential risk to the crew isn’t justified by an extreme endangerment to the life of the patient. Proceed to 9.

If the participants choose to enter the scene prior to the arrival of law enforcement, proceed to 7.

7. On patient contact, you find an unresponsive, breathing, 45-year-old male with an obvious head wound. A baseball bat is lying next to the patient. His wife is becoming more agitated as you treat the patient. She maintains that “some dude” beat her husband for no reason. Law enforcement hasn’t arrived. You see drug paraphernalia on the living room table. You also notice several empty bottles of pills and alcohol in the room, as well as a broken lamp on the floor.

If your student chooses to withdraw from the scene prior to the arrival of law enforcement, proceed to 9.

8. While treating the patient, the woman grabs the baseball bat and makes aggressive moves toward the crew.

If the crew remains on scene, go to 13.

9. Law enforcement arrives and clears you into the scene. The patient is a 45-year-old male with an obvious head wound. A baseball bat is lying next to the patient. The patient’s wife is becoming more agitated as you treat the patient. She maintains that “some dude” beat her husband for no reason. You see drug paraphernalia on the living room table. You also notice several empty bottles of pills and alcohol in the room, as well as a broken lamp on the floor. Law enforcement removes the woman for questioning.

10. The patient is packaged and moved to the ambulance without incident.

11. Your 10-minute transport to the emergency department is uneventful.

12. End scenario.

13. The woman on scene strikes your partner with baseball bat, requiring you to stop treating the patient, withdraw from the location and care for your partner. End scenario.

As pointed out in this scenario, all may not be as it seems on scene. Two different outcomes can occur depending on the crew’s situational awareness and the decisions they make. Scene conditions can change at any moment and significantly affect the outcome.

Student awareness of subtle and obvious clues is your first and best line of defense. Using all of your powers of observation and senses will help you recognize the indicators of an unsafe or deteriorating situation.

Always remember that the single most important factor in determining the success of any operation is that everyone goes home safe, healthy and whole at the end of the shift. Your personal safety and the safety of your crew should always be your top priority. JEMS

This article originally appeared in May 2011 JEMS as “Scene Safety: Situational awareness saves lives.”


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