Monday, March 7, 2011

Is the Scene Safe?

Back in our EMT-B class, one of the lectures was about scene safety.  Apparently, they had put an earlier class through a scenario where they were called to the scene of a 16 year old girl with abdominal pain.  Turns out, she's pregnant, and her father doesn't want to allow the EMTs in to treat her.  He argues with them.  He denies she is pregnant, even though it is apparent. The girl, in the background, appears to be getting significantly worse, finally becoming unresponsive.

What to do?

In that scenario, the father met the EMTs at the door, arms crossed, spouting obscenities.

He also had a "gun" in one hand, hidden by his arm.
If the EMT students ignored him, or tried to get around him, or in some other way were unobservant, in their rush to get to the patient (and who can blame them?) he would pull out the "gun" and "shoot them."

In that class, every student was "shot."  Every one.

A couple of years later, at a training on scene safety, the instructor (who was very good, and I'd recommend him) told us a story about a time when he was one of the evaluators for a practical exam.  After repeating the same thing over and over for each candidate for most of the day, he decided to change one small thing.

When students asked "Is the scene safe?" as we are all trained to do, they got the answer "Yes. For now."

"What do you mean, for now?!?" cried most of the students.

"I mean yes, the scene is safe, for now."

"Do you mean I am supposed to keep checking?"


Totally freaked out a bunch of students, and he had to stop doing it, but it is part of what caused him to start teaching safety classes. We are all told to check that the scene is safe, but how often are we told HOW to do that?  What does it mean?  What should we look for? How often should we look?  All the training just mentions it in passing, once, at the beginning.

Sometimes, it's obvious.
Sometimes, it's not.

It is very, very easy to miss things, in the adrenalin rush, and the focus on the patient.

This is one of my daughter's most important functions at our calls- she is our eyes and ears, and watches the scene, while we watch the patient.  She has noticed numerous things that may have caused us some trouble had no one noticed.  Sometimes, things I can't believe I didn't see.

We live in a pretty mellow, low key kind of place, and for the most part, people aren't out to do us any harm.
And believing that is the quickest way to end up in trouble.

We had a call once, a couple of years back, where we were met at the door with a shotgun, and told to get off the property.
We did.
The only correct answer to that is "Yes, ma'am" or "Yes, sir."

Bugged the crap out of me for a long time, though.
I wasn't second guessing our actions.  We did the right thing.
That patient had a delayed transport to the hospital.  And died there the next day.  The delay probably made no difference, but still.
It seems to me to be incredibly unfair that someone can deny another person medical care.  And I never understood why they called in the first place.

Months later, at a company training, someone brought up a call from years ago, long before we were in the department.  There was some weapon present, and no one noticed it. In the telling, the storyteller stopped the story before that point, and asked what people thought was going on, expecting no one to even consider there being a weapon involved.  The person telling the story said something along the lines of "none of us ever really pay attention to scene safety, do we?"

Well. No. Some of us do.

If you have the chance to have a scene safety class, I recommend it.  All sorts of weird crap happens out there, and reminders to keep eyes and ears open can't hurt.  And if you have the resources to assign someone to be safety officer on EMS calls, I recommend that, too.  It's really helpful to have someone not directly involved in patient care to stand back and see the whole picture.

Any suggestions for other ways to improve our safety?  Any tips or resources?  Any good habits or SOPs?  What is your weak point, and what is your strong suit?  What do you worry about the most?  Anything in particular?

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