My Safety comes First (somewhat long)

January 23, 2007

I think Sal, Dr Krin, Henry, and Wes have made excellent points. We need to

have guidelines that are set forth by " the company " , that give a framework

of how, what, where, when, and how. However, we must allow our folks on

scene to make some judgment calls because of the ever changing scenes. Which

I see only working if they have training on how to deal with these

situations.

When I was EMS chief at a small volunteer FD and ambulance service, I had

several problems with my folks entering violent scenes against the

guidelines of the department. I could not seem to drive home the point of

personal safety first. They all thought because we are here to help nothing

is going to happen. That may have been true 20 or 30 years ago, but not

today!

I came up with a plan for a live exercise with some real twists. I called a

friend of mine who was a local cop and got some 38 caliber police blanks,

the advantage is those cartridges have no wad just a power charge and make

enough noise to really get your attention.

I then selected quietest member of our department play the husband of an

injured patient. What was dispatched as an injured person was actually a

shooting and the husband was a crazed killer just looking for more victims.

I sent my fire first responders and ambulance up the street and we used a

back channel and did tones just like we would for a real call. We then

waited for the response to the station and then let them response to the

scene. The fire unit was first to respond and requested LE ETA and dispatch

responded LE was delayed and would give them an ETA as soon as it became

available. The fire unit or ambulance did not ask any other questions about

the call. There was the first mistake. Had they asked about details

dispatched would have told them the family was being evasive and not giving

the details of the injury.

The fire unit checked on scene, the meeting room of the station and I could

hear them gathering medical equipment off the truck.

They entered the scene and began a patient assessment. The husband/shooter

was being very evasive and would only say his wife had fallen and hurt

herself. The husband stood two feet from the responders with the gun in his

hand behind his back. I had given the shooter instructions to wait to

everyone was in the room and then let the carnage begin.

The ambulance arrived on the scene as the FR turned the patient over and

found the all the blood and multiple GSWs to the chest and abd. The officer

on the call asked if those were GSW's and was immediately shot multiple

times in the head. The husband/shooter reloaded and went to the parking lot

and killed all the other responders except one, an EMT on the ambulance who

ran from the scene. Our policy was to wait for LE if a violent call and to

back out if the scene became unsafe. These responders ignored the signs, the

husband being evasive and not asking dispatch for additional information.

Had this been a real situation would have resulted in 6 funerals at the

department. Is this an extreme case...yes for sure but it was staged to

increase their awareness, to make them think and maybe save someone from

injury or worse losing their life.

It was a very radical way to deal with the situation but it worked and

proved a point to my crews. ALWAYS BE AWARE and if your feel threatened back

out and wait for LE. The policy we established was there for a reason! BTW I

did film this whole event, except for the parking lot shooting and we all

sat and view the tape after the carnage ended. We spent the next hour

discussing what went wrong.

We do not teach enough scene safety in most of our EMS classes today. When I

was teaching at UT Arlington we had one day filled with calls of all types.

Everything from the unruly drunk to the violent patient/family, to the child

injured with no parents. We ran all the students through those calls as the

FR and/or ambulance crews. We must teach our folks how to handle those

situations and a one day training isn’t enough.

How would you handle a hostile family member, how would you deal with

physical confrontation, how would you defend yourself? All good questions

that need to be examined in detail before you are in that situation.

For those EMS administrators do you have guidelines how to handle violent

scenes/patients and train your crews using your guidelines? If not, why???

Bernie Stafford EMTP

________________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of krin135@...

Sent: Tuesday, January 23, 2007 10:46 AM

To: texasems-l

Subject: Re: New Thread (My Safety comes First)

In a message dated 1/23/2007 10:25:23 AM Central Standard Time,

petsardlj@... writes:

I think we need to be more concerned about how much the violence has made

our job that much harder, and think about those issues. I do believe there

needs to be some kind of relevant instuction on what the company feels is

the way

to deal with a violent patient. This way the employee understands when the

company will stand behind you and when the company will stand behind you.

I agree. Grayson and I did a number of 'scene safety classes' for both

Basic and Paramedic students over the years...two of them got realistic

enough that there were students that ended up almost needing to change their

knickers....funny that no one from either of those classes forgot to

actually

*check* for scene safety from that time forward...

ck

S. Krin, DO FAAFP

January 23, 2007

Bernie,

I wrote my post before reading yours, and you absolutely confirm what I was

trying to get across. The kind of training you described is exactly what must

be done.

Jane and I have done many scenarios that were quite similar to the one you

described. Students learn more from one scenario than from 10 hours of

lecture.

Gene

>

> I think Sal, Dr Krin, Henry, and Wes have made excellent points. We need to

> have guidelines that are set forth by " the company " , that give a framework

> of how, what, where, when, and how. However, we must allow our folks on

> scene to make some judgment calls because of the ever changing scenes. Which

> I see only working if they have training on how to deal with these

> situations.

>

> When I was EMS chief at a small volunteer FD and ambulance service, I had

> several problems with my folks entering violent scenes against the

> guidelines of the department. I could not seem to drive home the point of

> personal safety first. They all thought because we are here to help nothing

> is going to happen. That may have been true 20 or 30 years ago, but not

> today!

> I came up with a plan for a live exercise with some real twists. I called a

> friend of mine who was a local cop and got some 38 caliber police blanks,

> the advantage is those cartridges have no wad just a power charge and make

> enough noise to really get your attention.

> I then selected quietest member of our department play the husband of an

> injured patient. What was dispatched as an injured person was actually a

> shooting and the husband was a crazed killer just looking for more victims.

> I sent my fire first responders and ambulance up the street and we used a

> back channel and did tones just like we would for a real call. We then

> waited for the response to the station and then let them response to the

> scene. The fire unit was first to respond and requested LE ETA and dispatch

> responded LE was delayed and would give them an ETA as soon as it became

> available. The fire unit or ambulance did not ask any other questions about

> the call. There was the first mistake. Had they asked about details

> dispatched would have told them the family was being evasive and not giving

> the details of the injury.

> The fire unit checked on scene, the meeting room of the station and I could

> hear them gathering medical equipment off the truck.

> They entered the scene and began a patient assessment. The husband/shooter

> was being very evasive and would only say his wife had fallen and hurt

> herself. The husband stood two feet from the responders with the gun in his

> hand behind his back. I had given the shooter instructions to wait to

> everyone was in the room and then let the carnage begin.

> The ambulance arrived on the scene as the FR turned the patient over and

> found the all the blood and multiple GSWs to the chest and abd. The officer

> on the call asked if those were GSW's and was immediately shot multiple

> times in the head. The husband/shooter reloaded and went to the parking lot

> and killed all the other responders except one, an EMT on the ambulance who

> ran from the scene. Our policy was to wait for LE if a violent call and to

> back out if the scene became unsafe. These responders ignored the signs, the

> husband being evasive and not asking dispatch for additional information.

> Had this been a real situation would have resulted in 6 funerals at the

> department. Is this an extreme case...yes for sure but it was staged to

> increase their awareness, to make them think and maybe save someone from

> injury or worse losing their life.

> It was a very radical way to deal with the situation but it worked and

> proved a point to my crews. ALWAYS BE AWARE and if your feel threatened back

> out and wait for LE. The policy we established was there for a reason! BTW I

> did film this whole event, except for the parking lot shooting and we all

> sat and view the tape after the carnage ended. We spent the next hour

> discussing what went wrong.

>

> We do not teach enough scene safety in most of our EMS classes today. When I

> was teaching at UT Arlington we had one day filled with calls of all types.

> Everything from the unruly drunk to the violent patient/family, to the child

> injured with no parents. We ran all the students through those calls as the

> FR and/or ambulance crews. We must teach our folks how to handle those

> situations and a one day training isnâ€™t enough.

> How would you handle a hostile family member, how would you deal with

> physical confrontation, how would you defend yourself? All good questions

> that need to be examined in detail before you are in that situation.

> For those EMS administrators do you have guidelines how to handle violent

> scenes/patients and train your crews using your guidelines? If not, why???

>

> Bernie Stafford EMTP

> ____________ ________ ________ ________

> From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On

> Behalf Of krin135@...

> Sent: Tuesday, January 23, 2007 10:46 AM

> To: texasems-l@yahoogrotexasem

> Subject: Re: New Thread (My Safety comes First)

>

> In a message dated 1/23/2007 10:25:23 AM Central Standard Time,

> petsardlj@sbcglobalpets writes:

>

> I think we need to be more concerned about how much the violence has made

> our job that much harder, and think about those issues. I do believe there

> needs to be some kind of relevant instuction on what the company feels is

> the way

> to deal with a violent patient. This way the employee understands when the

> company will stand behind you and when the company will stand behind you.

>

> I agree. Grayson and I did a number of 'scene safety classes' for both

>

> Basic and Paramedic students over the years...two of them got realistic

> enough that there were students that ended up almost needing to change their

>

> knickers.... knickers....<wbr>funny that no one from either of those

> actually

> *check* for scene safety from that time forward...

>

> ck

> S. Krin, DO FAAFP

>

January 23, 2007

There have been sevearl comments that I agree and disagree with.

I think that we have too many medics coming out of the classes that are thrown

to the wolves ... they walk into things and learn the hard way... so the classes

tell them take care of yourself first. Employers tell them if dispatch tells

them to wait they wait.... I worked in a county where we may only have 1

officer... and we had a call that as we approached looked calm and safe... then

the front door flew open... I had to instruct the FR and my partner that we were

waiting at the truck until we got all clear from PD... then the wife runs out

and screams that the officer was fighting with her husband... I had to make a

decision to help him or wait for another officer to get there......

My training and back ground made the decision for me.. I have been doing this

for awhile... I helped the officer.. my crew was given instructions that they do

not enter unless they heard from me... and if needed to stage down the street if

they felt it was required(policy you see)...but i felt like i had a

responsibility to the officer to provide help to him... it was a personal choice

based on training and expeience...

but guys coming out of school have to be given the rules ... and they have to

have a senior person help train them... I have heard it said and said myself...

when they get out of class school begins.. but too many times they do not have

someone to teach them....

the excercise that Bernie ran sounds like a good one... taught the results and

helps to teach them what to look for...

I used to ask my partner what he saw when he walked into the room... it was an

excercise that we both ended up doing..

not only for safety but other things... where are the family members.. whose

bottles of meds are sitting on the counter if the patients states that they do

not take any.... is that a pellet gun or a 22 behind the front door...you would

be surprised how many times my partner reported he did not see any of the things

i did... and this does not only apply to working EMS.. the nurses in the er

still wonder how i knew that the DPS trooper, that EMS transported in without

his gun belt, had a gun ...

We all have to be responsible for the safety of ourselves, partners and our

patients...

when we become adults and go to school we have to be retaught things common

sense...

Bill Cosby i think said it best on one of his CDs..... Educated people have to

go to a class to learn Natural childbirth.....

we all have to take a part in the training... employers will train you one way

to limit the liability... school trains one way because it is in the book... but

we also have to learn from those who have the experience...

ok i have rambled on enough.. and probably made no sense... but that is my

2cents..

Tabor

If one person falls, the other can reach out and help.

But people who are alone when they fall are in real trouble.

--Ecclesiastes 4:10, NLT

January 23, 2007

, you and the other hoodwinks are entirely correct. They must be taught.

It is so much easier to teach a newby out of school than it is to teach the 10

year veteran from another service, that thinks he has been there and done all

that. It is another reason why it takes 9 months before you get a set of keys

to my ambulances. You have to learn what we practice and you have to practice

what you've learned.

Andy Foote

Re:My Safety comes First (somewhat long)