Emergency Service Personnel—Size up for Your Own Safety!
PERSONAL SAFETY
Anticipating a potentially dangerous situation when responding to an EMS call and minimizing the possibility of injury should be part of all emergency response training.
As emergency service personnel, we are often called upon to respond to crises about which we have received virtually no or a minimal amount of essential information. We have all responded to that ambiguous call of a sick or injured person, never knowing what has preceded that sicknessvor injury. From the training we have been given, we do respond as swiftly and as safely as possible, render assistance and return to quarters.
But has responding to numerous emergencies without incident made us complacent or overconfident? In many cases, EMS or rescue personnel arrive before or without the local police department. In these cases, what action should be taken by a rescue unit if the crisis escalates to the point where your safety is endangered?
A motor vehicle response
In this incident, let us assume a call is received to respond to a civilian slumped over the wheel of a vehicle at approximately 10 p.m. What action do we take? Do we assume automatically that this is an aided case, a call to assist a sick or injured person?
In a situation such as this, where no further information is available, nothing should be taken for granted. The person could very well be either sick or the victim of a heart attack; he could also be the victim of a crime; an armed (and scared) criminal; a drunk; a hallucinating addict; or possibly even a psychopath. Utilize the time spent in responding to work out the plan of action you will take when you arrive at the scene.
The first priority is your own safety and protection.
- Position your vehicle in such a way that it is at least a car length away from the rear of the victim’s vehicle.
- Turn the steering so your wheels are turned slightly left. This way if you must back up, you won’t go deeper into the shoulder of the road.
- Align your headlights in the middle of either the trunk or hood of the victim’s auto with your high beams on. Try to reflect your beams off his rearview mirror. This will illuminate the interior of the car and make your approach less visible. In so doing, you have afforded yourself protection from oncoming traffic and also utilized the headlights to visualize the interior of the auto.
- Note how many persons are in the auto, what their positions are, and the apparent condition of the driver.
- Write down the victim’s license number and leave it at your car’s radio. In the event of a hasty return to your vehicle, you have the necessary information to transmit to the dispatcher or police chase vehicle.
- Taking all this into account, you now approach the vehicle:
- Approach from the driver’s side while your fellow paramedic approaches from the passenger’s side. If at all possible, let your partner open the passenger door first to ascertain the victim’s condition. Keep your eyes on the victim’s hands. Opening the passenger’s door first will give the team that extra split second if the victim becomes violent.
- If operating alone, the approach should routinely be made from the passenger’s side.
- Check the trunk lid to make sure it is locked, and note the rear seat and
- floor, as these can be potential traps for responding paramedics.
- Keep behind the center post of the vehicle and carry an object (report book, bag) to throw at occupant’s face if there is any indication of a violent act. Should the victim become violent, return to the emergency vehicle at once and back up rapidly 100-150 yards to clear the kill zone.
- Observe the erectness and position of the victim and his hands at all times. Any sudden motions should cause retreat.
In most cases, the victim will be an aided case, but you have wasted no precious seconds by your actions. As an aside to the above incident: With the advent of dark tinted windows in the newer vehicles, it is often difficult or impossible to see inside the auto. Be particularly careful in these situations. In New York, as in many other states, the realization of potential danger to police or rescue units has caused laws to be passed as to the amount of tint that may be applied to windows.
Call to a residence
In another incident, you are called upon to respond to an injury in a home. Upon arrival, attempt to ascertain the type of injury and how it occurred. Was it an accident? Self-inflicted? Or perhaps the result of a family fight?
A family fight or domestic quarrel is the most potentially dangerous situation to which you will be called upon to respond. Federal Bureau of Investigation (FBI) statistics show that 16% of police deaths and 32% of assaults on police officers occur when they respond to reports of domestic violence. In cases where a rescue unit is to respond, the argument has already escalated to the point where an assault or injury has taken place. The last thing the instigator of violence wants to see is an unknown person becoming involved in what he considers a private affair. In most instances, the rage, and therefore the violence, too, is now directed at you.
If you have advance knowledge that you are responding to an aided case that resulted from a domestic dispute, you have the advantage of making a decision on the course of action you will take. Is the injury serious enough to require immediate action? Can you wait for a police unit to respond? If not, at least be prepared to defend yourself. Have your portable radio and/or flashlight handy. These may be the only weapons that are accessible to you.
Upon arrival at the scene:
- Do not broadcast your arrival to civilians. Turn off sirens and emergency lights as you enter the block.
- Park away from the front of the premises, at least 100 feet from the address location.
- Do not pattern your approach to the occupants. Refrain from using front walks directly to the main entrance. Cut angles in your approach across lawns, etc.
- Don’t become a silhouette. Avoid exposing yourself by either streetlight or houselight.
- Visually observe the condition of the occupancy, and listen for any indications of violent activity within the house.
- Knock and announce yourself and your affiliation loudly and clearly.
- Do not open the door and enter yourself, even if directed to do so from the interior.
- Remain on the side of the door opposite the hinge (the lock side). Keep as far out of the doorway as possible. Open the door as far as you can and check the hinge crack to see if anyone may be waiting behind the door.
- Keep the occupant between you and the interior of the occupancy as you follow him and enter.
- If there are obvious signs of violence or if the situation is doubtful, do not enter.
Know what you are going to do, but most important what you are going to say. Often, a violent argument can be either defused or inflamed depending on the demeanor of the mediators. Try to get the antagonist either out of the room or out of the house. Play on his ego and sympathy. While you are delaying the subject, your partner can render assistance to the injured party. Hopefully, the police unit will have responded in the time you have gained by placating the individual.
Handling the interior situation
If able to get the arguing parties separated, the interior performing paramedics should:
- Maintain visible contact with each other at all times.
- Observe the victim, his apparent condition, and note the location of any weapons that may be nearby.
- Watch the assailant and the victim at all times.
- If the situation begins to worsen,
- leave the premises for the safety of the EMS vehicle and await the appropriate assistance.
While it is not feasible to instruct all EMTs in self-defense or arm all rescue personnel with weapons, you should have enough knowledge to protect yourself. The most important aspect, however, is to be prepared for any eventuality and to have a plan of action worked out between your partner and yourself in advance.
