# What wisdom do you have about scene safety?



## DragonClaw (Jun 21, 2020)

Partner and I were talking about various tactical things. I mentioned the story our VST told us about a medic being blasted through the door with like a .44 mag or something.  He was DRT. VST (who was a medic or an EMT at the time)

Partner said you should never stand in front of the door for that reason. Stand to the side. He said he thought everyone was taught that a as basic. 

I know that because my dad's army training and all the stuff he would hound me about but now that I think of it, my EMT class certainly didn't teach much of scene safety. 

Granted, it was online mostly, but training varies heavily from one class to another and instructor. 

Even though we are transfer service, I have been extra careful going into residences, especially after dark and in bad areas.  We commonly didn't take our dispatch phone with the built in panic button (we don't get radios), but I've been making sure to. I usually did but now I go out of my way to make sure I have it.

Aside from getting hit on by a weird dude at a residence or going to an apparent drug dealers apartment after dark in the described "Worst/Most dangerous apartment complex" There's not really been anything too crazy. But still.  You never know.

 A stab victim approached a crew for help not too long ago. It was pretty minor as far as I've heard. 


With everything ramping up and increased tension, it's a good time to refresh on safety of all kinds.

Whether it is violence, hazmat, iso, what are your tricks of the trade for staying safe?


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## akflightmedic (Jun 21, 2020)

MA-1.
Partner.
Patient.

In that order, every time.

MA-1 = My A$S First.


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## VentMonkey (Jun 21, 2020)

No tricks. Common sense and good judgment. That is all.


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## CALEMT (Jun 21, 2020)

Know when to back out/ run, and know when to fight. 

Something I do on every medical aid is pre-plan the building (entry points, points of egress, emergency egress), mainly because I can get a lay of the land (floor plans) for when I get a fire in the neighborhood. With most new builds theres a common floor plan.


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## DragonClaw (Jun 21, 2020)

CALEMT said:


> Know when to back out/ run, and know when to fight.
> 
> Something I do on every medical aid is pre-plan the building (entry points, points of egress, emergency egress), mainly because I can get a lay of the land (floor plans) for when I get a fire in the neighborhood. With most new builds theres a common floor plan.



I honestly size up every person I meet/see. I don't like to let sketchy people behind me. I'll redo my stance or my position to have good line of sight of them. 

Know when to hold 'em, know when to fold 'em.

People notice if you notice and if you're alert and look like a hunter more than prey, they will see that.  Maybe I don't look like much but I'm not going to be taken by surprise. There's that much. 

 I was downtown the night after the riots/protests and was taking a dude to a gas station in a bit so great place.  His car ran out of gas.  While we were there, there were like 4-5 people milling around the gas station. One of them that was watching us walked behind the pump we were near and I couldn't see him anymore.  I backed up the car until I could see him again and he was closer than before.  We got the gas and left. 

I have always checked ingress and egress points.  Choke points and kill boxes. Where you could lay down fire from defilade, preferably with enfilading fire. Sitting where I can see the whole area clearly, with exits and entrances in a good spot. 

What are my weapons and tools. What could be.  Who can I count on to help? Who might need help? How far away would help be? 


My dad always pounded this into us from a young age. 

I've been told that my hypervigilance and readyness to fight is just a form of PTSD. But then among our own, I've just been told I've got the "cop brain" (or in general, first responder mentality)

Sometimes you have to fight.  Sometimes you should leave the area as soon as possible (Las Vegas shooting).

But even with the way I think and what I know, I still have little experience utilizing it in any combat sense.  And I haven't been here very long anyway.  I'm not stupid enough to "you can't tell me because I know". 

Yes, use common sense, but there's a reason we train.  Cops, FF, EMS. You don't get told "Do your best" the day you're hired and now you're expected to know everything. Sometimes it's good to listen to the old in a professional where people die young (figure of speech)..

Speaking of.  What's life expectancy in these fields?


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## mgr22 (Jun 22, 2020)

Think of safety as relative, not absolute.


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## ffemt8978 (Jun 22, 2020)

CALEMT said:


> Know when to back out/ run, and know when to fight.
> 
> Something I do on every medical aid is pre-plan the building (entry points, points of egress, emergency egress), mainly because I can get a lay of the land (floor plans) for when I get a fire in the neighborhood. With most new builds theres a common floor plan.


Heard that as Kenny Rogers singing the Gambler.


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## DrParasite (Jun 22, 2020)

1) always know how you are getting out of a location.
2) always keep an out of for alternative exits
3) try not to have anyone between you and the door
4) if the scene is deteriorating leave.  if you can grab the patient, great.  if not, oh well.  come back when PD has everything under control
5) just because the cops say it's a safe scene doesn't mean there are no threats to you.  Always check your patients for possible weapons.
6) the field is, by its very nature, an insecure environment.  the sooner you are in the truck, and off the scene, the more secure for all involved.


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## DragonClaw (Jun 22, 2020)

DrParasite said:


> 1) always know how you are getting out of a location.
> 2) always keep an out of for alternative exits
> 3) try not to have anyone between you and the door
> 4) if the scene is deteriorating leave.  if you can grab the patient, great.  if not, oh well.  come back when PD has everything under control
> ...



So I've seen a few things about you and your partner first, then the pt. 

If you've already made pt contact, how can you leave with without it being abandonment?


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## Tigger (Jun 22, 2020)

DragonClaw said:


> So I've seen a few things about you and your partner first, then the pt.
> 
> If you've already made pt contact, how can you leave with without it being abandonment?


I think you know the answer to that. Your safety or that of your partners is worth more than anything else and it can hardly be considered abandonment if you aren't able to provide care to the patient.

Also, I caution people to be too aggressively minded when on scene. Remaining alert and continuously evaluating your scene is essential. But when this concern affects the ability to interact with people in a human manner, the job becomes harder and frankly not any safer. Appearing hypervigilant or demonstrating an aggressive posture rarely makes things better. There's a time and a place, but most of the time such behavior is _misplaced. _


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## akflightmedic (Jun 22, 2020)

DragonClaw said:


> So I've seen a few things about you and your partner first, then the pt.
> 
> If you've already made pt contact, how can you leave with without it being abandonment?



I will take abandonment any day over me sustaining a serious injury or loss of life. Heroes go home in pine boxes...I do not care to be a hero, ever. My kids need their dad, end of story. As for the patient...it is THEIR emergency, not mine. If it goes upside down, that is on them. I can sleep at night just fine.


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## DragonClaw (Jun 22, 2020)

Tigger said:


> I think you know the answer to that. Your safety or that of your partners is worth more than anything else and it can hardly be considered abandonment if you aren't able to provide care to the patient.
> 
> Also, I caution people to be too aggressively minded when on scene. Remaining alert and continuously evaluating your scene is essential. But when this concern affects the ability to interact with people in a human manner, the job becomes harder and frankly not any safer. Appearing hypervigilant or demonstrating an aggressive posture rarely makes things better. There's a time and a place, but most of the time such behavior is _misplaced. _



Are there any court cases where they went after the crew for leaving a legitimately unsafe scene?


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## DesertMedic66 (Jun 22, 2020)

Don’t be a **** or ******* to your patients. 90% of the EMTs/Paramedics I know who have been assaulted on duty, everyone knew it was coming because of how they act. Is it right? No. But when you hear “a patient hit medic X” your first reaction was “surprised it took this long”. These tend to also be the people that yell at their partners. In 10 years I have never needed to yell at any partner, I have had to have some sit down talks with them but never yell.


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## CALEMT (Jun 22, 2020)

DesertMedic66 said:


> “a patient hit medic X”



Ah yes I remember a couple of those incidents that you’re referring to.


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## DragonClaw (Jun 22, 2020)

DesertMedic66 said:


> Don’t be a **** or ******* to your patients. 90% of the EMTs/Paramedics I know who have been assaulted on duty, everyone knew it was coming because of how they act. Is it right? No. But when you hear “a patient hit medic X” your first reaction was “surprised it took this long”. These tend to also be the people that yell at their partners. In 10 years I have never needed to yell at any partner, I have had to have some sit down talks with them but never yell.



I hadn't thought about this. But you're right. And I know a few that fall under this umbrella. I wouldn't work with them becauseI'm not gonna catch their punishment with them when it happens.


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## Akulahawk (Jun 23, 2020)

DragonClaw said:


> So I've seen a few things about you and your partner first, then the pt.
> 
> If you've already made pt contact, how can you leave with without it being abandonment?


If you're having to abandon your patient for your own/crew safety and you cannot exit the area with the patient (sometimes because the patient is the person causing the unsafe scene) then you will need to EXTENSIVELY document the reasons for leaving. That should include calls for assistance from other agencies, like law enforcement and you being able to return when the scene is reasonably safe/secure (it'll never be 100% safe or secure).


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## Akulahawk (Jun 23, 2020)

DesertMedic66 said:


> Don’t be a **** or ******* to your patients. 90% of the EMTs/Paramedics I know who have been assaulted on duty, everyone knew it was coming because of how they act. Is it right? No. But when you hear “a patient hit medic X” your first reaction was “surprised it took this long”. These tend to also be the people that yell at their partners. In 10 years I have never needed to yell at any partner, I have had to have some sit down talks with them but never yell.


Always treat your patients well. You can be firm, if not VERY firm in letting them know how you expect to be treated, but you do NOT have to be abrasive (at the "nicest" way of putting it). I have patients that treat me well and with respect. These same patients don't treat others well. I basically tell them that if they're going to act like an animal, I'll treat them as such. If they act like a decent human, I'll treat them as such. With me, how they're treated is THEIR choice. I also tell them that I won't lie to them, that I WILL be their advocate while under my care, and that if there's something I can do for them, I'll try to make it happen. Of course if there's something I can't do, well, I won't lie and say that I can. There are things that I do KNOW that I can't get for them, but I'll tell them as such but that I will ask if I can make "it" happen. When I'm told "no" about whatever "it" is, I'll tell them that.


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## VFlutter (Jun 23, 2020)

If you can't be safe, be dangerous.


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## Akulahawk (Jun 23, 2020)

VFlutter said:


> If you can't be safe, be dangerous.


Be Dangerous. Don't seek danger.


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