# GSW - Scene NOT Safe



## DenverEMT (Sep 14, 2008)

I, and very grateful for it, was not on this call. A couple of my co-workers however, were.

You are dispatched to a Gun Shot Wound. Your additional information en route is "30s female, shot multiple times in the chest and arm, barely conscious, is breathing. Was shot by her ex-husband, unknown where he is....stage for a scene safe from PD". You, along with the Fire Department, stage about a block away. PD advises shortly after that your scene is safe.

U/a you find about 10 police officers, a hysterical 'boyfriend', and your female patient. This is a load and go patient. PD states that the male half on scene witnessed the stabbing and they have cruisers out looking for the suspect. You transport emergent to the trauma center which is about 10 minutes away. 2 firefighters are riding in with you, and the boyfriend, who requested to ride in with the patient, is up front with your partner who is driving. The privacy door is shut to prevent the boyfriend from hearing things that would upset him even more. You have one police cruiser following you in hot. 

While en route to the hospital, your patient is able to make it aware to you and the firefighters that the 'boyfriend' that is in the front seat is the shooter. You are not sure if the police searched him or not due to the chaos on scene. 

What would you do?


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## So. IL Medic (Sep 14, 2008)

Cell phones are handy.

First reaction is use my cell phone to call my dispatcher to contact PD that we might have the shooter. Second call to the hospital to let them know what was up and have security waiting. Play it cool on the ride in while reviewing the policy, in choice words, of letting family members ride along. Personally, I wouldn't let anyone but the patient and my partner in the truck at a scene like that.


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## Bosco578 (Sep 14, 2008)

Why the H-Double tooth picks is he in the unit to begin with?  As far as what to do, your kinda SOL at this point. Play it cool until you arrive at the hospital and as soon as you can speak to the LEO that is following, let him/her know.

Do you have any type of 10 code to tip dispatch off?


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## DenverEMT (Sep 14, 2008)

The only 10-code that is used in our system is "code 4" which is scene safe/are you ok?

I agree that the guy should have never been allowed to ride in, but our protocols and company policy does allow one family rider to be up front, but that's totally up to whoever the crew is.

In this case, apparently one of the firefighters pushed his "emergency button" on his radio. There was nothing suspicious to hear during the open mic phase that we have when we push the button, but when the dispatcher asked if he was "code 4" he simply said "that's negative". The outcome was just fine and thank god nothing happened, but still very scary


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## MMiz (Sep 14, 2008)

You don't have any system-wide code that you use?  I worked in private EMS and we had a code word, though it wasn't a "10" code.

I would have notified PD via my prep/portable radio, but most likely I wouldn't have it in back.  Fortunately one of the fire folks would.  After letting PD know, I'd ask my partner to pull over so I could assess vitals, and let the PD do their job.  I'd feel like crap if I didn't do something and something happened to my partner.

A few things:
1.  No one rides up front on those type of calls.  They either follow behind in their vehicle or PD can transport.
2.  With many calls, PD will quickly search personal belongings before letting a patient into the ambulance.  Once in, we separate a person's personal belongings from the patient/person.  Patient is on the cot while the personal belongings are behind their head or up front.
3.  I almost always searched shady characters, though most of my transports were psych patients.  We did a lot of hospital to psych facility transfers, and they almost always had to change back into their street clothes.  When security gave me the bag, I'd simply ask the patient if they didn't mind if I quickly went through their stuff to make sure they got everything back.  I told them that I wanted to make sure they didn't leave and then realize they left something.  I'd much rather have an incident in a hospital with security around then in the back of my rig.  I never had an issue, and actually found some small stuff (pocket knives, etc.).


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## rhan101277 (Sep 14, 2008)

I wanted to give this a shot, since I am in class.  I would communicate with the hospital as to what was coming in.  I would carry on as usual in route to the hospital.  I think it would be very dangerous to communicate over the radio about your thoughts that the suspect might be the front seat.  Also I am not so sure about the mental status of the female and if what she is saying is true.  If i was suspicious I would communicate my suspicions to law enforcement after arrival at hospital.  The police are going to be there anyhow to question her etc.


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## boingo (Sep 14, 2008)

What was the fire sent for?  I can understand sending them to a medical arrest if they have o2/saed, but a shooting?  I guess they need to get the run numbers somehow....


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## Scout (Sep 14, 2008)

Driver pull over, can you give us a hand whith the vital check NOW.

               he gets out after pulling in

PD pulls in behind.

               open door and inform PD

They move up and now have the boyfriend in the front on his own. if you want they could ask him to come out and"help" he's now out of the cab with PD kaking care of him, you hop back in and away

??


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## EMTCop86 (Sep 14, 2008)

Scout said:


> Driver pull over, can you give us a hand whith the vital check NOW.
> 
> he gets out after pulling in
> 
> ...


 
I was thinking along the same lines


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## Blacke00 (Sep 14, 2008)

Scout said:


> Driver pull over, can you give us a hand whith the vital check NOW.
> 
> he gets out after pulling in
> 
> ...



With the information given, this might tip him off that you suspect something...too risky IMHO.

He knows how critical the patient is, mainly by how fast you got her loaded and rolling. Not to mention he's the one that inflicted the injuries.

Also, you'd now have 2 firefighters and your patner in the back with you, why would he chill in the cab, as opposed to following along?

I'd think, as others have said, either use your system's "10-" code or code word, call it in "off-line" via cell phone to dispatch and ED, or hold it til you arrive...

Kevin


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## Sasha (Sep 14, 2008)

Honestly? I would pee my pants.


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## Jon (Sep 14, 2008)

I don't bring family along if the patient isn't near stable. I don't want a 3rd party along up front while I try to drive emegently and communicate with my partners in the back.


PD can transport them if needed in a case like this, otherwise they get to follow behind.


That said - if I was in the back: If I had law enforcement following me, I'd think about getting my driver into the back to help me with something (like CPR) while making the LEO's aware of the situation.

Beyond that, my only other option would be to call dispatch and get them in on the deal. At work, I'd be VERY concerned about this, because our vehicle radio scans the police channels - if anything was said on the police channel, we'd be in trouble.

Jon


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## mycrofft (Sep 15, 2008)

*If you were slack enough to let someone ride with you...crikey!!*

Letting anyone other than your team or certified FD or LE with a JOB to do there into the vehicle at a crime scene is just plain Darwinian dumb, you may have killed someone that way.

Scout has it right basically. _Get trail car's attention_ (flashlight signals, throw stuff, anything), then wait for or initiate a _stop_ and everyone runs out, leave the back doors open, toss chocks in front of tires if you have the time, but _get out and away_. The driver and the pt may be left behind, but by stopping the vehicle and reducing the number of potential hostages you have just made the police's job much easier and the bad guy's immensely tougher. If he brandishes a weapon, run away, you will be a lot harder to hit and this will expand the territory he will have to try to control. Someone aggressive enough or crazy enough to get into your unit is not going to follow rules of polite society, so don't try to "fool" him, GTFO, and save yourself. 

You should have a duress plan, in case the patient goes off or someone somehow gets into your unit, front or rear compartment, but prevent it! Lock it, post someone to watch or leave the lights on and engine running, look inside before you mount up, but NEVER take riders.


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## AnthonyM83 (Sep 15, 2008)

Use your cell phone to communicate to dispatch/PD who the shooter is. No action should be taken (like pulling over) until everyone else is out of the ambulance (both to protect yourself and prevent patient treatment delays).

If there was no partition to the front, I would text message to a co worker to contact dispatch/PD.

I've never had anyone other than LE ride in on a GSW, though...


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## BossyCow (Sep 15, 2008)

We have a cell in the back of the rig that we use to contact the hospital. I would probably use that to contact dispatch, since any radio transmission would be heard by the passenger in the front. In a case like this, LEO is generally in a patrol car directly behind us. I would probably have dispatch get law enforcement to call us on the cell, and explain it to them.

This is really touchy since the guy in the front seat has proven his instability already today. I would want to be really sure that whatever is done would not put EMS at risk or the pt at further risk. 

So, we have no idea if the guy sitting next to our driver is armed or not? This call would definitely have a high sphincter factor!:sad:


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## onwego (Oct 12, 2008)

Well after I would recover from crapping in my pants, I would have to go along with the idea of maybe contacting the PD or ED about the situation on a cell phone and then just playing it cool until you arrived at the hospital and everybody had vacated the ambulance.


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## traumateam1 (Oct 12, 2008)

I would advice dispatch via phone of a 10-33. Unit needs immediate assistance, in immediate danger. I would tell dispatch what the p/t said, our situation and get them to contact police and have additional units to respond to the hospital. Make sure the following unit knew of our situation. I don't know how I would get ahold of the drivers attention and advise the driver one way or another. 
If the shooter in the front started to get out of control, I would hope the driver would pull over and get out of there safely. 
Continue to the hosp. because the p/t is still in need of doctors. However first rule of EMS: Our safety. 
This situation does not have a definite answer, as do many EMS questions.. it would be a "play it by ear".

I guess the first step is prevention. In these kinda calls do not allow anyone in the front of the ambo, regardless. Put them with the LEO and explain (quickly) that you cannot have them in the ambulance. 

Remember: *Scene safe*. 

Stay safe!


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## ILemt (Oct 14, 2008)

Luckily this situation wouldn't exist in my area: No passengers are permitted anytime the unit rolls "hot" 

Now i_ have_ had a rival gang member try to approach a scene with a weapon to kill my pt, for that you have PD and... And K-9's


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## csly27 (Oct 14, 2008)

hmmmm. I thought it was the ex-husband that did shooting? Is it wise to attempt to pull over with a pt that has multiple shots If they really do not need to for other interventions.. As long as the boyfriend has no idiea that you think he is suspect. I would call ahead and inform receiving hospital of the info and just get pt to trauma center as quick as possible. Also you said 2 fire guys rode along with right? if things go to hell in a hurry you can always have one of them restrain him. Sorry if I missed anything I still a student.


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## MMiz (Oct 14, 2008)

csly27 said:


> hmmmm. I thought it was the ex-husband that did shooting? Is it wise to attempt to pull over with a pt that has multiple shots If they really do not need to for other interventions.. As long as the boyfriend has no idiea that you think he is suspect. I would call ahead and inform receiving hospital of the info and just get pt to trauma center as quick as possible. Also you said 2 fire guys rode along with right? if things go to hell in a hurry you can always have one of them restrain him. Sorry if I missed anything I still a student.


I know what you're saying, but I don't think that delaying patient transport really was in anyone's mind when they replied.  The most important thing as an EMT is your safety, followed by your co-worker's safety, followed by the patient's.  A dead or injured driver isn't going to be of any help.


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## csly27 (Oct 14, 2008)

I get that your safty and that of your partner is first and formost. That is one of the very first things that we are taught. But if you can get pt transported with out suspect realizing that he is a suspect, wouldent it be better to try and avoid conflict untill you do have the back up that is needed?


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## DT4EMS (Oct 15, 2008)

This call is not unlike hundreds that go on daily throughout the US and the UK when it comes to EMS. Truth is.......... most EMS providers are injured on "Safe Scenes".

Those of you that are blessed to work in services that don't allow family members to ride well......... God Bless You. That is not a reality in many systems.

As far as the suspect and victim "lyin" about the incident........... come on........... you're joking right............. I mean, no one lies to EMS. (Serious sarcasm intended)

I am glad it worked out.


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## Sasha (Oct 15, 2008)

You know what would really just suck? Is if the guys in the back had forgotten their cells that day and couldnt make an off air call or text.

(Thats how my luck would go. The one day I really need my cell at work, I forget it.)


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