# Scene safety, what would you do?



## TransportJockey (Dec 21, 2010)

This is based on a real call I ran a few weeks back that got me a written complaint. I'll tell ya'll what I did after I get some feedback.

You and your partner (both EMT-Is) are dispatched out to a bee sting. You're the only truck in the county at the moment and the nearest backup is 40 minutes away from a BLS service. You have a VFD available within 10 minutes, but there are no EMTs with that VFD. 
Weather: Typical mid December day: mid 70* weather, clear, some gusty winds.
Fully stocked ALS bus.

Get on scene to the bee sting, and see two kids laying on the ground. There are bees flying around all over. Looking around you see a large stick next to the kids and a broken hive on the ground. Kids appear to still have chest rise that you can see from the front seats of the bus

What do you do?

Oh, and for the purpose of this call, you and your partner are both literally deathly allergic to bee stings, and are wearing short sleeve uniforms with no jackets in the bus.


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## JPINFV (Dec 21, 2010)

jtpaintball70 said:


> This is based on a real call I ran a few weeks back that got me a written complaint. I'll tell ya'll what I did after I get some feedback.
> 
> ...
> 
> Oh, and for the purpose of this call, you and your partner are both literally deathly allergic to bee stings, and are wearing short sleeve uniforms with no jackets in the bus.



No PPE and both providers deathly allergic? Well.. bye until the fire department arrives. (on a side note, I always carry my jacket in the ambulance, regardless the weather).


Minus the allergy, access to rope? Run in, wrap the feet, and pull.  Alternatively, there's the fire extinguisher.


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## mc400 (Dec 21, 2010)

Get epi ready for yourself and your patients and man up and get the kids. Drive up as close as possible one gets out and tosses kids into the bus and the start working on yourself if needed and your patients lol. Gotta risk a lot to save a lot. I work for a FD but we have our own rescue ambos. In this situation I would have access to turnouts, mask, scba etc so hopefully I never have that problem. What did you do?


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## abckidsmom (Dec 21, 2010)

Tough call.  Bees are generally not going to sting you unless you are aggressive with them.   It could be that they are over the act of aggression that was the kids breaking the hive.  I would probably get out to assess the behavior of the bees, and likely end up going in and getting the kids out.

Thinking hard here, I'd probably put on the isolation gowns in the truck and maybe even drape a pillowcase around my head and neck to keep them from getting in the shirt. I'd take a sheet to drag the kids out on, and not bring them into the truck without stripping them, because they're going to have bees in their clothes, likely.

But I'm a risk-taker in general.  Maybe draw up the epi before I go, times 4, just in case.


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## TransportJockey (Dec 21, 2010)

JPINFV said:


> No PPE and both providers deathly allergic? Well.. bye until the fire department arrives. (on a side note, I always carry my jacket in the ambulance, regardless the weather).
> 
> 
> Minus the allergy, access to rope? Run in, wrap the feet, and pull.  Alternatively, there's the fire extinguisher.



Our jackets were at the station, since we don't post. We generally leave everything that we don't need on a call there


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## Mobey (Dec 21, 2010)

mc400 said:


> Get epi ready for yourself and your patients and man up and get the kids



I knew you were FD based as soon as I read that sentence.


You are of no help if you yourself are in anaphylaxis. For those of you saying to inject yourself with epi, and keep treating the kids I have 2 questions.

1) Have you EVER dealt with a true anaphylaxis??

2) Basic scene management -
Who is our highest priority?

A) The patient
B) Yourself and your partner
C) Bystanders


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## abckidsmom (Dec 21, 2010)

Mobey said:


> I knew you were FD based as soon as I read that sentence.
> 
> 
> You are of no help if you yourself are in anaphylaxis. For those of you saying to inject yourself with epi, and keep treating the kids I have 2 questions.
> ...




This is not a definite risk though.  It's possible to be around bees and not be stung.  It's all about limiting skin exposure and remaining calm with slow, careful movements.  With the standard equipment on an ambulance, it's possible to cover almost all of your skin.

Standard bee behavior means that they would be calming down by the time the ambulance got there.


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## silver (Dec 21, 2010)

abckidsmom said:


> Standard bee behavior means that they would be calming down by the time the ambulance got there.



Texas is Africanized bees area. Not so sure if I would have gotten out of the truck, without thinking of a good plan.


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## 8jimi8 (Dec 22, 2010)

Post and wait for fire/rescue.  You cannot perform as a HCP if you yourself are a patient.  Me personally, not allergic so I'd get he limited Ppe  and drag the kids out.  I've walked into a swarm of angry bees without being stung.


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## Fox800 (Dec 22, 2010)

We had a similar scenario a few years back. Car crashed into a tree with thousands of Africanized bees swarming, driver was DOS. Several providers got stung, one had to be transported if I recall correctly. FD eventually had to don level A HAZMAT suits to do work if I remember correctly.


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## mc400 (Dec 22, 2010)

Mobey said:


> I knew you were FD based as soon as I read that sentence.
> 
> 
> You are of no help if you yourself are in anaphylaxis. For those of you saying to inject yourself with epi, and keep treating the kids I have 2 questions.
> ...



LOL, I knew that would be coming, fourtunately I would have the equipment needed with me and not have to wait for fire to show up and watch the children possibly die, sometimes fire based is good right , we don't have to wait for the hero's to show up....j/k. Yes I have dealt with anaphylaxis before on several occasions. And yes I know that in the scene safety thingy my safety is first, but you risk a lot to save a lot. I would have a really hard time at least not giving it a shot. 

This raises a few concerns for me. If you are in an area with the possibility of bee attacks you should have some sort of ppe to deal with it. Waiting for mutual aiod from far away is not acceptable. We are in the life saving business, be prepared. 

And in the scenario the VFD does not need emts to turn out and start laying out a protective fog foan stream. Call for them asap!

There are very few times in a career where the risk a lot to save a lot protocol can make a difference. This is one of them.


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## b2dragun (Dec 22, 2010)

I would take a minute to think about it, get the FD enroute.  If they get there quick have them suit up and get the kids, using their big garden hose to clear the bees.  If I have to go in I am putting on PPE and taping up the sleeves and neck.  I go in and my partner stays, one person should be able to drag a couple kids, you need one person completely safe.  I would try going it with nothing first, just playing it cool with the bees.  If they don't like that get the fire extinguisher.  I would prob bring some prefilled drugs with me in case I have to treat and leave.  It wouldn't be that hard to go in assess and then give drugs needed.

As long as there are bees on them they do not get in my box, treat it like any other contaminate.


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## nakenyon (Dec 22, 2010)

I think I would have requested FD to respond as they have TOG and SCBAs -- Especially as both you and your partner were deathly allergic. There is no sense in putting yourselves in danger. If you were to get stung, then you've got three patients instead of two. Just my .02.


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## Akulahawk (Dec 22, 2010)

Fashion an isolation gown and gurney sheets into a protective outer garment. Use tape to seal any openings. Don't forget to do the pant leg cuffs... heavy gloves if available, and tape some more. Move slowly non-aggressively, but purposely. Be ready to drag your patients out of the immediate area of the swarm. Once close to the ambulance, stop, pull out the scissors, cut patient's outer clothing off. Check yourself and partner for any bees... get moving. Oh, and make sure you're downwind. CO2 from your ambulance exhaust can drive bees nuts. And since you're in a bee area, kick yourself for not having bee-keeping stuff on hand at all times that the bees are active.

While getting suited up as quickly as possible, call for FD and have them put a water fog out to provide a further barrier against the bees. The idea is that while the VFD is doing the fog, you should be ready for the extrication. Move fast!


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## uhbt420 (Dec 22, 2010)

jtpaintball70 said:


> Kids appear to still have chest rise that you can see from the front seats of the bus


considering the fact that they are still breathing, i would call the fire department and draw up some epi.  i'm not going in there, sorry.  

the other option of improvising iso gowns, etc as protection is something i would consider if i didn't see chest rise.  frankly it would take just as long to suit up as it would for the FD to arrive.


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## lightsandsirens5 (Dec 22, 2010)

8jimi8 said:


> Post and wait for fire/rescue.  You cannot perform as a HCP if you yourself are a patient.  Me personally, not allergic so I'd get he limited Ppe  and drag the kids out.  I've walked into a swarm of angry bees without being stung.



This sounds like the most concise and logical answer. I am not allergic either, so I'm willing to take a few stings to get the kids. If I was allergic however, I'd have no choice but to wait for more help. FD in turnouts is probably going to be the best option in this case. 

Unless of course a bug exterminator happens to be working at the house down the street. If there is, get him to put on his bee suit and drag the kids out. (Just don't let him go spaying chemicals all over the place first!) B)


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## TransportJockey (Dec 22, 2010)

Nice to see the responses  What I did was put in a call to our chief who was about 15 minutes out, called VFD to come and hose things down, along with breaking out Epi 1:10 for IV and some 1:1 for IM if they're that bad and some Benadryl and laid it all out along with IV supplies in the back of our bus. We also called local animal control and asked if they had any idea about a bee keeping suit (they did and headed our way, but FD got there first).

We don't have any commercial bee keeping outfits near us that I know of, and yea we are i nthe middle of africanized territory so me and my partner were both wary. 

Pt outcome was good. Both patients started to have respiratory swelling by the time we got them in our bus but we some 1:1 Epi followed by IVs and 1:10 Epi and Benadryl solved it pretty well.


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## uhbt420 (Dec 22, 2010)

jtpaintball70 said:


> Nice to see the responses  What I did was put in a call to our chief who was about 15 minutes out, called VFD to come and hose things down, along with breaking out Epi 1:10 for IV and some 1:1 for IM if they're that bad and some Benadryl and laid it all out along with IV supplies in the back of our bus. We also called local animal control and asked if they had any idea about a bee keeping suit (they did and headed our way, but FD got there first).
> 
> We don't have any commercial bee keeping outfits near us that I know of, and yea we are i nthe middle of africanized territory so me and my partner were both wary.
> 
> Pt outcome was good. Both patients started to have respiratory swelling by the time we got them in our bus but we some 1:1 Epi followed by IVs and 1:10 Epi and Benadryl solved it pretty well.



u shouldnt have gotten a complaint.  scene safety is day 1 of emtb class.  discretion is the better part of valor in this job

as for the responses about putting on iso gowns and trudging heroically towards the victims... not to be rude but that's just a bad idea on so many levels

u did the right thing


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## Bosco578 (Dec 22, 2010)

Interesting call, why the complaint issued and by whom?


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## TransportJockey (Dec 22, 2010)

Bosco578 said:


> Interesting call, why the complaint issued and by whom?



One of the patient's mothers. For our delay on scene in getting to the kids. Just a complaint though, not a write up.


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## Aidey (Dec 22, 2010)

Frankly, if she wasn't willing to run in there and drag the kids out without PPE, why should you be? Now, if someone with proper PPE refused, I could see the issue, but you guys were not equipped at all.


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## Bosco578 (Dec 22, 2010)

jtpaintball70 said:


> One of the patient's mothers. For our delay on scene in getting to the kids. Just a complaint though, not a write up.


 
Sorry to hear that. Great Job on you and your partner though.B)


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## Melclin (Dec 23, 2010)

+1 on you doing the right thing. Even if with the various MacGyver solutions kicking around, I would never have a go at another healthcare professional for not wanting to put themselves at risk. I don't really identify with the emergency service thing that much, and I don't expect paramedics to put themselves in harms way like coppers and FF any more than I would expect a physio or an OT to. 

Assuming I was deathly allergic, I wouldn't go near them with a space suit and a fire extinguisher full of Raid. 

Realistically, I'm not allergic, we always have jackets in the car, as well as blankets, and I'm personally not that fussed by bee stings, so depending on the size of the swarm, I'd probably give running over and dragging them out with a blanket on my head a shot. 

But there is nothing worse than a Monday morning quarterback, as I suppose you guys would say.


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## amberdt03 (Dec 23, 2010)

I'd grab the fire extinguisher and use that. I've been told that it'll kill the bees, never seen it for myself though.


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## phideux (Dec 23, 2010)

With you guys being allergic, you did the right thing. Scene safety wasn't just the first day of EMT class, It has probably been mentioned just about every class day for the past 18 months. You 2 go in and the next crew to arrive has 4 patients to deal with, plus the bees.
Personally, I ain't allergic(I've been stung before). I at least have my Hi-viz jacket and rain gear on the bus. So does my partner. I'd throw it all on, both sets. We also have hard hats, heavy gloves, and goggles. We always have a dozen sheets and blankets in the back too. I could see myself wrapped up like a mummy trying to drag them out.
You just adapt to the situation, and do what needs doing. Sometimes that means waiting for additional resources.


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## jroyster06 (Dec 24, 2010)

Im not allergic so that would be a judgement call on my part whether or not to go in and try to scoop and swoop. If i was going to a bee sting case with 2 pedis, knowing me and my partner are allergic, i probably would have called for some additional resources enroute, you can always turn em around right? if you would have called at time of dispatch you could have cut the response from 15 min to 7 min for the fd. JMO sitting behind this computer at the station.


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