# Moral/Ethical Limits of Scene Safety



## steveshurtleff (Apr 20, 2011)

Ran a search for "scene safety", got over 500 hits, so am posting fresh.

Firstly, I know how much we have scene safety drilled into us during training, and why.  An injured EMT/Medic is of no use to anyone, and a burden to at least one other on a scene.

Secondly, I am not at all interested in being a "hero", nor am I a thrill-seeker.

That having been said, I am curious as to what situations, if any, would cause you to disregard the usual scene safety protocols in order to render aid to a patient.  This is likely one of those situations that can't really be answered without having it happen, but do you think there would be a case where you might put the patient ahead of yourself?

I can think of only one:  If a child or infant was in an unsafe environment and has a high probability of trauma but I believed I could get them to relative safety quickly to begin care, I would likely do so.  I'd accept some risk but am not sure I could handle doing nothing in the case of a little one.

What do you think might be your "line" when it comes to your own safety?


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## Sasha (Apr 20, 2011)

Not going to violate scene safety. If that infant is in danger, then you are also in danger trying to save them. If you get hurt, the patient has to wait even longer for care while another unit comes because you just incapacitated yourself.

Scene safety is of the utmost importance. Always.


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## steveshurtleff (Apr 20, 2011)

Sasha said:


> Scene safety is of the utmost importance. Always.



I'm not really questioning the value of keeping yourself safe, what I'm wondering about is the point at which your conscience might override it.

Just as an example, which is worse:  A fractured radius/ulna, or the memory of a lost child that you had a chance of helping?


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## Aidey (Apr 20, 2011)

Why does it have to be a child? Do you honestly think that changes anything? Well, anything aside from how easy they are to carry compared to someone older.


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## Sasha (Apr 20, 2011)

steveshurtleff said:


> I'm not really questioning the value of keeping yourself safe, what I'm wondering about is the point at which your conscience might override it.
> 
> Just as an example, which is worse:  A fractured radius/ulna, or the memory of a lost child that you had a chance of helping?



If you've got a fracture you are useless to the child and are further delaying care... That's a fairly easy concept.


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## steveshurtleff (Apr 20, 2011)

Aidey said:


> Why does it have to be a child?



That's an excellent question, and to be honest, I'm not sure I have a good answer for it, except that I do have a soft spot for kids, much more so than for other age groups.  Maybe that's a failing on my part, but that's just how I feel.


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## Sasha (Apr 20, 2011)

I have a soft spot for elderly, especially the demented. Not for kids, strangely enough. Most of them are little brats.


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## steveshurtleff (Apr 20, 2011)

Sasha said:


> If you've got a fracture you are useless to the child and are further delaying care... That's a fairly easy concept.



You do have a very valid point, and I'm not going to try to debate it - I would lose, plain and simple.  This thread really isn't intended to start an online argument.  It's about the level of risk, if any, you'd find acceptable for patient care.


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## Sasha (Apr 20, 2011)

steveshurtleff said:


> You do have a very valid point, and I'm not going to try to debate it - I would lose, plain and simple.  This thread really isn't intended to start an online argument.  It's about the level of risk, if any, you'd find acceptable for patient care.



I don't see it as an argument, more as a discussion.

There is no level of risk I would take for a patient because taking that risk has the potential to further delay care than it would have if you'd just stay put and wait the proper resources to either bring the patient to you or safe the scene.


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## steveshurtleff (Apr 20, 2011)

Sasha said:


> I don't see it as an argument, more as a discussion.
> 
> There is no level of risk I would take for a patient because taking that risk has the potential to further delay care than it would have if you'd just stay put and wait the proper resources to either bring the patient to you or safe the scene.



I have no doubts that you're not the only one who feels that way.


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## medic417 (Apr 20, 2011)

Sasha said:


> I don't see it as an argument, more as a discussion.
> 
> There is no level of risk I would take for a patient because taking that risk has the potential to further delay care than it would have if you'd just stay put and wait the proper resources to either bring the patient to you or safe the scene.



But there is a problem with  your argument Sashisha.  You actually do take a risk every time you go to a patient, in fact multiple risks.

1. You might fall or have another accident while getting to the ambulance.

2. You might get in a wreck on the way to the patient.

3. You might fall while going to the patient.

4. Patient might cough on you and give you some weird death dealing disease.

5. Your sweet little dementia patient might go Bruce Lee on you. 

6. on and on and on I could go but I think you see that you do take some risks as there is no such thing as a completely safe scene.


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## Sasha (Apr 20, 2011)

> 5. Your sweet little dementia patient might go Bruce Lee on you.



Those are my "favorite" kind. 

Of course there are risks with everything, you can't be an EMT/Paramedic and live in a bubble, but there is a difference from reasonable risks and knowingly taking on extra risks that put you in more danger than you would be normally.


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## steveshurtleff (Apr 20, 2011)

medic417 said:


> You actually do take a risk every time you go to a patient, in fact multiple risks.



That's true, but the same could be said for getting in the shower.  We take a risk by getting out of bed or driving to work/school, but those actions aren't a deliberate move into a known dangerous area so much as a deliberate move into a potentially dangerous area.


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## Aerin-Sol (Apr 20, 2011)

steveshurtleff said:


> This is likely one of those situations that can't really be answered without having it happen, but do you think there would be a case where you might put the patient ahead of yourself?



In the very unlikely event that my patient was someone very close to me, my concern for them would probably overwhelm my rationality/training, but there's no situation in which I'd enter an unsafe scene for someone I don't know.


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## HMFD166 (Apr 20, 2011)

Aidey said:


> Why does it have to be a child? Do you honestly think that changes anything? Well, anything aside from how easy they are to carry compared to someone older.



I may be more likely to toe the line in the case of a child.  From my perspective as a parent I think it does make a difference whether or not a child is involved.


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## STXmedic (Apr 20, 2011)

If it's for a fellow EMT/Medic/Firefighter/Police Officer, then I would be more lax with scene safety. Right or wrong, I consider them family.


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## HMFD166 (Apr 20, 2011)

Ultimately we are discussing a theoretical line....

I mean I would never neglect BSI considerations, regardless of the victim's age, but I might accept a higher level of risk if the victim is a child and in imminent danger of sustaining greater injury.

I think there is a difference between increased risk and carelessness... and Im not advocating that doing so is the intelligent thing to do, but it may be something that occurs instinctually.

I am a firefighter currently in EMT training so I am speaking from my firefighting experience which may differ from the experience of others.  We are likely to arrive at a scene in full PPE, even when acting as an EMT, so perhaps its not an apples to apples comparison.  But I can add that even as a passer by, I would be much more likely to intervene in a situation where a child is at risk.


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## HMFD166 (Apr 20, 2011)

PoeticInjustice said:


> If it's for a fellow EMT/Medic/Firefighter/Police Officer, then I would be more lax with scene safety. Right or wrong, I consider them family.



I agree.  They would likely be the other exception (besides children)


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## Veneficus (Apr 20, 2011)

Scene safe is a relative term.

In EMS education there is a focus on "scene safe" but the only examples are grossly unsafe scenes to start with. Good for testing, not good for reality.

Scenes are fluid, they can be safe one minute and unsafe the next. 

Either way, the most dangerous scenes are the ones where providers don't recognize the danger. 

What is dangerous for let's say somebody with only EMT training and a technical rescue trained firefighter are very different.

I have noticed *most* non fire trained EMS providers often don't know what is safe or not at the scene of an MVA. 

One of the most unsafe practices I see being taught in EMS classes is to climb into a car to hold c-spine. The provider is basically trapped with no form of rapid egress and usually facing with oncomming traffic behind them.

They take no notice of airbags, liquid spills, etc. (I have actually seen "senior" 3rd service EMS providers drive through and park in) 

Perhaps my favorite though is when they pull face into a driveway. That way should the scene become hostile, they might already be blocked in, and can run for it on foot.


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## usafmedic45 (Apr 20, 2011)

> That having been said, I am curious as to what situations, if any, would cause you to disregard the usual scene safety protocols in order to render aid to a patient. This is likely one of those situations that can't really be answered without having it happen, but do you think there would be a case where you might put the patient ahead of yourself?



My *** before anyone else's with the exception of my fiancee and my daughter.  Other than that, I've stood by and listened to and/or watched people die before because I don't have any way of getting to them and have no qualms about doing so again.


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## DarkStarr (Apr 20, 2011)

Police need to clear the scene first.  If I happen to be on scene when it gets dangerous, well then, thats why you always place yourself with an out.  If you can safely extricate the patient, then do so, but I do not consider it abandonment if someone shoves a shotgun in my face and I book it.

That said, we had the police clear the scene once on a GSW, and the irate mother went down to the basement and brought up a rifle and started waving it around.  Police didnt do so well with that one, fortunately, the Medic diffused the situation very quickly cause myself and the other EMT were lookin to abandon ship.


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## abckidsmom (Apr 20, 2011)

Everything carries inherent risk.  I am willing to weigh the risks/benefits of action and inaction and act when a little more risk will have a big benefit.  It's a very case-by-case judgment call, and not everyone will make the same decision on the same scene.


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## BEorP (Apr 20, 2011)

As others have pointed out, safety is relative. Has anyone ever gone to an MVC and gotten into a vehicle with a patient where the airbags had not deployed? That can be quite risky there, but if fire has not yet arrived and your patients is trapped and needs care, maybe it is a risk worth taking.


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## Veneficus (Apr 20, 2011)

BEorP said:


> As others have pointed out, safety is relative. Has anyone ever gone to an MVC and gotten into a vehicle with a patient where the airbags had not deployed? That can be quite risky there, but if fire has not yet arrived and your patients is trapped and needs care, maybe it is a risk worth taking.



Just be aware of double stage airbags in some vehicles. 

Even if they are deployed they have the ability to deploy again.


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## firetender (Apr 20, 2011)

*It's an "in the moment" thing*



abckidsmom said:


> Everything carries inherent risk.  I am willing to weigh the risks/benefits of action and inaction and act when a little more risk will have a big benefit.  It's a very case-by-case judgment call, and not everyone will make the same decision on the same scene.



To add to this...

Chances are, if you take the time to think it out and choose, you probably won't end up taking action. In stuff like this you find yourself in the middle of this _*moment*_. 

You take in a whole bunch of information at once. Once you determine if someone's life is in danger, and to a significantly influential degree register that that life means something to you (for whatever reason) an almost instantaneous chain reaction occurs. You DO assess scene safety, exits and whatnot and if you're any good as a medic it's not something you think about and analyze; it just happens.  _*

I think the dominating factor is you recognize an opening and somewhere decide that it's now or never and you choose NOW!*_

That's how Heroes get here; they find themselves in a _*critical moment*_ and act. There's usually not a whole lot of thinking going on. Inside, their computer crunched all the data and came up with "GO!" so they went.

...and, yes, there are those who missed something or didn't have the smarts to figure and they end up nominated for the Darwin Award! 

To answer the OP's original query of 


> what situations, if any, would cause you to disregard the usual scene safety protocols in order to render aid to a patient.


It's not about regarding or disregarding; it's about the assessment of risk balanced against the perceived need for action divided by your ability to live with yourself if you chose to *not *act.

Actions like this either happen, or they don't.


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## Shishkabob (Apr 20, 2011)

It's a case by case basis with me, and no one else, making the final determination. 

What we do has inherent risks, some more so than others. Working an MVC is already one of the most dangerous things we do, and hardly anyone thinks twice about it on scene.

I won't go near the front seat of a car if the airbags haven't deployed yet....thats what firefighters are for


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## Veneficus (Apr 20, 2011)

Linuss said:


> I won't go near the front seat of a car if the airbags haven't deployed yet....thats what firefighters are for



You didn't think many firefighters have helmets or turnout gear that is remarkably the same color as a canary was a coincidence did you?


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## JPINFV (Apr 20, 2011)

Veneficus said:


> Scene safe is a relative term.
> 
> In EMS education there is a focus on "scene safe" but the only examples are grossly unsafe scenes to start with. Good for testing, not good for reality.
> 
> ...



This. ^

What's too dangerous is fluid and varies from person to person depending on experience, training, and knowledge and available equipment. Outside of grossly dangerous scenes (which are relatively rare), it's impossible to say where that line is.


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## mycrofft (Apr 20, 2011)

*Sometimes you find yourself up to bat, so to speak.*

You're there, you're with the pt, and things start to close in. You do what you were trained to do then get out.
It is also easy to think you are being a hero, when the situation honestly does not demand it.
Either or any way, you may find yourself an unemployed hero, and maybe even an injured one without work comp because you took risks.


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## the_negro_puppy (Apr 20, 2011)

Everyone has different values which might determine their actions/ exposure to risk.

My job is just that- a job. There are risks involved but I want to go home at the end of the day. Some people may call me selfish, but I value my life higher than that of a strangers, be it a baby, child or adult.


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## VFlutter (Apr 21, 2011)

I agree that it is natural for a person to perceive an Infant or child’s life to be more valuable and work extra risk or effort. However there are so many cases where this type of thinking has resulted in the death or injury of EMS providers. One life is not working risking running your career and or life. Think about how many people you will have the opportunity to help or save in a career. An example of this is the story I saw recently about a police officer (I think, maybe an EMT) who performed mouth to mouth on a 3 month old baby and contracted an infection which caused his death.


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## Sasha (Apr 21, 2011)

Actually I'd think a child or an infant is less valuable. They contribute absolutely nothing to society.


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## mcdonl (Apr 21, 2011)

usafmedic45 said:


> Other than that, I've stood by and listened to and/or watched people die before because I don't have any way of getting to them and have no *qualms *about doing so again.



qualms plural of qualm (Noun) 1. An uneasy feeling of doubt, worry, or fear; a misgiving.

I would have qualms about it. I would do it again, and again but I would always be uneasy and have misgivings about watching someone die. I hope to never get to the point where only two lives on this planet cause me misgivings when they die.


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## steveshurtleff (Apr 21, 2011)

Sasha said:


> Actually I'd think a child or an infant is less valuable. They contribute absolutely nothing to society.



That's only because, as infants or children, they haven't yet had the chance to.


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## Sasha (Apr 21, 2011)

steveshurtleff said:


> That's only because, as infants or children, they haven't yet had the chance to.



But they still don't contribute to society in the least. Some elderly can contribute, they can work at grocery stores and crap like that. Kids don't. Ask Vene about some plan to save only teens and adults. Heartless but it makes sense


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## MediMike (Apr 21, 2011)

Sasha said:


> But they still don't contribute to society in the least. Some elderly can contribute, they can work at grocery stores and crap like that. Kids don't. Ask Vene about some plan to save only teens and adults. Heartless but it makes sense



Agreed. Treat 'em all the same. Unless you're going for that front page story BS.  And all that ends up in is having to buy the crew beer. No one wants to do that. You start treating certain patient demographics as "special" or deserving of better/more advanced care you're screwing up the job.


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## Smoke14 (Apr 21, 2011)

MediMike said:


> Agreed. Treat 'em all the same. Unless you're going for that front page story BS.  And all that ends up in is having to buy the crew beer. No one wants to do that. You start treating certain patient demographics as "special" or deserving of better/more advanced care you're screwing up the job.



Agreed.

Anyone who has served in a combat situation can carry out triage properly and correctly for the most part. Those that have not served let emotions cloud their judgement.

On a side note, air bags will not and can not deploy if the ignition switch is turned off.


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## medic417 (Apr 21, 2011)

Smoke14 said:


> On a side note, air bags will not and can not deploy if the ignition switch is turned off.



Actually they can.  Electrical current can be directed their way in other ways.  Odds are no but it is wrong to say they will not/can not.


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## Aidey (Apr 21, 2011)

Smoke14 said:


> Agreed.
> 
> Anyone who has served in a combat situation can carry out triage properly and correctly for the most part. Those that have not served let emotions cloud their judgement.
> 
> On a side note, air bags will not and can not deploy if the ignition switch is turned off.





medic417 said:


> Actually they can.  Electrical current can be directed their way in other ways.  Odds are no but it is wrong to say they will not/can not.



I don't think I have it anymore, but I used to have this great chart that listed airbag deployment times by manufacturer. It listed how long after the ignition had been turned off that the air bag still had the power to deploy. Almost everyone cuts off at 2 minutes, Lexus was at the top of the pack with 10 minutes.


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## CAOX3 (Apr 21, 2011)

Sasha said:


> Actually I'd think a child or an infant is less valuable. They contribute absolutely nothing to society.



This is quite disturbing.

Considering most of their injuires are the fault of some more "valuable" member of society.

Ridiculous.


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## Sandog (Apr 22, 2011)

CAOX3 said:


> This is quite disturbing.
> 
> Considering most of their injuires are the fault of some more "valuable" member of society.
> 
> Ridiculous.



I am with you on this one.


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## Sandog (Apr 22, 2011)

For some, there can come a time in their life where they must grapple with a life altering choice. This is the place where gut checks occur, a test of your humanity takes place, the moment in time where a no-name private earns the medal of honor. 

The decision you make can alter all that you are; It can haunt you, kill you, or make you reach a self discovery.

In this discussion, I am reminded of a true story and I would like to share this story.  Some time ago there was this horrible wildland fire. Fire crews were being overran and forced to retreat. During the retreat a female fire fighter saw two stranded hikers about to meet their maker. She took the two hikers and moved them to a small clearance and she deployed her fire shelter along with the two hikers. What you need to understand is that a fire shelter is like a aluminum bag designed for one person to protect from heat. She laid on top of the hikers, deployed the shelter as the fire flared up and the O2 in the shelter must of been really thin. I think they endured an hour of intense heat, smoke, and lack of O2.

Both hikers lived, the female fire fighter suffered major burns on her back, but survived. She could have just looked the other way and ignore the hikers, but she did not, she put the safety of others above her own. 

I don't know about you, but stories like this inspire me.


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## Veneficus (Apr 22, 2011)

CAOX3 said:


> This is quite disturbing.
> 
> Considering most of their injuires are the fault of some more "valuable" member of society.
> 
> Ridiculous.



It's not all that ridiculous. 

In many societies around the globe, the child is the most replacable part of society.

In some cultures it is even the male who is considered the most important part of society as they strictly follow the tenents that only a male can work outside of the home.

When they have to choose who goes to the doctor or eats first it is always the male as only such can provide for the rest. 

Some would argue this is far removed from modern western society, but is it?

In some modern countries the maternity benefits for women are so desirable that companies find "other" reasons not to hire women in order not to lose the labor force.

Examples even exist in America where parents get credit under their children's names which the parents default on. Which basically ruins the childs credit for the gains of the adult.

Consider the roles of the parents in multichild families or where the father is the primary provider and the mother the primary care giver. Should either of the parents not be able to fulfil such roles, the whole family structure were to break down. However the loss of a child still preserves social order.

Interestingly enough, the value of children as lesser is also addressed in the guidlines for medical care in the event of a major disaster.

As food for thought, the loss of both parents will also equate to the loss of a child in many instances.


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## CAOX3 (Apr 22, 2011)

Ok.

But as a professional I dont value one member of society over another.  No one is more important then the other.

My personal beliefs, well Im a parent so guess where my priorities lie.


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## Sandog (Apr 22, 2011)

The children propagate the species and ensure our continued existence, I think Darwin had a point...


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## Combat_Medic (Apr 22, 2011)

Scene safety is a little different for me.  Hence why they issue me an IOTV (body armor), M4 carbine, and a M9 pistol.


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## Sandog (Apr 22, 2011)

Combat_Medic said:


> Scene safety is a little different for me.  Hence why they issue me an IOTV (body armor), M4 carbine, and a M9 pistol.



God bless you brother. I am ex military as well...


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## Combat_Medic (Apr 22, 2011)

Just thinking now.  Kinda messed up.  You shot my buddy, then I shot you.  Now I have to treat you and my buddy.


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## Sandog (Apr 22, 2011)

Combat_Medic said:


> Just thinking now.  Kinda messed up.  You shot my buddy, then I shot you.  Now I have to treat you and my buddy.



Of course you know, the guy that shot your buddy was doing what he was told, just as you would if you shot the enemy... After all, when all is said and done, we are all humans.


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## Combat_Medic (Apr 22, 2011)

I think we are about to open up a can of worms.  I just hate the idea of having to treat someone from wounds I inflicted.


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## Veneficus (Apr 22, 2011)

Sandog said:


> The children propagate the species and ensure our continued existence, I think Darwin had a point...



Only if they survive long enogh to reproduce.


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## CAOX3 (Apr 22, 2011)

Combat_Medic said:


> I think we are about to open up a can of worms.  I just hate the idea of having to treat someone from wounds I inflicted.



It must be tough to have to switch gears so quickly, be safe out there.


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## 18G (Apr 22, 2011)

First and foremost my goal is to come back home to my kids at the end of my shift. They are in the forefront of my mind and weigh in with every decision I make regarding putting myself at increased risk while at work. 

With that said, there is an inherent risk with the job we have all chosen to do. At some point we may be faced with a situation where our actions immediately determine if someone lives, dies, suffers, or ends up with life long disabilities. And as a primary principle our safety always comes first. But "safety first" is relative to our positions, training, and experience.  What I cold do relatively safely with a fire background, perhaps my partner could not. 

The decision to act needs to be a personal one in the context of the OP's scenario. That is it needs to be based on that EMS providers experience and cross-training.  If I pull up in the Medic unit first on-scene of a structure fire and have a person hanging out a second story window I may or may not attempt a rescue depending on what factors are involved. But I can't say that I wouldn't attempt to make entry and save that person's life. If it were my girlfriend, son, or daughter hanging out that window I be damned if I want someone saying, "well scene safety, I can't even try to save their life, too bad, so sad".... um... no. 

As Vene has said, it's not as easy as class where we can call "scene safety" and choose to do nothing all the time. If you feel you can "safely" carry out a rescue and have been trained for it and feel you will be risking a lot to save a lot, than that's your call and no one else should fault you for what ever decision you make.


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## 18G (Apr 22, 2011)

Sasha said:


> Actually I'd think a child or an infant is less valuable. They contribute absolutely nothing to society.



Wow is about all I can say to that statement. 

In my opinion, a child is vulnerable and depends on us for their existence and they deserve every chance at life. An elderly adult has already lived their life and experienced prob most of what life has to offer. A child hasn't. And that in no way is to say one life is more important than the next.

And you couldn't be more wrong. A child offers more to society than you can even begin to realize. Have a child of your own and you will understand.


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## Veneficus (Apr 22, 2011)

18G said:


> Wow is about all I can say to that statement.
> 
> In my opinion, a child is vulnerable and depends on us for their existence and they deserve every chance at life. An elderly adult has already lived their life and experienced prob most of what life has to offer. A child hasn't.
> 
> And you couldn't be more wrong. A child offers more to society than you can even begin to realize. Have a child of your own and you will understand.



I think you guys are really arguing 2 seperate things.

The emotional side of what a child represents is definately not the biological aspect of it.

In terms of sociological contribution, in order for a child to contribute anything in the future, it requires an intact society, basic needs of life provided, and opportunity.

Without such things a child is actually a burdon to survival and to society. So much so even human females stop ovulating because of environmental stress.

An adult, at least in theory can fend for itself to meet basic needs. It can also reproduce and provide basic needs for offspring.

Arguing emotional vs biological is pointless. Biological always wins in the long run.


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## cruiseforever (Apr 22, 2011)

Combat_Medic said:


> Just thinking now.  Kinda messed up.  You shot my buddy, then I shot you.  Now I have to treat you and my buddy.



If I shoot at something.  I shoot to kill.  If you are shooting to wound.  Why are you shooting?


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## Chimpie (Apr 22, 2011)

cruiseforever said:


> If I shoot at something.  I shoot to kill.  If you are shooting to wound.  Why are you shooting?



Let's keep this on the topic of whether or not to enter an unsafe scene and not turn it into a discussion on how to shoot.  If you have a specific question for a user please use the PM feature.

Sent using the Tapatalk app!


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## Aerin-Sol (Apr 22, 2011)

Sandog said:


> The children propagate the species and ensure our continued existence, I think Darwin had a point...



And with worldwide population decline and the looming threat of human extinction, that's a very important point.


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## MrBrown (Apr 22, 2011)

If Police have advised Ambulance the scene is unsafe or Ambulance Communications feels the Police are required the crew will wait for them.

Other than that we generally approach all scenes that we feel are safe, as we approach the crew are going to be looking for hazards, thinking about leaving gates unlocked or something like that.

We are lucky here we do not have to worry a lot about guns or gangs or things like that - yes, they are a fact of the environment and assaults and abuse against Ambulance Officers is getting worse.  

If Brown feels that Brown can safely approach and treat or extricate a patient without additional resources eg Police, Fire service, SERT (CBRN) and Brown's partner (Black) agrees .... then in we go


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## Sasha (Apr 22, 2011)

Sandog said:


> The children propagate the species and ensure our continued existence, I think Darwin had a point...



Actually only "children" who are of reproductive maturity, which aren't really children.

A 3 or 4 year old? Contributes nothing.


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## 18G (Apr 22, 2011)

Sasha said:


> Actually only "children" who are of reproductive maturity, which aren't really children.
> 
> A 3 or 4 year old? Contributes nothing.



A unique innocence and bond that a child brings into the world, the influence that has on adults which curtails behavior, and children who have saved their parents and others lives through having the intelligence to know how to recognize an emergency and call 911 is all just nothing?

You speak of children as if they are of absolute zero value. That's like not even human coming from any gender. Have a child of your own and you will see first hand the effect they have on you as a parent and in society. 

Back on topic... it really comes down to training and experience. Fire/Rescue/EMS is about selfless service to risk ones life to save another. It's part of the deal. Losing our life while performing our duty is the reality of what we do. And that is why we train and train hard to be prepared and mitigate the inherent risks as much as possible. 

A human life holds the highest level of value. Risk a lot, to save a lot is a core principle in this decision making. You can use the excuse of "me first" and standby while someone dies without even trying, or you can be trained to react and put ones self on the line for someone else. This is what is called selfless service. No it's not for everyone but I believe in going all the way and ask that you go all the way and do the same for my family and I as well.


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## Aerin-Sol (Apr 22, 2011)

18G said:


> A unique innocence and bond that a child brings into the world, the influence that has on adults which curtails behavior, and children who have saved their parents and others lives through having the intelligence to know how to recognize an emergency and call 911 is all just nothing?



If all children are special because of these reasons, then how are they unique attributes? 




> A human life holds the highest level of value.



Except, apparently, for the lives of people in EMS, which should be cheerfully sacrificed for others.



> You can use the excuse of "me first" and standby while someone dies without even trying, or you can be trained to react and put ones self on the line for someone else. This is what is called selfless service. No it's not for everyone but I believe in going all the way and ask that you go all the way and do the same for my family and I as well.



I don't know where you went through training, but the primary thing emphasized in mine was ensuring my own safety.


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## steveshurtleff (Apr 22, 2011)

Aerin-Sol said:


> Except, apparently, for the lives of people in EMS, which should be cheerfully sacrificed for others.



Nobody said anything about EMS members being less valuable than others or that their lives should be "cheerfully sacrificed for others".  Please refer to the first page and read the original post.


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## 18G (Apr 22, 2011)

Aerin-Sol said:


> If all children are special because of these reasons, then how are they unique attributes?
> 
> *They are unique as a group or an age population in comparison to adults. I didn't think I needed to spell out the context of that statement. *
> 
> ...



...


----------



## Aerin-Sol (Apr 22, 2011)

steveshurtleff said:


> Nobody said anything about EMS members being less valuable than others or that their lives should be "cheerfully sacrificed for others".  Please refer to the first page and read the original post.



Please read the post I was responding to. 



> If your a firefighter



If I was a firefighter I would be posting on a FF board, not posting on an EMS board and then typing 3 paragraphs about entering a burning building.


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## steveshurtleff (Apr 22, 2011)

Aerin-Sol said:


> Please read the post I was responding to.



I did.  Again, who said anything about cheerfully giving up your own life for another?

The topic of this thread is about the possible conditions under which you might disregard normal scene safety rules in order to provide care.  If the patient is at the bottom of a 500' cliff, nobody is going to blindly jump.  However, if there is a potentially injured child in a car that has been in a collision and FD/HR has not yet arrived, yet you believe you can get the kid out, would you not?


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## nemedic (Apr 22, 2011)

Combat_Medic said:


> Just thinking now.  Kinda messed up.  You shot my buddy, then I shot you.  Now I have to treat you and my buddy.



But unless the buddy is obviously a DOA, and assuming no other people w/ injuries, I'd treat the buddy 1st every time.(and I will freely admit this would be the case on the civilian side).

And for the tango, my 1st line treatment would be high velocity lead injection therapy. Failing that, an accidental air embolus


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## 18G (Apr 22, 2011)

Aerin-Sol said:


> If I was a firefighter I would be posting on a FF board, not posting on an EMS board and then typing 3 paragraphs about entering a burning building.



I was using the FF example to try and make a point that if you have the training and experience than use that in the decision making. I was also trying to illustrate that the decision in the field isn't as easy as the one declared in the classroom and many other factors play apart in deciding to provide care/rescue in a hazardous situation. Pretty much all I was trying to say is there is no real answer to the question posed and its not cut and dry. A lot of variables come into play from one situation or provider to the next. My bad if it didn't come across that way.

As an EMS provider, we are tasked with some rescue responsibilities (actually less than what we should be) and it is our job many times to make patient access and provide care throughout the extrication process whether it be a MVC, high/low angle rescue, confined space rescue, etc. How are we supposed to do this if we use the "scene safety card" and not subject ourselves to some risks? With more training and skills drills comes risk reduction. I would highly recommend all EMS providers to be cross trained in basic rescue techniques. 

Also, many EMS providers do have fire/rescue backgrounds so I was trying to be inclusive of all possibilities. If your also a FF on a Medic unit, do you only play Medic for the day or do you do what your trained to do? For most I think it would be do what your trained to do. And even if not trained as a FF I would still say play it safe and err on the side of caution but give it your best effort and at least make the attempt.

Those looking to eliminate all risks and never go above and beyond the basic duty should probably look for a new job. 

That's just my opinion.


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## steveshurtleff (Apr 22, 2011)

18G said:


> I was also trying to illustrate that the decision in the field isn't as easy as the one declared in the classroom and many other factors play apart in deciding to provide care/rescue in a hazardous situation.



That's what I meant by possibly not being able to answer without actually being in the situation.  It's like asking someone what they would do if they were aboard a plane that was about to crash.  Until you're there, the question can't be accurately answered, but my question was still hypothetical (Do you think you'd disregard the guidelines?).


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## Sasha (Apr 22, 2011)

> Those looking to eliminate all risks and never go above and beyond the basic duty should probably look for a new job.



Sorry I don't see anywhere in my job description that says I have to take stupid and extraordinary risk to save lives of the already sick/injured.

This isn't the military, I didn't get into this job with the expectation of laying down my life for something else.


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## 18G (Apr 22, 2011)

Sasha said:


> Sorry I don't see anywhere in my job description that says I have to take stupid and extraordinary risk to save lives of the already sick/injured..



We agree mostly Sasha. I don't feel EMS should take "stupid" risks either. But risks based on odds of a successful execution which are based on training and experience I think we should take if were risking a lot to save a lot. If we don't who will?

Is 911 no longer the number to call for rescue teams who are trained and willing to give their all to people in dangerous situations? If so I never got that memo.


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## Sasha (Apr 22, 2011)

Not me.

I'm not risking my life to save someone if that risk puts me in more than just the "normal" danger.


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## 18G (Apr 22, 2011)

And that is a personal choice that you nor anyone else should be judged for as long as you did not breach your duty to act. 

At the end of the day we all go to bed with the choices we have made that affect our lives and the lives of others.


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## Veneficus (Apr 22, 2011)

18G said:


> I think we should take if were risking a lot to save a lot. If we don't who will?



I would like to share with you a quote:

"A risk is a chance you take; if it fails you can recover. A gamble is a chance taken; if it fails, recovery is impossible."
---Erwin Rommel

"If we don't who will?"

I don't think anyone is obligated to.

The romantic ideas of what various emergency services do or are have very little basis in reality.

A flag and a wreath do not feed your family. A gravestone does not comfort them in their times of need.

Even when providers are lucky enough to survive, their lives and families are destroyed from their disability. In a few years even your coworkers will not remember you. Do you think any member of society is going to look out for the financial well being of you or your family after a failed attempt at heroism?

The evidence all points that they don't.

I hate to be the one to point this out, but it is this kind of romantic thinkking that gets people injured and killed needlessly. It should not be advocated.

Just as you will never find a fool who believes himself deficent, you will never find a would be hero who thinks they will fail because the situation is beyond them either.


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## Sasha (Apr 22, 2011)

Maybe your choices at work affect your life, but I don't take work home with me.


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## Gecko24 (Apr 22, 2011)

This one time I knocked a German Shepherd out with a mag light.  Ahhh good times.  Gotta do what you gotta do.


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## steveshurtleff (Apr 22, 2011)

18G said:


> But risks based on odds of a successful execution which are based on training and experience I think we should take if were risking a lot to save a lot. If we don't who will?



I agree completely.  The training is what prepares us to face that situation and possible increased risk rationally rather than foolishly, and yes, different positions obviously carry different training.  Like I said, if I believe I can get that child out of danger, I might do so.  But do I believe I can get the child out of a car that's already on fire?  Well, no, I don't.  That would be suicide.


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## firetender (Apr 22, 2011)

Sasha said:


> I'm not risking my life to save someone if that risk puts me in more than just the "normal" danger.



The way it happens is you're in the middle of a situation, you see an opening, you assess your risks and take action if all your computations come up go.

And then, out of nowhere (in your view anyway) BOOM! you're dead.

It doesn't matter what you missed or how you calculated or what actually occurred, behind you will be legions of medics saying to themselves and each other either you deserve a Purple Heart or you got what you deserved; a Darwin Award nomination!

My point is, once you figure out you're within the range of "just the 'normal' danger" it is the Unseen that determines your future or absence of one thereof.



Sasha said:


> Not me.



You are not in a job where that applies. You are a lightning rod for the twisted Gods. It's all about doing your best with the odds, and what you can live with.


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## DrParasite (Apr 22, 2011)

Seemed appropriate

http://www.ems1.com/safety/articles/998633-UK-medics-told-they-must-risk-their-lives/

http://www.9news.com/news/story.aspx?storyid=162817&catid=339

and 

http://www.wlbt.com/Global/story.asp?S=13191657

I'm reminded of a Rescue 77 episode (anyone else remember that show?) where there was an active shooting at the school.  so with everyone pinned down by gun fire, the three paramedics donned bullet proof vests, kept their heads down and ran to help the injured students who had been shot.

Me personally?  i don't want to get shot.  I don't want to get hurt.  I want to go home in the same condition I started my shift in.  Violent EDP in a house stabbing nuns?  wait till PD secures the violent person using the training and tools they have, and then I will help out the injured.  Domestic in progress, where one party is beating the other with their 1 years old son?   wait till PD secures the violent person using the training and tools they have, and then I will help out the injured.  

Without the proper tools, PPE, and training, it isn't brave to enter an unsafe scene to make a rescue, it's foolish and stupid.  an unsafe scene is an unsafe scene, regardless of who the victim is.  Let those with the proper tools, PPE and training make the scene safe, and then do what you are trained to do


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## 18G (Apr 22, 2011)

Veneficus said:


> "If we don't who will?"
> 
> I don't think anyone is obligated to.



Not even the FD? They should never enter burning buildings? Never enter confined spaces with who knows what kind of atmosphere? Never enter rushing water? It is the FD's job to train and practice for these hazards. It is why they take the job and is their obligation!

Not even the PD? They should never pursue or approach an armed gunman? They should never engage in a firefight? Never taken down an assailant? They should turn and run?

Not even our armed forces? They should not do all that they do? They should not patrol roads with potential IEDs? Engage the enemy? All because they may get killed? They do what they do because it is part of the job!

There is an obligation and duty to act. It has absolutely nothing to do with fantasy, playing hero, or romanticizing. Fire/Rescue/EMS/Law Enforcement are dangerous jobs and you never know what situation you may find yourself in. That's why we train to be able to handle the situation and work through it. 

A firefighter does not fight fire or search an apartment building engulfed in flames to be a hero. They do it because it is their job and obligation. 

A cop doesn't pull his side arm and fire shots to be a hero. It is his/her job. 

A Paramedic does not attempt to rescue a person entrapped in an auto or attempt to pull someone from a house fire to be a hero. They do it because it's their job and obligation. 

A Marine does not engage the enemy to be a hero. They do it because it is their duty and their job. 

RISKING YOUR SELF IS AN OBLIGATION AND PART OF THE JOB. YOU DO IT SAFELY, NOT BLINDLY AND IGNORANTLY. SOMETIMES WE DON'T ALL MAKE IT HOME AND THAT PART SUCKS. BUT WE SACRIFICE BECAUSE OF OUR LOVE FOR OUR FELLOW MAN AND STRIVE SO THAT THEY CAN LIVE AND CONTINUE WITH A FUTURE. JUST AS WE WOULD EXPECT THE SAME IN RETURN. IF YOUR IN A SITUATION WHERE YOUR GONNA DIE UNLESS SOMEONE ELSE PUTS THEMSELVES IN EQUAL DANGER, ARE YOU OKAY WITH THEM STANDING BY WATCHING YOU DIE? OR ARE YOU GONNA BE HOPING THEY HAVE THE TRAINING TO GET YOU OUT OF WHATEVER SITUATION YOUR IN?

ITS NOT ABOUT BEING A HERO. ITS ABOUT TAKING THE TRAINING AND SKILLS YOU WORKED YOUR *** OFF TO ACHIEVE AND PUTTING THEM TO USE TO SAVE ANOTHER'S LIFE. 

As FireTender basically said, it's a calculated risk based on all information available at the time. We can only hope when its all said and done that the math adds up and we end up okay. 

Has the world really turned that selfish where we no longer can support someone giving their all to aid another human being? Where we no longer expect our emergency services providers to put themselves in harms way to save another's life? That we just want to stand back and watch?

I would never ask someone to put themselves in a situation they are not trained to handle and have NEVER advocated that in this thread. Bottom line... if your trained, experienced, and based on your calculations you can carry out a safe rescue in spite of extreme hazards than you decide what your gonna do. Just don't tell someone else that they are foolish or stupid for putting forth the effort and skill to save someone else when the decision is of sound judgement based or training and professional experience.


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## Sasha (Apr 22, 2011)

It is selfish for the world to expect my family to go on without me because someone got sick or hurt. 

I'll give my skills and knowledge, but not putting my life in danger with extraordinary risks. You want to, that's fine, but stay off my ambulance.


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## HotelCo (Apr 22, 2011)

18G said:


> Not even the FD? They should never enter burning buildings? Never enter confined spaces with who knows what kind of atmosphere? Never enter rushing water? It is the FD's job to train and practice for these hazards. It is why they take the job and is their obligation!
> 
> Not even the PD? They should never pursue or approach an armed gunman? They should never engage in a firefight? Never taken down an assailant? They should turn and run?
> 
> ...



Where in there does it say something about EMS that isn't trained in extrication/fire fighting?


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## 18G (Apr 22, 2011)

HotelCo said:


> Where in there does it say something about EMS that isn't trained in extrication/fire fighting?



Your a Paramedic. Are you not tasked with a rescue responsibility? Your patient is trapped in an auto, under a building, in a silo, etc. How do you plan on getting to them to deliver the care they need at that point in time? The FD may not have EMS capability so it is up to EMS to be integral in the rescue operation and make patient access.  

Your patient is heavily entrapped in an MVC and needs their airway managed like now. Is it not your responsibility as the Paramedic to get in the vehicle and take care of it? Is it not partly your responsibility to coordinate extrication with the FD? What if the FD is taking forever because they are clueless or have no clue about the priority of the patient? 

Should we as EMS neglect our rescue responsibility? Rescue after all is totally patient driven since the whole operation is focused around a human being that we are responsible for. 

If your not trained in rescue to some degree I would highly recommend you get the training.


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## ffemt8978 (Apr 22, 2011)

Do I need to put this thread in a 24 hour timeout?


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## Gecko24 (Apr 22, 2011)

A old EMS axiom, watch your own *** first, or there will be no one around to treat the patient. 

Do not try and out hero the other person, that is only for TV.


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## EMTBHillbilly (Apr 22, 2011)

I'm new to EMS but I have a lifetime of experience with raising children, taking care of elders and general living.  I believe that as an Emergency Medical Technician, I might at some time have to put myself in some level of danger in order to safe another in an emergency situation.  I'm not a Fair Weather Medical Technician or a "Walk in the Park Medical Technician, I'm an EMERGENCY MT.  As such, I don't expect there to be no element of danger at times when doing my job.  
I get "scene safety," it's just that scene safe can be different from scene to scene.
Perhaps I did too many dangerous things in my past career for no good reason and in this career I can think of lots of good reasons to put myself into a little danger.


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## HotelCo (Apr 22, 2011)

18G said:


> Your a Paramedic. Are you not tasked with a rescue responsibility? *I respond to the scene of an accident, but as for extrication, no. That's left to the fire department.*
> 
> Your patient is trapped in an auto, under a building, in a silo, etc. How do you plan on getting to them to deliver the care they need at that point in time? *I don't. I'll wait until the FD gets them out. Why would I crawl under a building?*
> 
> ...



...


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## Sasha (Apr 22, 2011)

Plus one to what hotel said. All of it.


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## 18G (Apr 23, 2011)

Is Pennsylvania really that different?



> I respond to the scene of an accident, but as for extrication, no. That's left to the fire department.
> 
> *Is that what is best for your patient all the time? How do you know that the FD is not doing something that is going to affect your patients condition negatively? Shouldn't EMS be aware of their rescue techniques and on average how long it takes them to be employed?
> 
> ...



...


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## DrParasite (Apr 23, 2011)

Sasha said:


> Plus one to what hotel said. All of it.


I don't always agree with Sasha or HotelCo, but +2



18G said:


> Not even the FD? They should never enter burning buildings? Never enter confined spaces with who knows what kind of atmosphere? Never enter rushing water? It is the FD's job to train and practice for these hazards. It is why they take the job and is their obligation!


18G, do you have any experience as a firefighter?  ever heard the phrase "exterior operations?"  it's when firefighters won't enter a burning building to search for trapped people, because the danger is too great for the responders.  

as for your confined space example, you know that the majority of secondary victims are those who attempted to enter the confined space, and end up being incapacitated by the same thing that trapped the initial victim.  that's why firefighters and rescue personnel do air monitoring, breathing hoses (SCBA or an SCBA mask and long air hoses), and have specialized confined space rescue teams.

entering running water?  no, they won't, at least not with the appropriate equipment and manpower (ropes, swift water vests, rafts/boats, etc).  That means the engine company is going to stand there and wait for the Rescue company to show up.


18G said:


> Not even the PD? They should never pursue or approach an armed gunman? They should never engage in a firefight? Never taken down an assailant? They should turn and run?


PD can shoot back, they have body armor, and have SWAT teams.... and have metal/plastic restraints to contain the opposition party... can you say you have the same?


18G said:


> Not even our armed forces? They should not do all that they do? They should not patrol roads with potential IEDs? Engage the enemy? All because they may get killed? They do what they do because it is part of the job!


military is much different than civilian life.  the military has a phrase which scares the :censored::censored::censored::censored: out of me: "acceptable losses."  thankfully most jobs in civilian life don't have that term in their operational plan.


18G said:


> There is an obligation and duty to act. It has absolutely nothing to do with fantasy, playing hero, or romanticizing. Fire/Rescue/EMS/Law Enforcement are dangerous jobs and you never know what situation you may find yourself in. That's why we train to be able to handle the situation and work through it.


yes, and if you lack the training or the equipment, you shouldn't get involved, let those who are trained and equipped handle it 





18G said:


> A firefighter does not fight fire or search an apartment building engulfed in flames to be a hero. They do it because it is their job and obligation.
> 
> A cop doesn't pull his side arm and fire shots to be a hero. It is his/her job.
> 
> A Paramedic does not attempt to rescue a person entrapped in an auto or attempt to pull someone from a house fire to be a hero. They do it because it's their job and obligation.


I do my job; if its a bad MVA, car teetering over a cliff with a badly injured person, then on, I, an EMS worker,will not be climbing into the car in my uniform shirt and pants and rendering care.  nor will I, as a heavy rescue technician, go near a car with downed power lines on it, regardless of who is dying, until the power company has cut power to the lines that are on top of the care


18G said:


> RISKING YOUR SELF IS AN OBLIGATION AND PART OF THE JOB. YOU DO IT SAFELY, NOT BLINDLY AND IGNORANTLY. SOMETIMES WE DON'T ALL MAKE IT HOME AND THAT PART SUCKS. BUT WE SACRIFICE BECAUSE OF OUR LOVE FOR OUR FELLOW MAN AND STRIVE SO THAT THEY CAN LIVE AND CONTINUE WITH A FUTURE. JUST AS WE WOULD EXPECT THE SAME IN RETURN. IF YOUR IN A SITUATION WHERE YOUR GONNA DIE UNLESS SOMEONE ELSE PUTS THEMSELVES IN EQUAL DANGER, ARE YOU OKAY WITH THEM STANDING BY WATCHING YOU DIE? OR ARE YOU GONNA BE HOPING THEY HAVE THE TRAINING TO GET YOU OUT OF WHATEVER SITUATION YOUR IN?


I don't plan on sacrificing myself for anyone, and wouldn't expect anyone to sacrifice them self for me.  I want to come home after every shift, as well as every cop, firefighter, EMT/Paramedic, and HazMat Tech that I work with.  and if you are OK with not making it home, well, then you scare me, and a dead hero is still dead.


18G said:


> ITS NOT ABOUT BEING A HERO. ITS ABOUT TAKING THE TRAINING AND SKILLS YOU WORKED YOUR *** OFF TO ACHIEVE AND PUTTING THEM TO USE TO SAVE ANOTHER'S LIFE.


yeah, and saving the other life, not losing your own.





18G said:


> As FireTender basically said, it's a calculated risk based on all information available at the time. We can only hope when its all said and done that the math adds up and we end up okay.
> 
> Has the world really turned that selfish where we no longer can support someone giving their all to aid another human being? Where we no longer expect our emergency services providers to put themselves in harms way to save another's life? That we just want to stand back and watch?
> 
> I would never ask someone to put themselves in a situation they are not trained to handle and have NEVER advocated that in this thread. Bottom line... if your trained, experienced, and based on your calculations you can carry out a safe rescue in spite of extreme hazards than you decide what your gonna do. Just don't tell someone else that they are foolish or stupid for putting forth the effort and skill to save someone else when the decision is of sound judgement based or training and professional experience.


If you lack the equipment, or the training, or the PPE to do the job, call the people who have the equipment, training, and PPE.  once they have mitigated the unsafe condition, then you can step in and save the injured people.


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## 18G (Apr 23, 2011)

> 18G, do you have any experience as a firefighter? ever heard the phrase "exterior operations?" it's when firefighters won't enter a burning building to search for trapped people, because the danger is too great for the responders.



PA Firefighter I. 

Please don't pick and choose the context of my statements. I have stated numerous times not to be careless or foolish and to use your judgement based on training and experience.


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## DrParasite (Apr 23, 2011)

18G said:


> I'm talking about the FD taking too long with the extrication because perhaps they are utilizing a technique that may take double the amount of time which your patient doesn't have. If EMS is rescue trained they can help prevent this, advocate, and be assertive for their patient.


yep, which is why I kinda think having an EMS based Rescue Crew is a good idea:

http://www.city.pittsburgh.pa.us/ems/html/rescue_division.html

http://www.uh-ems.org/rescue.html

www.rescue1.org/rescuepics.html


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## Sasha (Apr 23, 2011)

> I don't always agree with Sasha or HotelCo, but +2



You don't agree with me? Sob. :-(



> And your ambulances don't carry light extrication equipment?



We have a backboard, stairchair, and scoop stretcher. Same for private 911 ambulances. The only way we'd have a screw driver is if someone brought it from home for some random reason.

I can see it in my head now "Oh my god, a car accident! Oh my god, the doors are locked! Quick, go over to the 711 and see if they'll let you buy a screw driver with our fuel card, because some guy on the forum said we shouldn't wait for the people who are equipped for the job to get the patient out!"


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## steveshurtleff (Apr 23, 2011)

Sasha said:


> I can see it in my head now "Oh my god, a car accident! Oh my god, the doors are locked! Quick, go over to the 711 and see if they'll let you buy a screw driver with our fuel card, because some guy on the forum said we shouldn't wait for the people who are equipped for the job to get the patient out!"



Who on here said that you "should"?  The thread is about whether you would if you thought you could successfully provide care in a hazardous situation, and you have answered that.

I do agree with you about one thing, though, I'm also glad I won't be on your rig.


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## EMTBHillbilly (Apr 23, 2011)

Doors locked, windows up, unconscious patient that needs help now, no fire/rescue. . . a window is going to be broken and I'm going in with my situational awareness in overdrive.


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## Sasha (Apr 23, 2011)

Suit yourself. My partners and patients love me


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## Aerin-Sol (Apr 23, 2011)

18G said:


> And that is a personal choice that you nor anyone else should be judged for as long as you did not breach your duty to act.
> 
> At the end of the day we all go to bed with the choices we have made that affect our lives and the lives of others.



Do you really not see how "that's a personal choice no one should judge you for" and "if you aren't willing to risk your life you aren't going above your basic duty & you should find a new job" are contradictory statements? 


I think this thread is a great example of why FF & EMS should be separate entities.


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## 18G (Apr 23, 2011)

Aerin-Sol said:


> Do you really not see how "that's a personal choice no one should judge you for" and "if you aren't willing to risk your life you aren't going above your basic duty & you should find a new job" are contradictory statements?
> 
> 
> I think this thread is a great example of why FF & EMS should be separate entities.



They appear contradictory when presented side by side. But in the context that they were wrote and the post they were written in response to does not make them contradictory. 

A few are saying strongly that as EMS they will never place themselves in harms way to help save someone which is where the, "if you aren't willing to risk your life and go above your basic duty, you should find a new job" came in. They appear to be using the excuse of "I'm just an EMT or a Paramedic, there is no way I could ever be expected to or actually safely carry out a rescue". Almost as if they are better than that which is really sad.

And I couldn't agree more that Fire and EMS should be separate.... not that this thread has anything to do with that. I am 100% pro-EMS which is why I believe strongly in EMS being the ones to do rescue and not the FD. Tradition does not always dictate best practice. 

And yes, EMS does have responsibility to access patients and provide care in rescue situations. The patient may not have time to wait to be brought to you. Put yourself in that patients position and think what you would want and expect from that EMT or Paramedic on the scene to assist you. Would you want delayed care by 20,30,40mins all because of a crappy attitude?

If you don't want to work in the field and be exposed to hazards of rescue situations maybe the hospital ED is a better place to work. 



> I do agree with you about one thing, though, I'm also glad I won't be on your rig.



My thoughts as well


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## ffemt8978 (Apr 23, 2011)

This thread is on a 24 hour time out


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## ffemt8978 (Apr 24, 2011)

This thread is now reopened.  If it has to be closed again, somebody will get a forum vacation.


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## EMTBHillbilly (Apr 25, 2011)

I'm a newbie here so please excuse my ignorance.
I'm just wondering why this forum was closed for 24 hours.  It seemed as if there was a constructive discussion going on about EMS duty in rescue situations.  Is a little disagreement on issues not allowed?
Just asking.


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## ffemt8978 (Apr 25, 2011)

EMTBHillbilly said:


> I'm a newbie here so please excuse my ignorance.
> I'm just wondering why this forum was closed for 24 hours.  It seemed as if there was a constructive discussion going on about EMS duty in rescue situations.  Is a little disagreement on issues not allowed?
> Just asking.



Disagreement is allowed as long as it remains polite and civil.  Since there were comments posted that can be construed as being impolite (Im glad I'm not on your ambulance), and it was starting to get off topic (military scene safety vs civilian), this thread was closed for 24 hours to allow for a cool off period and to allow it to get back on topic.


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## MediMike (Apr 25, 2011)

(cough)SashaI'llridewithyouanytime(cough)


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## DrParasite (Apr 25, 2011)

18G said:


> They appear to be using the excuse of "I'm just an EMT or a Paramedic, there is no way I could ever be expected to or actually safely carry out a rescue". Almost as if they are better than that which is really sad.


I don't believe anyone actually said that.  what they said was "I'm just an EMT/Paramedic, if there is an unsafe scene, let those who are trained and equipped to mitigate said unsafe scene do so, before I let my untrained and unequipped attempt to get involved, where I have a high likelihood of not helping or even worse adding to the incident when I get hurt."

I don't want any of my coworkers get hurt because they tried to enter an unsafe scene and got burned.  I also don't want to be the *** who does something equally stupid and tries to help said coworker get out of said unsafe situation (although I probably would).

I don't care if a dozen babies die, the nuns perish, the school kids don't make it, I know it sounds harsh to some people, but if you try to be a hero and do something stupid and end up getting hurt, you have not helped anyone, you have made the situation worse.  You want to try to save everyone, more power to you.  

if it's an unsafe scene (building collapse, active shooting, MVA with overturn and entrapment, electrocution, assault in progress, hazmat scene, you name it), I am going to let those who are trained and equipped to mitigate the situation do there job, and if it's still unsafe, bring the sick and injured out of the unsafe scene and to me, because I want to go home at the end of my shift.


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## Sasha (Apr 25, 2011)

MediMike said:


> (cough)SashaI'llridewithyouanytime(cough)



Yay!! 

Anyway, I asked for the thread to be unlocked because I had an "experience" that made me instantly think of this thread the night it was locked.

I was on shift, and my partner and I were lost. Our GPS was not being very friendly. We were in the ghetto of the ghetto. Scary in itself, but we made the best of it by playing spot the prostitute (I lost by one point.) but we were riding along and down an alley we see, one guy laying on the ground, and what looks like four people around him (there could of been more.. but they were black and it was dark. Yes, I understand that sounds racist but it's the truth, when you're black wearing black clothes you are difficult to see.) beating the crap out of him. 

We did a U-Turn, and as we were coming upon that alley again we chirpped the siren like a cop would. They scattered like roaches, and the man on the ground didn't stir. Got on the phone, called 911, reported what we saw (leaving out the fact that we were in an ambulance.) my partner wanted to stop. 

I told her flat out NO! We are two very unintimidating white girls. Don't know where they ran off too, if they're coming back and what they'd have on them when they came back. Could we have probably pulled up to the guy, jumped out and dragged him into the truck relatively quickly? Yes. Was I willing to risk the few minutes of exposure? No.

The man could be dead or dying for all I knew. He could have been the sweetest man just walking back from his job at the gas station and got jumped, or some hardened drug dealer. It's not my place to play judge, but there was no way I was taking that risk. 

We did kind of maintain around the area until the cop got there to make sure SOMEONE got there, then we got on out of there.


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## Sandog (Apr 25, 2011)

18G said:


> Not even the FD? They should never enter burning buildings? Never enter confined spaces with who knows what kind of atmosphere? Never enter rushing water? It is the FD's job to train and practice for these hazards. It is why they take the job and is their obligation!
> 
> Not even the PD? They should never pursue or approach an armed gunman? They should never engage in a firefight? Never taken down an assailant? They should turn and run?
> 
> ...



Well said, I love this post, you could not have said it better. If this post does not cause people to take pause, I do not think anything will. You put the A in articulation.


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## Veneficus (Apr 25, 2011)

18G said:


> I would never ask someone to put themselves in a situation they are not trained to handle and have NEVER advocated that in this thread. Bottom line... if your trained, experienced, and based on your calculations you can carry out a safe rescue in spite of extreme hazards than you decide what your gonna do. Just don't tell someone else that they are foolish or stupid for putting forth the effort and skill to save someone else *when the decision is of sound judgement based or training and professional experience*.



That is the key phrase.

Those are the people who decide when to attempt to effect a rescue. Not the people who feel it is taking too long for them to arrive.  

Rescue may be a part of EMS in your area, but it is not recognized as part of EMS according to the majority of EMS training standards. I think it should be, but my opinions don't change anything.

If you notice in this thread, I didn't elude to what my action or reaction would be, but i spoke about what I advocate others to do.

I don't want somebody to think it is ok to put themselves in danger that is beyond them. As I said, it is most often people who do not realize the dangers or don't know enough about it who get themselves injured or killed.

In my experience, the people who are trained and experienced don't ponder what they are going to do in such situations because they already know.    

Furthermore I don't want people thinking that the purpose of the job is to get killed if need be. Getting killed is what happens when something goes wrong on the job. Be it fire, EMS, law enforcement, or the military.

"No :censored::censored::censored::censored::censored::censored::censored: ever won a war by dying for his country. He won it by making the other poor dumb :censored::censored::censored::censored::censored::censored::censored: die for his country.
---George S. Patton"

Though I think a variation of this was originally uttered by Napolean.


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## mcdonl (Apr 25, 2011)

HotelCo said:


> Question: If your not trained in rescue to some degree I would highly recommend you get the training. Answer: If I did, what good would it do? I don't have the equipment, or gear to carry out most rescues. I suppose I could help someone up that fell in a pothole...



My opinion, the good it would do would be to give you a better level of scene assessment. If you had proper training for instance on MVA's, you could determine if the scene was safe (At the FD level) and then make the determination if you could assist the patient while waiting for the patient to be freed from the vehicle. Not sure what state you are in, but in Maine all EMS training involves removing patients from vehicles and other tight places. 

Our Intubation training require we tube patients in tight spaces as well. 

So, the training does not mean you need to carry extrication tools but it would give you a new level of scene assessment that could benefit the patient. I know our safety is number one, but somewhere in the top ten is the patient...


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## lampnyter (Apr 25, 2011)

In my class we learned extrication. If a person was in a car and the FD was there i would go in the car...


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## crazycajun (Apr 25, 2011)

I would reccomend anyone to attend some sort of extracation class if you are a 911 EMS provider. Even if you never plan to use it you never know what you might emcounter. I refresh yearly with the local FD eventhough I am not a fire fighter. It helps.


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## 18G (Apr 25, 2011)

Sasha said:


> Yay!!
> 
> Anyway, I asked for the thread to be unlocked because I had an "experience" that made me instantly think of this thread the night it was locked.
> 
> ...



A very smart move indeed. No EMS crew should put themselves in that situation. No one is sayng every unsafe or potentially unsafe situation go throw yourself into it. Even if I were a cop off-duty working as a Medic I wouldn't have got out and helped that guy. 

The rule is to NOT put yourself into an unsafe situation. The topic focuses on those rare situations where your faced with a critical decision where you may safely rescue someone as an exception under less than ideal circumstances.


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## HotelCo (Apr 26, 2011)

18G said:


> And that is a personal choice that you nor anyone else should be judged for as long as you did not breach your duty to act.
> 
> At the end of the day we all go to bed with the choices we have made that affect our lives and the lives of others.



Seems like you're doing an awful lot of judging...



18G said:


> They appear to be using the excuse of "I'm just an EMT or a Paramedic, there is no way I could ever be expected to or actually safely carry out a rescue". Almost as if they are better than that which is really sad.



Who said they're better than that. From what I've read, people are saying that they won't put themselves in an unsafe situation, especially since they don't have the training to be in that situation, safely. 



18G said:


> And yes, EMS does have responsibility to access patients and provide care in rescue situations. The patient may not have time to wait to be brought to you.



I don't have the training to do so safely. I'll wait the 4-7 minutes it takes for a suburban department to get on scene (and since our response time is longer than theirs, I'd venture to say that they'll be there before us).



18G said:


> Put yourself in that patients position and think what you would want and expect from that EMT or Paramedic on the scene to assist you. Would you want delayed care by 20,30,40mins all because of a crappy attitude?



I wouldn't want someone else getting killed because they were trying to help me, no. What good does a dead paramedic do? 



18G said:


> If you don't want to work in the field and be exposed to hazards of rescue situations maybe the hospital ED is a better place to work.





18G said:


> Or, I could let those training in extrication, extricate...





MediMike said:


> (cough)SashaI'llridewithyouanytime(cough)


This



DrParasite said:


> I don't believe anyone actually said that.  what they said was "I'm just an EMT/Paramedic, if there is an unsafe scene, let those who are trained and equipped to mitigate said unsafe scene do so, before I let my untrained and unequipped attempt to get involved, where I have a high likelihood of not helping or even worse adding to the incident when I get hurt."
> 
> I don't want any of my coworkers get hurt because they tried to enter an unsafe scene and got burned.  I also don't want to be the *** who does something equally stupid and tries to help said coworker get out of said unsafe situation (although I probably would).
> 
> ...



This.



18G said:


> Not even the FD? They should never enter burning buildings? Never enter confined spaces with who knows what kind of atmosphere? Never enter rushing water? It is the FD's job to train and practice for these hazards. It is why they take the job and is their obligation!



They're trained to do so, I'm not.



18G said:


> Not even the PD? They should never pursue or approach an armed gunman? They should never engage in a firefight? Never taken down an assailant? They should turn and run?



They're trained to do so, I'm not.



18G said:


> Not even our armed forces? They should not do all that they do? They should not patrol roads with potential IEDs? Engage the enemy? All because they may get killed? They do what they do because it is part of the job!



Where in my employment contract does it state: "I am prepared to give my life..." (taken from Article I of the US Armed Forces Code of Conduct)? It doesn't, and it doesn't say it in yours.



18G said:


> There is an obligation and duty to act. It has absolutely nothing to do with fantasy, playing hero, or romanticizing. Fire/Rescue/EMS/Law Enforcement are dangerous jobs and you never know what situation you may find yourself in. That's why we train to be able to handle the situation and work through it.


I must have missed the day that we trained to remove someone from a collapsed building.



18G said:


> A firefighter does not fight fire or search an apartment building engulfed in flames to be a hero. They do it because it is their job and obligation.
> 
> A cop doesn't pull his side arm and fire shots to be a hero. It is his/her job.



This seems like further babbling (I can think of no better word) continued from above, which I've answered.



18G said:


> A Paramedic does not attempt to rescue a person entrapped in an auto or attempt to pull someone from a house fire to be a hero. They do it because it's their job and obligation.



What EMS-only departments do you know that go into burning buildings?



18G said:


> A Marine does not engage the enemy to be a hero. They do it because it is their duty and their job.



And because they'll be killed if the enemy engages them first, and lands some rounds on target. How am I going to die if I don't enter a house fire?



18G said:


> RISKING YOUR SELF IS AN OBLIGATION AND PART OF THE JOB.



No, it's not.



18G said:


> YOU DO IT SAFELY, NOT BLINDLY AND IGNORANTLY. SOMETIMES WE DON'T ALL MAKE IT HOME AND THAT PART SUCKS. BUT WE SACRIFICE BECAUSE OF OUR LOVE FOR OUR FELLOW MAN AND STRIVE SO THAT THEY CAN LIVE AND CONTINUE WITH A FUTURE.


Rambling...



18G said:


> JUST AS WE WOULD EXPECT THE SAME IN RETURN. IF YOUR IN A SITUATION WHERE YOUR GONNA DIE UNLESS SOMEONE ELSE PUTS THEMSELVES IN EQUAL DANGER, ARE YOU OKAY WITH THEM STANDING BY WATCHING YOU DIE? OR ARE YOU GONNA BE HOPING THEY HAVE THE TRAINING TO GET YOU OUT OF WHATEVER SITUATION YOUR IN?



If they have the training, and equipment, how is that equal danger?

If I'm laying in a pool of water, with a downed power line in it, do I expect the paramedic to jump in and pull me out? No...



18G said:


> ITS NOT ABOUT BEING A HERO. ITS ABOUT TAKING THE TRAINING AND SKILLS YOU WORKED YOUR *** OFF TO ACHIEVE AND PUTTING THEM TO USE TO SAVE ANOTHER'S LIFE.



Rule #1: I go home at the end of the night.
Rule #2: Nothing interferes with Rule #1.



crazycajun said:


> I would reccomend anyone to attend some sort of extracation class if you are a 911 EMS provider. Even if you never plan to use it you never know what you might emcounter. I refresh yearly with the local FD eventhough I am not a fire fighter. It helps.



Get the local community college to put me through their course, free of charge, and I'll be glad to learn...


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## Sandog (Apr 26, 2011)

HotelCo, I think 18G stated his argument succinctly and with respect to the readers. I did not see his post as being judgmental at all as he did mention that the actions one decide to take is a personal call and one that that person will have to live with. I do not see any of what 18G had to say as ramblings and find that comment to be uncalled for as 18G has remained courteous throughout this post. I have not chimed in on this post as I am not able to express myself as well as 18G does, but I am in agreement with his philosophy and thus I am speaking now to give 18G my support.


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## crazycajun (Apr 26, 2011)

Most FD's will let you train with them for free. Atleast for basic extraction courses.


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## Sasha (Apr 26, 2011)

crazycajun said:


> Most FD's will let you train with them for free. Atleast for basic extraction courses.



Really? not here.


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## Sasha (Apr 26, 2011)

18G said:


> The rule is to NOT put yourself into an unsafe situation. The topic focuses on those rare situations where your faced with a critical decision where you may safely rescue someone as an exception under less than ideal circumstances.



And how did that not fit the situation? we could have pulled up and dragged him into the truck, it might have been safely executed, just like you taking your extraordinary risk might be safely executed. 

I agree with everything that Hotel Co said. I especially second the "If it was me, I'd be ticked someone risked their life for me".

I wouldn't want to be the reason someone got injured or killed. If it ever comes down to safely waiting for the resources to rescue me, or playing cowboy and doing it unsafely, wait for the resources for me.


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## Veneficus (Apr 26, 2011)

HotelCo said:


> Get the local community college to put me through their course, free of charge, and I'll be glad to learn...



And paid for your time.

It is only right.


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