# Staging in EMS



## EPICMEDIC (Jul 24, 2011)

Lately there seems to be a lot of talk about staging for EMS calls. I always ask the question of is it necessary, but it seems everyone blindly stages without a real reason. For instance, a psych call at a nursing home seems a bit ridiculous to me. Or, staging for police on calls where "the calltaker thought they sounded angry or was using foul language". I am in no way saying to take unnecessary risks, but it seems that blind staging without reason is taking over. Please provide your thoughts and reasons behind your rationale.


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## Shishkabob (Jul 24, 2011)

Dispatch can request a stage, but in the end it's up to the crew.  If PD is on scene, we tend to go in.


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## DesertMedic66 (Jul 24, 2011)

If dispatch requests that we stage then we will stage until police clear the scene. The crew doesn't have a choice on to stage or not to stage if dispatch requests it. The crew can also make a choice to stage on calls if dispatch doesn't tell us to. 

Everything that the PD gets called out for we get staged automatically. If it's an unattened full arrest we stage until they clear the scene. 

I honestly don't have a problem staging for any call, and would not argue with dispatch if we were requested to stage for a runny nose.


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## DrParasite (Jul 25, 2011)

We sometimes stage.  I know units that will go into shootings and stabbings before PD get there, as well as hear stories of crews who would be on the scene and leaving the scene with the shooting/stabbing victim as PD was pulling up.  

me personally?  If I get a report of a violent EDP, or an armed EDP with no PD on scene, I'm gonna stage until PD get there.  stabbing and shootings, I'm probably going to wait until PD get there.

as for staging due to angry callers or foul language, ehhh, judgement call.  I'd rather send 2 LEOs into an intense scene followed by the EMS personnel, because the LEOs can make sure everyone behaves, and take appropriate action in case they don't.  I've been told by callers "just send the :censored::censored::censored::censored:ing ambulance, and stop asking me why" which usually gets an LEO response because I don't want anyone messing with my EMS crews as they are trying to do their job.

side note, situational awareness is a lost skill.  knowing when not to get too far into a scene, knowing how to get out, knowing when to get out, are often forgotten traits.  for example, I was dispatched to an armed suicidal juvie EDP running through the woods. Cops are chasing him, dispatch request we stage.  my partner stays in the truck, I decide to wander up to see what is going on. a slow walk, I meet up with one of the cops, get a size up the situation, and when 5 cops dog pile on the kid to disarm him and take him into custody, all I'm doing is holding the flashlight so they can see what they are doing (since it was 2am).  not getting directly involved, but being close enough to be aware of what is going on in case something goes wrong.

and I would never ever stage for a full arrest, unless there was a really good reason.  sooner CPR/Defib is initiated the better the chance of survival.


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## MedicBender (Jul 25, 2011)

At my station it's the units judgement call on if we stage. Dispatch will advise us that PD is enroute or on scene, but they wont tell us to stage or not to stage. 

Every scene is potentially unstable. That's why they added SCENE SAFETY into EMT class. While some scenes you absolutely need to stage, for example something like a shooting or stabbing, some you need to use your judgement and decide for yourself. 

If it's decided that we are entering a scene, we are smart about it. Make sure you have your ingress/egress, keep your eyes open, and travel together.


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## Elk Oil (Jul 25, 2011)

When dispatch tells us to stage, we stage until dispatch tells us the scene is secure.  I guess you can consider all staging to be "blind" because until we're on scene, we don't have any idea what's really going on.


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## dixie_flatline (Jul 25, 2011)

We generally only stage at the direction of PD, or if the address/caller is a known frequent flier that has given trouble before (I can name a couple addresses in our first due by memory, that we will not go into until PD is on scene).  The only times I would say we absolutely stage are assaults/domestics in progress, things like that. We are often asked to stage for suspected ODs, but that is left to the discretion of the crew.


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## feldy (Jul 25, 2011)

if we get called for a code 4 (staging) we wait until we are told to go in by PD. If its a while...we will call back in to see if we are still needed.


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## lifesavingsob (Jul 25, 2011)

EPICMEDIC said:


> Lately there seems to be a lot of talk about staging for EMS calls. I always ask the question of is it necessary, but it seems everyone blindly stages without a real reason. For instance, a psych call at a nursing home seems a bit ridiculous to me. Or, staging for police on calls where "the calltaker thought they sounded angry or was using foul language". I am in no way saying to take unnecessary risks, but it seems that blind staging without reason is taking over. Please provide your thoughts and reasons behind your rationale.


Maybe you should stage a little more often there epicmedic... then we could avoid SOG's being written hahaha


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## JeffDHMC (Jul 25, 2011)

I stage until the OP speaks up.

Jeff


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## WuLabsWuTecH (Jul 26, 2011)

Linuss said:


> Dispatch can request a stage, but in the end it's up to the crew.  If PD is on scene, we tend to go in.



Around here, if the dispatcher tells you to stage, and you don't, you better have a damn good reason ready when you walk back into the station and your chief greets you with two words: "Office. Now."



firefite said:


> If dispatch requests that we stage then we will stage until police clear the scene. The crew doesn't have a choice on to stage or not to stage if dispatch requests it. The crew can also make a choice to stage on calls if dispatch doesn't tell us to.
> 
> Everything that the PD gets called out for we get staged automatically. If it's an unattened full arrest we stage until they clear the scene.
> 
> I honestly don't have a problem staging for any call, and would not argue with dispatch if we were requested to stage for a runny nose.



In the urban area where I work, we stage for all calls that are violent (shooting, stabbing, injured from assault), all psych calls where there either is an attempt, or suicidal/homicidal ideations, and all unknown emergencies/911-hangups.

Out in the rural area, we stage for all of the above plus more.  Any uncertain situations, any addresses that have been flagged for previous violent behavior, and any addresses that have been flagged for domestic violence, violence towards public safety, heavy drug usage, the list goes on.  The reason for this is that we cover 190 square miles, which is a third of the county.  The 3rd shift has only 2 deputies on for the entirety of the county, so if we need someone, it can be 45 minutes or greater before we get someone there to assist.  Likewise, sometimes they'll have us stage at the firehouse, "in-service" so as not to tie us up while PD is responding in case a second run comes in.  Mutual aid is also at least 30 minutes out and there is no reason to tie up a unit waiting for PD when there is another run over the hill...


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## mcdonl (Jul 26, 2011)

HA! Our service chief makes us stay at the station.


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## Addicted2Narcan (Jul 26, 2011)

I'm not saying to go in on a shooting in the projects when the cops aren't there yet. Safety is still paramount, but staging on a full arrest? Think about the odds that's some kind of trap vs the odds that you're delaying care to that patient? You ever seen a cop do CPR? I think not. Everything in life involves risk, and if you're not willing to take some to help real people, get out of EMS and let the big boys do the hard work.


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## savingparamedics (Jul 26, 2011)

We don't stage at all. I don't think the dispatchers in my system know what that means. Hell, we're lucky to get the local sheriff to respond. We go in ready to take the patient down in those situations. We don't have the time to wait around for PD in the country.


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## ffemt8978 (Jul 26, 2011)

savingparamedics said:


> We don't stage at all. I don't think the dispatchers in my system know what that means. Hell, we're lucky to get the local sheriff to respond. We go in ready to take the patient down in those situations. We don't have the time to wait around for PD in the country.



Yeah, that works real well...
http://www.emtlife.com/showthread.php?t=11109

As far as the comment, "We don't have the time to wait around for PD in the country.", would you rather wait for PD to secure your scene, or spend the rest of your life waiting for the coroner to come pick up you and your crew?


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## AJ Hidell (Jul 26, 2011)

Just like an aeromedical flight; two to go, one for no.  If we both think, "what the heck, let's go for it," we do.  If either of us has any reservations, we stage.

Most of the time, it seems that the dispatcher tells units to stage just because they think they're supposed to always say that.  Just another one of those useless radio lingo terms that creeps into the culture and never goes away.  If you ask the dispatcher who advised us to stage, they lock up in confusion.  Nobody told us to stage to begin with.


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## ffemt8978 (Jul 26, 2011)

AJ Hidell said:


> Just like an aeromedical flight; two to go, one for no.  If we both think, "what the heck, let's go for it," we do.  If either of us has any reservations, we stage.


That's what we do here as well...any responding crew member can say, "hey, I think we should stage" and we do.


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## BandageBrigade (Jul 26, 2011)

Addicted2Narcan said:


> You ever seen a cop do CPR? I think not.



I know I am just feeding the many named troll. But Yes I have. On just about every code we have around here. The day they didnt assist in some way or initiate if they arrived first would be the day they are most likely looking for a new job.


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## Sasha (Jul 26, 2011)

Addicted2Narcan said:


> I'm not saying to go in on a shooting in the projects when the cops aren't there yet. Safety is still paramount, but staging on a full arrest? Think about the odds that's some kind of trap vs the odds that you're delaying care to that patient? You ever seen a cop do CPR? I think not. Everything in life involves risk, and if you're not willing to take some to help real people, get out of EMS and let the big boys do the hard work.



And then let the smart ones come work the code on the big boys when they get themselves killed for not staging when told to do so.


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## AJ Hidell (Jul 26, 2011)

Addicted2Narcan said:


> I'm not saying to go in on a shooting in the projects when the cops aren't there yet. Safety is still paramount, but staging on a full arrest? Think about the odds that's some kind of trap vs the odds that you're delaying care to that patient?


Once you have a little experience you'll learn that the odds are just as good that any shooter is going to bolt to avoid capture way before you get there.  That's why you leave your sirens on until you're stepping out.  Give them plenty of warning to run, so they don't feel trapped by your presence.

And we see plenty of cops doing CPR in my area.  You need better cops.


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## WuLabsWuTecH (Jul 27, 2011)

Addicted2Narcan said:


> I'm not saying to go in on a shooting in the projects when the cops aren't there yet. Safety is still paramount, but staging on a full arrest? Think about the odds that's some kind of trap vs the odds that you're delaying care to that patient? You ever seen a cop do CPR? I think not. Everything in life involves risk, and if you're not willing to take some to help real people, get out of EMS and let the big boys do the hard work.



The reason for this one is crowd control.  In the city, this is never a problem as the cops usually beat us there anyway and we send in 9 guys (2 medics, an engine, and a supervisor) so we have help in the crowd control department.  Out in the country, we'll take the first due medic, but everyone else is responding from home so the engine is going to be at least 5 minutes behind us if not more as is our second squad.  In this case, we'll wait until we have enough manpower to control a scene.  If the sheriff's office tells us that we are not getting a deputy on the run, I have seen them stage at station before and wait until the engine is in service and rolling both trucks out at the same time.

And yes, I've seen plenty of cops do CPR or otherwise help out on scene.



savingparamedics said:


> We don't stage at all. I don't think the dispatchers in my system know what that means. Hell, we're lucky to get the local sheriff to respond. We go in ready to take the patient down in those situations. We don't have the time to wait around for PD in the country.



If we have time to wait around for half an hour where I work, I'm sure you guys can wait there too if there is an active shooting.  Would _you_ go into a shooting scene to avoid waiting around?



AJ Hidell said:


> Once you have a little experience you'll learn that the odds are just as good that any shooter is going to bolt to avoid capture way before you get there.  That's why you leave your sirens on until you're stepping out.  Give them plenty of warning to run, so they don't feel trapped by your presence.
> 
> And we see plenty of cops doing CPR in my area.  You need better cops.



A trapped shooter is an unpredictable shooter.  And +1 on the needing better cops wherever he works!


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## mcdonl (Jul 27, 2011)

savingparamedics said:


> We don't stage at all. I don't think the dispatchers in my system know what that means. Hell, we're lucky to get the local sheriff to respond. We go in ready to take the patient down in those situations. We don't have the time to wait around for PD in the country.



This type of thinking is WHY our chief makes us stage at the station. He would rather have live crew members instead of dead hero's. You go in ready to take the patient down? Really? I am under the impression that taking a BP against the patients will is assault... I can only imagine what "taking the patient down" would be...


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## WuLabsWuTecH (Jul 27, 2011)

mcdonl said:


> This type of thinking is WHY our chief makes us stage at the station. He would rather have live crew members instead of dead hero's. You go in ready to take the patient down? Really? I am under the impression that taking a BP against the patients will is assault... I can only imagine what "taking the patient down" would be...


Oh boy!  We know what next month's dispatcher's training is going over!  How do they not know what staging is?

And any situation in which I could possibly need to go in ready to take the patient down, is exactly the situation I am staging on 100% of the time!


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## Elk Oil (Jul 27, 2011)

Addicted2Narcan said:


> Everything in life involves risk, and if you're not willing to take some to help real people, get out of EMS and let the big boys do the hard work.



Well, looks like I'll be getting out of EMS to let the big boys do the hard work.

It's been real!


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## mcdonl (Jul 27, 2011)

WuLabsWuTecH said:


> Oh boy!  We know what next month's dispatcher's training is going over!  How do they not know what staging is?
> 
> And any situation in which I could possibly need to go in ready to take the patient down, is exactly the situation I am staging on 100% of the time!



Dont get me wrong, we stage when asked or when we suspect we need to without being asked. Our service chief just prefers we stay right at the station. Too many nuts go after the first shiny vehicle with flashing lights. No staging near the scene for us.


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## Sasha (Jul 27, 2011)

Elk Oil said:


> Well, looks like I'll be getting out of EMS to let the big boys do the hard work.
> 
> It's been real!



Byeee.

Sent from LuLu using Tapatalk


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## firetender (Jul 27, 2011)

*Don't miss his point...*



savingparamedics said:


> We don't stage at all. I don't think the dispatchers in my system know what that means. Hell, we're lucky to get the local sheriff to respond. We go in ready to take the patient down in those situations. We don't have the time to wait around for PD in the country.


 
You can't just assume that every system is either able or willing to provide the backup necessary to have  the luxury of staging when immediate intervention is needed to preserve life of the patient. There are a lot of services out there -- especially "country" -- where the medics are thrust into a situation and must make the best of it.

Sometimes people here base their judgments of others on an ideal system that simply does not exist.


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## reaper (Jul 27, 2011)

firetender said:


> You can't just assume that every system is either able or willing to provide the backup necessary to have  the luxury of staging when immediate intervention is needed to preserve life of the patient. There are a lot of services out there -- especially "country" -- where the medics are thrust into a situation and must make the best of it.
> 
> Sometimes people here base their judgments of others on an ideal system that simply does not exist.



I have staged for an hour on calls. I do not care if the pt is going to die before then. If the call warrents staging, then you stage. Our lives are not expendable just because we work in EMS. I have worked very "country" systems and have never not staged for a call. When they want to deputize me and give me a gun, then I will enter a bad scene.

A certain posters comments on here shows inexperience. No ones life is more important then yours, NO ONES! When they gain some real experience, they will see what working EMS is all about.


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## Addicted2Narcan (Jul 27, 2011)

reaper said:


> I have staged for an hour on calls. I do not care if the pt is going to die before then. If the call warrents staging, then you stage. Our lives are not expendable just because we work in EMS. I have worked very "country" systems and have never not staged for a call. When they want to deputize me and give me a gun, then I will enter a bad scene.
> 
> A certain posters comments on here shows inexperience. No ones life is more important then yours, NO ONES! When they gain some real experience, they will see what working EMS is all about.



See that's where you're wrong. Would I trade my life for a crackhead in the projects? Hell no. But would I trade my life for my partner's or an innocent child's if I had to make a decision that meant stepping up? You can count on it.

And I love my job. They said, "you wanna stick tubes and needles in people and not go to jail?" I said, "hell yeah, who don't?"


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## reaper (Jul 27, 2011)

Like said, no experience!

Sent from little black box


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## Sasha (Jul 27, 2011)

Addicted2Narcan said:


> See that's where you're wrong. Would I trade my life for a crackhead in the projects? Hell no. But would I trade my life for my partner's or an innocent child's if I had to make a decision that meant stepping up? You can count on it.
> 
> And I love my job. They said, "you wanna stick tubes and needles in people and not go to jail?" I said, "hell yeah, who don't?"



Hmm.... its more like playing god when you sit there and decide what patient is worth the risk. All human lives are valuable, the only one i hold in higher value are my own and my loved ones for obvious reasons. Other than that its all or nothing.

Sent from LuLu using Tapatalk


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## Elk Oil (Jul 27, 2011)

Addicted2Narcan said:


> But would I trade my life for my partner's or an innocent child's if I had to make a decision that meant stepping up? You can count on it.
> 
> And I love my job. They said, "you wanna stick tubes and needles in people and not go to jail?" I said, "hell yeah, who don't?"



You have just convinced me how wrong I've been.  I'm going to make sure on my next violent call in which a child or my partner is present, I will sacrifice myself for them without question.


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## Elk Oil (Jul 27, 2011)

Sasha said:


> Byeee.
> 
> Sent from LuLu using Tapatalk



Feelin' the love.  Thank you.


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## Bullets (Jul 28, 2011)

firefite said:


> If dispatch requests that we stage then we will stage until police clear the scene. The crew doesn't have a choice on to stage or not to stage if dispatch requests it. The crew can also make a choice to stage on calls if dispatch doesn't tell us to.


Thats some real BS. Im on scene, i know the situation better then the Dispatchers sitting in a room miles away. IF i feel the scene is safe thn i will make entry. Im not waiting for the cops to tell their dispatchers who call mine who tell me, how about i just walk over there? 

Dispatchers never supersede on-scene EMT's, especially my dispatchers


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## Elk Oil (Jul 28, 2011)

Bullets said:


> Thats some real BS. Im on scene, i know the situation better then the Dispatchers sitting in a room miles away. IF i feel the scene is safe thn i will make entry. Im not waiting for the cops to tell their dispatchers who call mine who tell me, how about i just walk over there?
> 
> Dispatchers never supersede on-scene EMT's, especially my dispatchers



Depends on your system.  Ours is different.  We can't possibly know if the scene is safe PRIOR to arriving, so if it is suspected that it's unsafe, we stage.

I used to work in a system in which the dispatchers' word was equal to a supervisor, so yes, they did supersede field units.


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## guttruck (Jul 28, 2011)

around here staging is a must due to the high amount of meth od's and other od's that are not in the "best" parts of town. Its never a bad idea to request that an S.O. be in rout or there in this neck of the woodsh34r:


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## AJ Hidell (Jul 28, 2011)

Elk Oil said:


> You have just convinced me how wrong I've been.  I'm going to make sure on my next violent call in which a child or my partner is present, I will sacrifice myself for them without question.


Some of us are alive today because someone did that.  It's no laughing matter.


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## DesertMedic66 (Jul 28, 2011)

Bullets said:


> Thats some real BS. Im on scene, i know the situation better then the Dispatchers sitting in a room miles away. IF i feel the scene is safe thn i will make entry. Im not waiting for the cops to tell their dispatchers who call mine who tell me, how about i just walk over there?
> 
> Dispatchers never supersede on-scene EMT's, especially my dispatchers



Dispatchers here are basically supervisors. So if you want to argue and not listen to them, then you can kiss your job goodbye. The dispatchers always have more info then the crews get so they can make a more informed choice. All the info we are given is just the location and possibly the nature of the call. If we stage fire is staging also. Neither us or fire will go into a scene until the all clear is given by the police. 

I honestly don't have a problem with that one bit. Yeah it takes longer for us to get to our patient but it means me and my partner are that much safer.


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## WuLabsWuTecH (Jul 28, 2011)

mcdonl said:


> Dont get me wrong, we stage when asked or when we suspect we need to without being asked. Our service chief just prefers we stay right at the station. Too many nuts go after the first shiny vehicle with flashing lights. No staging near the scene for us.



I guess it depends how far away you are from the scene.  We'll stage at the firehouse if it's in town since the village is less than a square mile.  But if the scene is 30 miles away, we'll head that way!  You do propose an interesting idea though.  We usually stage about a half mile to a mile away on the side of the road.  Maybe we can stage at other department's firehouses on their ramps--it would put us closer to other people...


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## WuLabsWuTecH (Jul 28, 2011)

firetender said:


> You can't just assume that every system is either able or willing to provide the backup necessary to have  the luxury of staging when immediate intervention is needed to preserve life of the patient. There are a lot of services out there -- especially "country" -- where the medics are thrust into a situation and must make the best of it.
> 
> Sometimes people here base their judgments of others on an ideal system that simply does not exist.





reaper said:


> I have staged for an hour on calls. I do not care if the pt is going to die before then. If the call warrents staging, then you stage. Our lives are not expendable just because we work in EMS. I have worked very "country" systems and have never not staged for a call. When they want to deputize me and give me a gun, then I will enter a bad scene.
> 
> A certain posters comments on here shows inexperience. No ones life is more important then yours, NO ONES! When they gain some real experience, they will see what working EMS is all about.



I work out in the country, and have 2 deputies that cover our county at night.  We still wait when we are unsure or if there is a history of violence at the address.  It's a risk just not worth taking.

And yes, if you work in TEMS, staging would not be an issue for you! 



Bullets said:


> Thats some real BS. Im on scene, i know the situation better then the Dispatchers sitting in a room miles away. IF i feel the scene is safe thn i will make entry. Im not waiting for the cops to tell their dispatchers who call mine who tell me, how about i just walk over there?
> 
> Dispatchers never supersede on-scene EMT's, especially my dispatchers



Why are we on this dispatchers vs. on scene personnel thing again?  It shouldn't be a head to head who is superseding whom thing!  Work with your dispatchers to try and determine the best information.  If they have a bad feeling about it, find out why!  But once we start working for dispatchers, or they start working for us, we're going to lose some utility out of a very good resource!


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## mcdonl (Jul 29, 2011)

WuLabsWuTecH said:


> I guess it depends how far away you are from the scene.  We'll stage at the firehouse if it's in town since the village is less than a square mile.  But if the scene is 30 miles away, we'll head that way!  You do propose an interesting idea though.  We usually stage about a half mile to a mile away on the side of the road.  Maybe we can stage at other department's firehouses on their ramps--it would put us closer to other people...



From our station we can get to any residence in less than 10 minutes. If the call is at the furthest point we will cut the distance in half, but never closer than a badguy with bad intent could walk while waiting for PD. But, most of our trouble spots (trailer parks) are just a mile or so from the center of town so we can get there from the station just as easy.


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## WuLabsWuTecH (Jul 29, 2011)

yeah, most of our trailer parks are much further out of town.  The one where the most trouble occurs is about 12 miles out.  Se do drive past a firehouse and a police station on the way there so usually the cops will beat us in unless one is tied up on a traffic stop!


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## DesertMedic66 (Jul 29, 2011)

Staging location for us is determined by the police department. Usually it's just a block away or just down the street. Sometimes it's further away and sometimes it's we are on scene but stay in the ambulance until they clear us to go in. It all depends.


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## Elk Oil (Jul 29, 2011)

AJ Hidell said:


> Some of us are alive today because someone did that.  It's no laughing matter.



I'm not laughing.  And since I already said you've convinced me, you're just belaboring the point now.


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