# Medical alert activation  WWYD?



## DrParasite (Apr 15, 2022)

Dispatched to a medical alert activation in a rural area.  crew arrives, knocks on the door, announces themselves, and gets no answer.  dispatch attempts a call back to the alarm company, who has no additional information, and has no number for the residence.  What do you do next?


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## mgr22 (Apr 15, 2022)

Call police, gain entry, see what's what.


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## DrParasite (Apr 15, 2022)

mgr22 said:


> Call police, gain entry, see what's what.


which is kinda what we did (sorta)... what would be your criteria for calling PD, vs marking it as unfounded?  

or would you always call PD and force the door, and not leave until the house was searched and it was verified that no one needed assistance?


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## mgr22 (Apr 15, 2022)

To me, the risk of assuming a medical alert is unfounded is greater than the risk of damaging the premises to gain entry, then discovering the alert is unfounded. Calling PD to gain entry and to check on the patient demonstrates my determination and my agency's determination to provide care, which is what we were called to do.


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## Jim37F (Apr 15, 2022)

Try for non destructive means of entry. Is there an open door or window? Can you see/hear anything from within? Jimmy open a latch or even pick a lock? 

A third party caller, especially a "good intent" passerby no longer on scene, yeah no need to break in anywhere, no patient found. 

But a medical alert device brings the suspicion of someone in need of immediate care and is unable to open the door (they've fallen and cant get up!) Is a lot higher (even if many medical alert activations I've been called to are false alarms, many aren't, and this is exactly the situation they're designed for..)


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## DrParasite (Apr 15, 2022)

Jim37F said:


> Try for non destructive means of entry. Is there an open door or window? Can you see/hear anything from within? Jimmy open a latch or even pick a lock?


in this case, no open door or window (except in the detached garage).  blinds were closed, couldn't hear or see anything (we checked).  couldn't jimmy open a latch, and I couldn't pick the lock at 10pm.  lights are on in the residence, an a nice pickup truck in the garage.  circled the house, knocked on back door, no answer.


Jim37F said:


> A third party caller, especially a "good intent" passerby no longer on scene, yeah no need to break in anywhere, no patient found.


agreed.


Jim37F said:


> But a medical alert device brings the suspicion of someone in need of immediate care and is unable to open the door (they've fallen and cant get up!) Is a lot higher (even if many medical alert activations I've been called to are false alarms, many aren't, and this is exactly the situation they're designed for..)


I would agree, however you have no confirmation of a fall.  no direct contact with the caller or additional information.  Furthermore, are you sure the address on file with the medical alert company is correct?    We have alert company that comes in regularly, where the person moved to another county, but never updated their address with the medical alert company.

Let's think worst case scenario... it's 1am, you have just gotten off a shift and a half (last half was OT, and it was busy), have made it home, and are snoozing.  EMS is dispatched for a medical alarm activation, but your neighbor put the wrong number on their account, so when they accidently pressed the button to test that it was working, the address given was yours.  fire shows up, bangs loudly, but your in dreamland.  decision is made to force the door; you are startled by the sound of your door getting broken down, think it's a home invasion, grab your legally owned firearm and start shooting, killing one of people who entered your house.  Who, if anyone, was wrong?


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## CCCSD (Apr 15, 2022)

That’s why you have LE make the entry decision.


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## E tank (Apr 15, 2022)

DrParasite said:


> which is kinda what we did (sorta)... what would be your criteria for calling PD, vs marking it as unfounded?
> 
> or would you always call PD and force the door, and not leave until the house was searched and it was verified that no one needed assistance?


the police go to 911 hang-ups every day for a lot less...


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## Jim37F (Apr 15, 2022)

DrParasite said:


> in this case, no open door or window (except in the detached garage).  blinds were closed, couldn't hear or see anything (we checked).  couldn't jimmy open a latch, and I couldn't pick the lock at 10pm.  lights are on in the residence, an a nice pickup truck in the garage.  circled the house, knocked on back door, no answer.
> 
> agreed.
> 
> ...


That seems a very.... wazoo, zebra scenario...

I've been dispatched to medical alert calls because the person wanted to test it to see if it works (it did lol). Also been dispatched to medical alerts where the person is down inside by themselves and we did have to force entry.

So we show up, everything is locked up, can't see/hear anything through the windows.... Contact the Alarm Company (or more likely have Dispatch contact them), have them contact the customer, if they can, to confirm address, things like taht. No answer on callback?

Well, *something* is going to get forced open. I'm not necessarily talking about taking the Irons and going to town on the front door, there's other, less destructive options. One we've used, and may not work fo ryou, is that a lot of (most all) residences, the windows are jalousies where there's several panes hinged almost like blinds. Slide the panes out (usually easier said than done, but can be done without actually breaking anything) and someone can wiggle into the house and open the front door.

This is where wearing proper uniform attire (we do actually wear high visibility jackets on all our medical calls) and making noise (FIRE DEPARTMENT!! IS ANYONE IN HERE?!) work to prevent that scenario. Is there an element of risk? Sure, but I'd wager the risk of getting hurt because our Engine got into a wreck and rolled over on the way to the call is a lot greater than the risk of someone waking up with a gun and shooting at us without asking questions first...


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## DrParasite (Apr 15, 2022)

Jim37F said:


> That seems a very.... wazoo, zebra scenario...


Is it really?  https://www.firehouse.com/safety-health/news/12196090/shooting-on-ems-call-leaves-md-ffmedic-dead


Jim37F said:


> I've been dispatched to medical alert calls because the person wanted to test it to see if it works (it did lol). Also been dispatched to medical alerts where the person is down inside by themselves and we did have to force entry.


Me too... and last night she didn't know how to reset it, didn't answer the alarm company when they called, and didn't hear us making all that noise when we pulled up, or kept knocking on her door.  and I will reiterate, if we see a person down, or can hear her calling for help, or someone has made positive contact and confirms that we need to force entry to get to the person, we are going in. But that wasn't the situation given


Jim37F said:


> So we show up, everything is locked up, can't see/hear anything through the windows.... Contact the Alarm Company (or more likely have Dispatch contact them), have them contact the customer, if they can, to confirm address, things like taht. No answer on callback?


as someone who has been the dispatcher, alarm companies are unsurprisingly less than helpful when it comes to having call back numbers for people.  


Jim37F said:


> Well, *something* is going to get forced open. I'm not necessarily talking about taking the Irons and going to town on the front door, there's other, less destructive options. One we've used, and may not work fo ryou, is that a lot of (most all) residences, the windows are jalousies where there's several panes hinged almost like blinds. Slide the panes out (usually easier said than done, but can be done without actually breaking anything) and someone can wiggle into the house and open the front door.


We don't have those by me... our windows are typically single or double hung window styles.  not as easy to pick...


Jim37F said:


> This is where wearing proper uniform attire (we do actually wear high visibility jackets on all our medical calls) and making noise (FIRE DEPARTMENT!! IS ANYONE IN HERE?!) work to prevent that scenario. Is there an element of risk? Sure, but I'd wager the risk of getting hurt because our Engine got into a wreck and rolled over on the way to the call is a lot greater than the risk of someone waking up with a gun and shooting at us without asking questions first...


You know, before the Breonna Taylor case, I would have agreed with you...

our uniform is a T-shirt, uniform pants, radios, etc, and we made some noise, to no avail.  Plus we pulled up in a truck with flashing lights.  Interesting idea of wearing a high vis jacket on all medical call.... I like the visibility, but it would get really hot really quick by me.


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## Tigger (Apr 15, 2022)

We would ask for law enforcement to come out and witness our entry into the home, as well as enter with us. 

Do you have to be careful? Yup. 

Last week our officer took us to the wrong house on a call. Right numerics, wrong street, just a weird geographical coincidence. No one came to the door, we entered through an unlocked rear slider and scare the crap out of the family. Did not like that.


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## MMiz (Apr 15, 2022)

Had this happen a few months ago. 

Colleague didn’t show up for work, 911 called for a welfare check but no response at door so PD didn’t make entry.

Person was unconscious and only found after we were able to track down family to make entry.

Patient care was delayed 6+ hours.


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## Carlos Danger (Apr 15, 2022)

DrParasite said:


> Is it really?  https://www.firehouse.com/safety-health/news/12196090/shooting-on-ems-call-leaves-md-ffmedic-dead


Yes, really. Policy shouldn’t be based on an isolated incident that happened 6 years ago.

If it were with any consistency, you’d see a lot more drastic changes in EMS than the way med alerts are handled.


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## johnrsemt (Apr 15, 2022)

I would call the police:  bad thing in my PT job, rural area, PD may be 2 hours away, and may refuse to come for that.

We have them refuse to come on a potentially dangerous run, "unless you are actively being shot at",

So we force entry.


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## Tigger (Apr 15, 2022)

MMiz said:


> Had this happen a few months ago.
> 
> Colleague didn’t show up for work, 911 called for a welfare check but no response at door so PD didn’t make entry.
> 
> ...


Though this is unfortunate, I think this is a little bit different than a medical alarm activation. Yes there are lots of false alarms but many welfare checks have minimal information and I understand the hesitation to not force entry given the many other places the patient could be.

I was also party to similar call, the patient was found dead. Unclear what would have happened if crews went in the first time.


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## akflightmedic (Apr 16, 2022)

In my career, I have forced entry ONE time before LE arrived. All the other times when no one could get to the door, LE was either on scene or called to the scene, and the decision making process from there was theirs to make. 

The one time I forced entry was when we saw an elderly person through the sliding glass door laying face down on the floor in an open area. I told dispatch what I saw, informed them I was going to make entry, and then did so. The situation ended well for all involved, and yes I am aware of all the potential hazards which could have occurred. I chose to make the decision based on what I knew at that time and mitigated as many risks as I could with knowledge of the ones I could not. I do not think there is ever a clear cut black or white response to this scenario.


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## DrParasite (Apr 16, 2022)

MMiz said:


> Had this happen a few months ago.
> 
> Colleague didn’t show up for work, 911 called for a welfare check but no response at door so PD didn’t make entry.
> 
> ...


I've worked for a hospital, where if you didn't show up for work with no notice, a welfare check was initiated.  10 years ago, a buddy of mine didn't show up for work.... this was the result... He was only 38


akflightmedic said:


> The one time I forced entry was when we saw an elderly person through the sliding glass door laying face down on the floor in an open area. I told dispatch what I saw, informed them I was going to make entry, and then did so. The situation ended well for all involved, and yes I am aware of all the potential hazards which could have occurred. I chose to make the decision based on what I knew at that time and mitigated as many risks as I could with knowledge of the ones I could not. I do not think there is ever a clear cut black or white response to this scenario.


I agree... if you see a person down, that's a different story.  if you hear them calling for help, there are no questions.  I'm going to request PD, and force the door.  If they get there before I do it, great; if not, oh well.  I can deal with the consequences of my actions.

But that's also a different scenario than a medical alert activation with no confirmation that anyone needs emergent help.


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## mgr22 (Apr 16, 2022)

DrParasite said:


> But that's also a different scenario than a medical alert activation with no confirmation that anyone needs emergent help.


I'm wondering if a medical alert activation is different, legally or procedurally, from a 911 call requesting help. In the latter case, I wouldn't expect EMS to just pack up and go home if no one answers the door or phone.


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## Jim37F (Apr 16, 2022)

DrParasite said:


> Is it really?  https://www.firehouse.com/safety-health/news/12196090/shooting-on-ems-call-leaves-md-ffmedic-dead
> 
> Me too... and last night she didn't know how to reset it, didn't answer the alarm company when they called, and didn't hear us making all that noise when we pulled up, or kept knocking on her door.  and I will reiterate, if we see a person down, or can hear her calling for help, or someone has made positive contact and confirms that we need to force entry to get to the person, we are going in. But that wasn't the situation given
> 
> ...


Yeah, a zebra case doesn't mean it's never happened, but is exceedingly rare. One individual case vs the however many hundreds of such calls occurring everyday? Yeah that's a zebra case. Like I said, I'm far more worried about breaking my neck in a roll over on the way to the call than getting shot....

(and yes our medical jackets do indeed get very warm very quickly especially in our tropical environment where it's routinely in the 80*s year round)

And no, I am not saying anything about just smashing the door down as soon as we get there. We're still requesting PD and looking around, investigating. We're calling the Alarm Company, having them contact the customer at a minimum (where we'd have them clarify address issues). 

I will say you need to have an articulatable reason for clearing the scene as "No Patient Found" other than "we couldn't see anyone from the outside" because the entire point of the medical alert devices is for people who are down inside where we wouldn't be able to see them still being able to call for help. What if they're down in the bathroom where there's no windows? Or the bedroom with the drapes/blinds/whatever closed so you can't see in? Just for a rescue crew to shrug and go "eh must be a wrong address, no one is answering the door" and leave?


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## DrParasite (Apr 17, 2022)

mgr22 said:


> I'm wondering if a medical alert activation is different, legally or procedurally, from a 911 call requesting help.


That's a good questions, and I'm not a lawyer, so I don't know what the legal outcomes are..


mgr22 said:


> In the latter case, I wouldn't expect EMS to just pack up and go home if no one answers the door or phone.


And you'll also comparing apples and oranges.  In a 911 call, it's a 1st or second party call.  from a medical alert activation, it's a 3rd or 4th party.  on a 911 call, we have additional information, vs a medical alert (in this scenario), we have a report of an alarm, but no additional info.


Jim37F said:


> Yeah, a zebra case doesn't mean it's never happened, but is exceedingly rare. One individual case vs the however many hundreds of such calls occurring everyday? Yeah that's a zebra case. Like I said, I'm far more worried about breaking my neck in a roll over on the way to the call than getting shot....


you should really attend the The Myth of Scene Safety in EMS class being held at FDIC/JEMScon... I attended it in Connecticut, and the presenter provided several examples of EMS providers getting shot (with several killed) on "routine" EMS calls.   it's not always from medical alert calls, but it happens more than most people want to believe.


Jim37F said:


> And no, I am not saying anything about just smashing the door down as soon as we get there. We're still requesting PD and looking around, investigating. We're calling the Alarm Company, having them contact the customer at a minimum (where we'd have them clarify address issues).


Not disagreeing.  that's exactly what we did.  We looked around, made noise, called the cops, asked the alarm company to contact the customer (they said they were unable to make contact with anyone, and could not provide a direct call back to the residence), and they had initially given us the wrong address. 


Jim37F said:


> I will say you need to have an articulatable reason for clearing the scene as "No Patient Found" other than "we couldn't see anyone from the outside" because the entire point of the medical alert devices is for people who are down inside where we wouldn't be able to see them still being able to call for help. What if they're down in the bathroom where there's no windows? Or the bedroom with the drapes/blinds/whatever closed so you can't see in? Just for a rescue crew to shrug and go "eh must be a wrong address, no one is answering the door" and leave?


Again, not disagreeing.  And everything you said is a valid concern (one of the reasons why we didn't just clear on a no patient found).  and if they are there, you are 100% correct.

But what if you are wrong?  if no one is there, is your department paying for the repair or replacement of the door and door frame?  What if they are there, sleeping, and you just broke down some guys door unnecessarily?  is your department liable?

Just to reiterate, I have 0 issues forcing entry into a residence or commercial structure to help someone in need... life over property, it's the same as breaking a car window during a hot day with a kid inside; I'll call the cops, but when there is a known hazard, I might not even wait (I'm in the sticks, so the deputies are rarely around the corner).  

But the question becomes, if you have only a 3rd or 4th party report, no confirmation of any actual emergency, what is your criteria for forcing the door?  @Jim37F , lets put this as a hose dragger example: dispatched to a fire alarm.  you pull up, with visible strobes and audible alarms going off, but no water gong sounding, no smoke, no fire visible from the outside.  no knox box, no keyholder response as per the alarm company.  360 shows nothing.  you look in the door, and don't see anything.  you forcing the door, or rather, forcing entry using as minimal damage as possible?


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## FiremanMike (Apr 17, 2022)

DrParasite said:


> Dispatched to a medical alert activation in a rural area.  crew arrives, knocks on the door, announces themselves, and gets no answer.  dispatch attempts a call back to the alarm company, who has no additional information, and has no number for the residence.  What do you do next?


Without any other info, we’re done, back in service, nothing found

Other info necessary -
Prior history at the address
Cars in driveway
Do a lap around the house, can I see in windows, do I see anyone/anything?
SOMEONE has a number here, call alarm company back, get emergency contact, ask them “are they home?”


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## DrParasite (Apr 17, 2022)

FiremanMike said:


> Without any other info, we’re done, back in service, nothing found


fair enough


FiremanMike said:


> Other info necessary -
> Prior history at the address


none


FiremanMike said:


> Cars in driveway


no cars in the driveway, but there is an old car in the detached garage with no plates, and a nice pickup truck with a box


FiremanMike said:


> Do a lap around the house, can I see in windows, do I see anyone/anything?


nope.


FiremanMike said:


> SOMEONE has a number here, call alarm company back, get emergency contact, ask them “are they home?”


you would think so... alarm companies are notorious for not having or providing emergency contacts.

hence the question


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## FiremanMike (Apr 17, 2022)

DrParasite said:


> fair enough
> 
> none
> 
> ...


What do you mean about a nice pickup with a box, is this a vehicle in the driveway that would indicate someone is likely to be home?


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## DrParasite (Apr 18, 2022)

FiremanMike said:


> What do you mean about a nice pickup with a box, is this a vehicle in the driveway that would indicate someone is likely to be home?


sorry, that sentence should have been "no cars in the driveway, but there is an old car  with no plates, as well as a newer pickup truck with a box (I think it was a generator or something, new in box from home depot) in the bed of the truck in the detached garage."

But the garage doors were both closed, so did I think someone was likely home?  yes... but they could have taken another car on a trip, and left those two cars in the garage for when they returned.  not really a smoking gun that I was hoping for.

oh, and the grass looked like it hadn't been mowed in over a month


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