Moral/Ethical Limits of Scene Safety

[Sasha]

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.

 

[HotelCo]

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.

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

 

[18G]

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.

 

[ffemt8978]

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

 

[Gecko24]

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.

 

[EMTBHillbilly]

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.

 

[HotelCo]

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?

The FD may not have EMS capability so it is up to EMS to be integral in the rescue operation and make patient access. I don't know of any department around here that doesn't require medical training.

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? Heavily entrapped? I'll wait for FD. If I can throw in an adjunct through a window or something, I'll give it the ol' college try.

Is it not partly your responsibility to coordinate extrication with the FD? Coordinate? You mean say: "Hey, guys. See the person in that mangled car over there? *point* Yeah, could you go ahead and get them out for me? Thanks."

What if the FD is taking forever because they are clueless or have no clue about the priority of the patient? If they're taking forever to get to the scene, what do you expect me to do? Eat some Wheaties, and muscle the car apart? As for the priority... See above.

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. Yep, the focus is on the person, but it's not in my job description to extricate people. I have neither the training, nor the tools to do it.

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

...

 

[Sasha]

Plus one to what hotel said. All of it.

 

[18G]

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?

And your ambulances don't carry light extrication equipment? You don't know how to remove a windshield, bust a side window? Use a screw driver to bust the locking mechanism? This was all basic rescue covered in my EMT program. And not to mention light extrication equipment is required for licensure of all BLS/ALS units in PA. Perhaps I am wrong in assuming this is standard in other states.

Why would I crawl under a building?

ummm.... once the building is secured by the FD who else is gonna treat the pt. for crush syndrome and other injuries?

I don't know of any department around here that doesn't require medical training.

Around here it's not uncommon for volly FD personnel to not have medical training or be very limited. And as the ALS provider you are in charge of what happens to that patient.

Heavily entrapped? I'll wait for FD. If I can throw in an adjunct through a window or something, I'll give it the ol' college try.

Don't put forth too much effort for your patient. I wouldn't want you to scrape your arm in the process.

Coordinate? You mean say: "Hey, guys. See the person in that mangled car over there? *point* Yeah, could you go ahead and get them out for me? Thanks."

I guess as a minimalist that approach is okay. What I'm talking about is aiding the extrication crew with what the best approach is (since u should be inside the vehicle) to get the pt. out, suggest a certain extrication technique based on your vantage point, knowledge of pt. injuries, etc.

If they're taking forever to get to the scene, what do you expect me to do? Eat some Wheaties, and muscle the car apart? As for the priority... See above.

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, the focus is on the person, but it's not in my job description to extricate people. I have neither the training, nor the tools to do it.

You should really take at least a basic vehicle rescue course. It makes you safer and better serves your patient. None of your EMS training or education included rescue?

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...

You have no rescue training so you are not able to see the value first hand. As I said before, with basic rescue training you can learn how to do an appropriate size-up, know which additional resources to call, remove windows, pop doors with screw drivers, halligan bar, etc., make pt. access, stabilize the vehicle, learn about airbag systems, battery placements, fuel types, and so much more.

Extrication courses aren't all about cutting the car apart. They include patient focus and are very beneficial.

The Pennsylvania Dept of Health developed a great curriculum for vehicle rescue called Vehicle Rescue Technician (VRT) which consists of classroom and extrication evolutions. There is also a state exam to become certified. PA recognizes the great importance of EMS involvement in rescue.

Maryland also conducts great rescue programs - Rescue Technician and Rescue Specialist which are both really patient oriented. I hold certifications in rescue from both PA and MD. So yeah, they are very beneficial programs for EMS and recommend all to look into rescue programs in their area.

...

 

[DrParasite]

Plus one to what hotel said. All of it.

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

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.

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?

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.

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

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

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.

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.

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.

 

[18G]

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.

 

[DrParasite]

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

 

[Sasha]

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!"

 

[steveshurtleff]

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.

 

[EMTBHillbilly]

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.

 

[Sasha]

Suit yourself. My partners and patients love me

 

[Aerin-Sol]

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.

 

[18G]

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

 

[ffemt8978]

This thread is on a 24 hour time out

 

[ffemt8978]

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