Moral/Ethical Limits of Scene Safety

[DarkStarr]

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.

 

[abckidsmom]

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.

 

[BEorP]

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.

 

[Veneficus]

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.

 

[firetender]

It's an "in the moment" thing

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.

 

[Shishkabob]

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

 

[Veneficus]

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?

 

[JPINFV]

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.

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.

 

[mycrofft]

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.

 

[the_negro_puppy]

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.

 

[VFlutter]

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.

 

[Sasha]

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

 

[mcdonl]

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.

 

[steveshurtleff]

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.

 

[Sasha]

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

 

[MediMike]

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.

 

[Smoke14]

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.

 

[medic417]

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.

 

[Aidey]

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.

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.

 

[CAOX3]

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.