Moral/Ethical Limits of Scene Safety

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steveshurtleff

Forum Crew Member
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?
 
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.
 
Sasha said:
Scene safety is of the utmost importance. Always.
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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?
 
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.
 
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?
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If you've got a fracture you are useless to the child and are further delaying care... That's a fairly easy concept.
 
Aidey said:
Why does it have to be a child?
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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.
 
I have a soft spot for elderly, especially the demented. Not for kids, strangely enough. Most of them are little brats.
 
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.
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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.
 
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.
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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.
 
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.
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I have no doubts that you're not the only one who feels that way.
 
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.
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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.
 
5. Your sweet little dementia patient might go Bruce Lee on you.
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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.
 
medic417 said:
You actually do take a risk every time you go to a patient, in fact multiple risks.
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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.
 
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?
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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.
 
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.
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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.
 
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.
 
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.
 
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.
 
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?
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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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