Scene Safe...

[med109]

So in light of recent events a recent call has been on my mind alot. I thought I would share my concerns with you all and see what you would have done, so I can make changes as needed.

It was 1740, our shift change is 1800, I guess the sheriff deputies also change at 1800. We get called to a man down, CPR in progress. The address is about 25 miles out in the middle of know where, so it is a call for deputies to respond to, they are 10 minutes from us (on a good day) plus the 25 miles. We got lucky, cause about 6 miles up the very bad road, we noticed we had a deputy behind us. We got about 10 miles from the address when we hear 2 officers talking on the radio. The one (shift boss I guess) informed the other that since it was 1800, he needed to turn around and head home, and another officer would respond from town. Then the deputy that was behind us, leaves! We arrive on scene, the patient is DOA, and due to time down, and family wishes (the didn't want anymore CPR being tried), we do nothing. I decided to remain on scene until officers arrive for family support ect.

With the recent events, I realize that going to a call that far out in the middle of nowhere, with no police, is dangerous, very dangerous. The only reason I agreed to continue was I knew who's house we were responding to (a friend of my husbands). I think the issue is something that needs to be addressed with my crew, dispatch, and officers.

What would you have done? Knowing CPR is in progress, would you have simply got on the radio and informed the officers that if you didn't have an officer you wouldn't be responding? Pull over and wait for the next officer (30+ mins) to come along? What would you do now? Go talk to someone at the sheriffs office and explain that we won't be responding to calls like that again, unless we have an officer? Talk to dispatch as well? It is kind of tough for us cause about 80% of the time, we don't have ANY law enforcement respond to our calls.

 

[DrParasite]

do you have a first responder? if you have a 25 miles response, almost every cardiac arrest will be a DOA.

your concerns should be brought up white shirt to white shirt; that means your department head or supervisor should have a sit down with the PD or SO and discuss what policies they want to have. let the higher ups decide policy.

Also, on 90% of the medical calls, you don't need PD. there are no security issues, there will be no problems. But like a simple assault, a cardiac arrest is a police call (unattended death needs to be investigated until proven otherwise). PD needs to be there to do their law enforcement responsibilities.

For a CPR call, I'm going to the scene. I'm probably going to beat the PD there too. If it's an unsafe scene, and PD isn't there, I'm going to be transporting the dead body to the hospital, and getting the family to help me get him or her out. Even if you are in gang member territory, where everyone has a weapon on them, if you look like you are helping their family member, and you take them to the hospital, they won't bother you. in fact, they will probably make sure no one else bothers you. and if they are DOA, and the family doesn't want you to work them, than you can respect their wishes. no safe issues there at all.

 

[med109]

I am the dept. head, that is why I am concerned. No we don't have a first responder, A 25 miles responce is rare for us, but there are about 10-15 houses in that area so it is for sure possible that it will happen again. Yes, 90% of the time we don't need police on our calls, but a month ago I would say chances are you won't run into an armed man shooting at you from a burning building, and chances are slim that you would have someone call 911 for medical help and then shoot at you as you arrive but it happens more and more. I will be meeting with the SO about this, I am just curious how others handle a call that is so far away from police support.

So if the scene is known to be unsafe, you would still enter the scene to recover a patient, and you would ask bystanders to help?

 

[DrParasite]

I am the dept. head, that is why I am concerned... I will be meeting with the SO about this, I am just curious how others handle a call that is so far away from police support.

than you meet with the Sheriff or another high ranking person; as the department head, you should be meeting with their department head (Sheriff, Patrol captain, etc). You shouldn't be meeting with the shift Sgt, you meet with a high up during business hours who sets policy, and has the middle management enforce it. I know you already know this, but all too often I see EMS people meeting with PD liaisons, when the department head should be meeting with a captain or chief (with the liaison being present if needed). It's not right to be forced to deal with a subordinate, any more than the chief wanting a meeting with EMS and being forced to talk to a crew chief instead of a chief officer. if you want to be treated like one of the big boys, than you got to act like you belong at the table.

So if the scene is known to be unsafe, you would still enter the scene to recover a patient, and you would ask bystanders to help?

No, however nothing is telling me this is an unsafe scene. Middle of no where does not mean unsafe scene. dispatched to a cardiac arrest doesn't make it an unsafe scene.

Did dispatch say it was a cardiac arrest post assault? were there shots fired? reports of a shooting or stabbing? was the EMS crew greeted at the door by multiple armed civilians brandishing weapons?

The basic truth is that if you are being lured into an ambush, having the entire police force there won't prevent anything. For example, if the person with the rifle is in the 2nd floor bedroom (or neighbor, make up your own location), and lets the 2 cops in first to deal with the cardiac arrest on the 1st floor, and when EMS arrives, starts picking them off 1 by 1, it's going to happen. hence the term ambush.

back to your original question, would I tell a crew to enter an unsafe scene? domestic/assault in progress, shooting/stabbing, violent EDP, or electrocution, nope, my crew can stage until PD arrives. I don't care if it take PD an hour to get there, if babies are dying, or if the EDP is attacking everyone. my crews are to stay safe, and dispatch should tell the caller to leave the scene until PD arrives.

but the nature being a cardiac arrest doesn't make it an unsafe scene in my mind.

 

[med109]

Thanks for your thoughts! I fully intend to meet with the Sheriff about this. As far as local police that is a whole other story, and I don't know what we will do about that.

 

[MIT]

I think it's definitely something that you need to talk to the deputy about and your supervisor.

It's one of those things, I personally would want to respond to a CPR in progress as quickly as I could but it's not worth getting shot or stabbed at BUT with a 25 mile response they're going to be DOA regardless of what you do 99% of the time! Your safety is a priority

 

[Handsome Robb]

DrParasite and I have been agreeing more and more recently...what on earth is going on? Cardiac arrest, no matter where it is (inner city, suburbs, BFE) does not make the scene unsafe unless it's secondary to a crime, environmental hazard or anything else that would make the scene unsafe. We routinely work arrests with just us and the FD then call for PD after we pronounce. Hell, I've worked and pronounced arrests with just myself and my partner, no FD or PD.

I don't understand why PD is needed for this call besides chain of custody of the body if it's an unexpected death... Was there some indication of foul play or potential safety issues for responders during the initial 911 call?

Do you usually respond with deputies? I agree that's crap that the deputy turned around. It's a life threatening emergency, granted PD isn't going to do much but they need to suck it up and deal with the hour of OT pay they are going to have to fork out. Especially if it's in their SOPs to respond with EMS and FD for cardiac arrests.

I understand with all the recent events people are scared of these random acts of violence but are you going to spend the rest of your life living in fear? I hate to be the one that says it but the recent shootings have accounted for ~50 deaths and injuries. Now compare that to the 315,028,000 (per wiki - :censored::censored::censored::censored:ty source, sorry) people in the U.S. They also occurred in <10 incidents. Compare that to the millions of 911 runs nationwide that EMS/PD/FD responds to annually. See what I'm getting at?

Unless there is some indication that the scene is unsafe we enter. Keep your head on a swivel, your eyes open and make sure you have at least one route of egress. If something doesn't feel right, it probably isn't right and scoop the pt up and run with them or leave 'em and get out of dodge and come back and deal with it when it's safe for you to do so. Like MIT said, our safety is the number 1 priority. It's already been said but a response that long to CPR in progress, especially an unwitnessed arrest, there really isn't a whole lot you are going to do, although there have been recorded cases of extended effective CPR resulting in the patient leaving the hospital neurologically intact but those cases are the minority.

If family was requesting no resuscitation why were they preforming CPR prior to your arrival? Semantics but that's odd to me. Not to say I haven't been in similar situations, 15 year old end stage ovarian cancer patient in cardiac arrest comes to mind.

Talk to the brass at the PD if you feel the need to. It's something that's going to have to come from the top and work it's way down, not visa versa.

 

[Fish]

We walk into Cardiac arrest all the time without PD, unless there is a reason to stage. That being said, PD DOES come to every cardiac arrest and a lot of the time beat us to the address. If we arrive first, which happens half of the time I would say PD will come in after us and ask questions of the family or staff, wait onscene to see if we end up transporting then takeover custody of the body if we leave the patient on scene.

If this was a suicide, assualt, GSW, Stabbing, or something else crime related that you were responding to then I would be concerned and not enter the house until it has been cleared by Law enforcement. If it is a 80y/o Cardiac arrest with no reason to suspect foul play then enter without PD. I have never heard of a system staging on every Cardiac Arrest call and it would be very strange to do so, 99% of the time they are purely sudden significant Medical events and non-violent in nature.

 

[abckidsmom]

I think your real issue here is not scene safety, but a difference in opinion in how you feel end-of-tour, high-priority calls should be handled. So you are going on your high-priority call, but the PD handled it differently.

Some would say that it's an overtime issue, or a quality of work life issue, or just that the 80 yo cardiac arrest is not a high priority call for law enforcement, enough to justify someone running lights and sirens for 25 miles for a late call.

I really believe that throwing the scene safety card on this one is not going to get you anywhere. The likelihood of this scene being unsafe was low(if YOU knew the address, don't you think the cops probably knew it too?), and in an extremely rural area, when calls can take SO long, the overtime must be managed appropriately on EOT calls or it gets excessive really fast.

 

[Fish]

I think your real issue here is not scene safety, but a difference in opinion in how you feel end-of-tour, high-priority calls should be handled. So you are going on your high-priority call, but the PD handled it differently.

Some would say that it's an overtime issue, or a quality of work life issue, or just that the 80 yo cardiac arrest is not a high priority call for law enforcement, enough to justify someone running lights and sirens for 25 miles for a late call.

I really believe that throwing the scene safety card on this one is not going to get you anywhere. The likelihood of this scene being unsafe was low(if YOU knew the address, don't you think the cops probably knew it too?), and in an extremely rural area, when calls can take SO long, the overtime must be managed appropriately on EOT calls or it gets excessive really fast.

Good point, the supervisor probably viewed this as medical and not law enforcement there for low priority so it could wait for a non-overtime deputy. Since EMS was going to have to arrive and do there thing, then turn over care of the body to SO. He figured he probably had some time.

 

[Handsome Robb]

We walk into Cardiac arrest all the time without PD, unless there is a reason to stage. That being said, PD DOES come to every cardiac arrest and a lot of the time beat us to the address. If we arrive first, which happens half of the time I would say PD will come in after us and ask questions of the family or staff, wait onscene to see if we end up transporting then takeover custody of the body if we leave the patient on scene.

I should amend my statement and say that PD does come to all of our arrests but unless there's something dangerous or fishy about the cause it's a "medium" priority call for them, until we request them for our safety, crowd control or chain of custody then it goes to the top of the list, still a non-code response though unless there's heavy traffic or a long ways away. Violent/dangerous crimes in progress still supersede it from what I'm told *this is all word of mouth from officers and deputies that I've talked to, I don't know their SOP/SOGs about it*

Good point, the supervisor probably viewed this as medical and not law enforcement there for low priority so it could wait for a non-overtime deputy. Since EMS was going to have to arrive and do there thing, then turn over care of the body to SO. He figured he probably had some time.

I'd say you're probably right on this one.

 

[mycrofft]

This is an example of rural situations versus the sub/urban stereotype.

Yeah, sit down and voice your misgivings with them and work on it.

 

[med109]

"If family was requesting no resuscitation why were they preforming CPR prior to your arrival? Semantics but that's odd to me."

The entire thing was a little weird. The family had picked up their brother (the patient) at the nursing home for a family dinnner. When they arrived to the house the patient had said he was very tired and wasn't ready to walk to the house yet. So they left the truck running, gave the patient blankets, and checked on him every 20-30 minutes. When they checked on him the last time, they didn't find a pulse. They began CPR, with patient sitting in the vehicle. After doing CPR for awhile, they realized it wasn't effective, and after discussing his (long) medical history they figured there was no hope, and stopped CPR. They were all ETOH (family not patient) so I am sure that had something to do with it as well.

 

[mycrofft]

Reckon so.

 

[DrParasite]

I don't understand why PD is needed for this call besides chain of custody of the body if it's an unexpected death...

that's why we do it. even if it's an expected death, until PD confirms that grandma wasn't smothered by her son for the insurance money, it's a crime scene (well, maybe not crime scene, but PD need to investigate it).

It's a life threatening emergency, granted PD isn't going to do much but they need to suck it up and deal with the hour of OT pay they are going to have to fork out. Especially if it's in their SOPs to respond with EMS and FD for cardiac arrests.

also keep in mind, a cardiac arrest is a much higher priority than a pronouncement. a cardiac arrest is an imminent life threat, while a pronouncement is about as low as you can get; after all, a dead body can't get deader can it?