The new reality of "scene safe..."

[Akulahawk]

Put a vest on a medic, and teach them how to boogie and take cover and follow orders. That's it. I don't know about you, but in my opinion teaching medics how to shoot back is actually the opposite of what our job description is.

Now yes, there are some EMTs and Medics who will run into a scene, even with an active shooter, if someone they care about or a LEO has a gsw. The scene certainly isn't safe, but by giving them a gun it becomes even MORE unsafe. We carry knives, pepper spray, mace (in some cases), or other things that are lethal, but not long range. Firing a gun is easy, hitting the correct target isn't. If it's solely your target, then it becomes a bit easier (albeit shooting under fire can be quite an issue for some people). But when youve got an MCI, with multiple active shooters in the crowd, giving a medic a gun is going to do more harm then good.

Properly instructing a Paramedic to be a defensive shooter will take less time than properly training a cop to be a medical provider.

Just my opinion, and certainly doesn't solve the problem...

I think ballistic vests need to be mandatory. Not "self provided" or optional.

If you are caufght not wearing it, you go home for the day kind of stuff.

Uncomfortable, sure, but how many cops complain?

It is sort of like insurance, if all goes well, you will never need it.

The other thing I was thinking is sort of a "sniper team" mentality.

Since EMS usually works in pairs, one person treats, the other "looks out" and doesn't get involved in anything else but looking out.

The problem becomes one not just of training, but properly equipping both members of the EMS team for such responses. Full-up Level III armor, rifles, pistols, and the like will cost a bit of money. Couple that with the need to provide the training and equipment to a lot of crews on shift in EMS and it could be initially very expensive. It is, however, doable, and for tactical response EMS teams, I'd suggest they respond or group up into teams of 3. Two to treat/extricate and one for overwatch. It should be rather obvious who the cops and EMS is and who is not... even when armored up.

Cops go after active shooters even though their armor will not protect them against rifle shots because they know that a swift, aggressive response actually saves lives because the shooter now has to engage someone who is shooting back and not pay attention to shooting bystanders.

Oh, and cops don't get a lot of training in firearms use, (a little over 100 hours) it's just that the training they do get is specific to the types of threats they're likely to face, so the become good at that instead of just marksmanship.

 

[bahnrokt]

The logistics of a couple TEMS trained ambulances in a region area doesn't work. If you are hung up on minutes, you don't want to be waiting for this special crew to come out from the city center to the scene which could be tens of minutes away. By the time they get to the scene the shooter is probably contained. That's also banking that the TEMS team didn't get sent to a routine call 25min before and isn't available. If you want EMS to go into hot zones with PD it needs to be something that you can implement on every rig to be effective...and that takes cash.

If you start looking at the cost to put 2 vests, 2 helmets and other gear on each rig, then train every emt and medic...its a huge dollar amount. And how many innocent lives will this save every year if implemented correctly? A handfull? Plus your average EMT or Medic will never go into a hot zone even9 if they had the right gear and training. So 5 years after training when an event like this happens, your going to remember 3% of what you learned.

It would be much easier to make every SWAT team and some PD officers through some rapid assessment and triage training. Just enough to toe tag them, apply some basic bandages and drag them out. Or even to get the information on the radio of # black, # red, # green and # yellow along with approx where the critical pts are.

 

[Christopher]

Properly instructing a Paramedic to be a defensive shooter will take less time than properly training a cop to be a medical provider.

Considering we would be engaging active shooters on even fewer occasions than we would be placing endotracheal tubes...would we end up killing more or less people by giving paramedics guns and removing ETI? It might actually be a net benefit to our populous ;-)

There is no rational reason to arm paramedics who don't function as members of a tactical team. A hot wash of the Giffords shooting showed just how effective training and equipping law enforcement personnel for basic first aid can be! Cheap and effective.

 

[DPM]

Properly instructing a Paramedic to be a defensive shooter will take less time than properly training a cop to be a medical provider.

Where is this firearm kept? What happens when your non-government healthcare provider shoots someone? If you feel that cops don't get sufficient range time, how much less are these paramedics going to get...?

No one is saying train the PD up to paramedic standard. I was a battle casualty drills instructor when I was in the army. Every single soldier, regardless of their trade / job, knew how to use a tourniquet, a field dressing, a chest seal and Celox gauze. It takes maybe a day to teach these skills to a cadre of 30+ new recruits, and an afternoon to test and re-cert them annually. No IV's or anything like that. Bleeding is the number one cause of death in GSW / blast trauma, and those interventions save lives.

Just saw Christopher's link. That is exactly what I am talking about! Even down to the equipment mentioned.

 

[Tigger]

Properly instructing a Paramedic to be a defensive shooter will take less time than properly training a cop to be a medical provider.

Though I admit I am only a casual user of firearms, I do not agree with this. The Army has had much success in teaching all of its soldiers combat lifesaver courses, and from what I can tell this takes less than 40 hours at most. There just aren't many skills that make a difference, and those that do are fairly simple.

In the meantime, assembling a tactical EMS team is going to be far more expensive and require much more on going training.

 

[Ghostnineone]

Do TEMS medics not treat injured by standers? I understand that if they leave the medic behind and :censored::censored::censored::censored: hits the fan then the SWAT team has no medic to respond immediately and that screws them (and also one less person to help clear), do SWAT teams not use trailers anymore? I.e. people shot in store #1 cleared by SWAT and finds no shooter, they call for trailers, (EMS or TEMS, with LEO or SWAT to do overwatch) then move on and continue clearing.

I understand that that is rather difficult at the best of times, and that even if SWAT officers carry IFAKS and have medical training that their job is to find and neutralize the threat and not to render aid because they have to move on, but I don't think they should wait to clear and entire structure before sending in EMS, unless they don't actually do that.

Also, bulletproof vests don't stop knives (at least I was told they don't, ones with SAPI plates might though.) so do you issue EMS both stab and bulletproof vests, or one or the other depending on which one is deemed more common or whatever? (I vote for both if that's possible)

I do think that it's a good idea to maybe teach EMS self defense techniques and to maybe arm them with something less lethal like pepper spray or batons or tasers. I think "they're too stupid and would just hurt themselves because they aren't LEO's" is a stupid argument. But I also have a feeling that if some guy tries to shank you and you disarm him and end up breaking/dislocating/spraining/bruising something that he would probably end up suing you, and would sadly win most likely...but I mean really, if some :censored::censored::censored::censored::censored::censored::censored: tries to stab me and I'm able to, he's going on the ground. I don't care if they fire me or if I end up with a big gash from defending myself vs having several new holes in me that require exploratory surgery if they don't outright kill me.

 

[Ghostnineone]

Properly instructing a Paramedic to be a defensive shooter will take less time than properly training a cop to be a medical provider.

I disagree with this, a cop will be a much better medical provider even after a 8 hour course than a medic will be after an 8 hour pistol course, there's no way you can give an EMS person a gun with no previous firearms experience and a short pistol course (or even a long pistol course) and expect them to be able to shoot defensively or even offensively if they have to, even police don't get enough range time, as you said.

 

[Sandog]

For many years, "scene safe" has been the mantra of EMS.

While checking out the recent thread about the temple shooting I was wondering.

Are the days of staging outside the scene until the all clear over?

I am not suggesting we should be running into unsafe scenes. I am suggesting the times have changed and no scene may ever be safe as we have come to expect again.

As the future of the world progresses, will it be common in the US not only for EMS to enter an "unsafe" scene, but know even prior to going to work every scene you ever enter will be "unsafe" as we have defined it in the past?

How do we prepare for this future?

While violence does occur and will continue to do so for a long time, I do not see the world as declining into some futuristic, anarchy, bloodletting we so often see portrayed in Hollywood, and what you prognosticate.

History shows us a very violent past, much more so than now. From the crusades to the Saint Valentine Day Massacre, men like Stalin and Hitler typify evil in its purest form.

Indeed man has grown a conscience as the days of WWI have proven. Mustard gas, nerve agents and trench warfare are now seen as unthinkable.
If we look back into history the number of deaths in wartime, and civilian against civilian has declined dramatically. Just compare the numbers of dead and wounded since WWII.

So to answer your question:

As the future of the world progresses, will it be common in the US not only for EMS to enter an "unsafe" scene, but know even prior to going to work every scene you ever enter will be "unsafe" as we have defined it in the past?

I think no.

 

[med51fl]

I don't know if violence has decreased per say. The fact that deaths have decreased is more a testament to trauma care and advances in medicine. Patients that would have died 50 years ago are now being saved and therefore are not "deaths".

I know from my personal exposure that there has been an increase in not only violent assaults in our service areas, but they typically now seem to have multiple victims. 15 years ago we would get 1 to 2 shootings per week. Now we have at least 1 shooting per shift, frequently with multiple victims. Of course my system covers an urban area with alot of gang / drug violence. Not everybody has that "pleasure".

 

[DesertMedic66]

I was looking at the California Highway Patrol website a couple of days ago and all of their officers have to be at least EMRs. A lot of the life saving items are taught at the EMR level.

But the CHP was the only place I could find info about EMRs. So city PD and Sherrif may not have the EMR training.

And I agree with Ven about the vests. A couple of months ago there was a drive by shooting at the exact place one of our street posts is.

 

[Jon]

First, I think Kip (DT4EMS) put you up to posting this. Your timing couldn't be more spot-on.

ALL of us need to read this article. Then read it again:
http://www.emsworld.com/article/10741287/violence-against-ems-providers-what-can-we-do-about-it

The article was written by our own Kip, as well as Skip Kirkwood of NEMSMA/Wake County EMS. There's also a NEMSMA Position Statement on EMS Safety, but it hasn't been published to their website yet. I'll link it once I see it.



There is no such thing as a safe scene. In fact, the ones we stage for are often the SAFEST. Why? Because when we finally get to the scene, LEO's are there, in force, and no one else has the gumption to start more trouble.

As was said - we do a disservice by making students say "scene safe" without actually teaching them to be aware. If you learn to walk into a room and say "scene safe, BSI" without actually even knowing what a threat looks like, you'll fail miserably when it matters most. Fight as you train, train as you fight.

I also think that the question of firearms is a red herring, just as was said in the article. There is perhaps a place for OTHER defensive tools (OC, Taser, Baton - in that order), however I feel a firearm is MUCH more hassle than it's worth. If anyone wants to debate firearms further, please dredge up one of the old threads and let us continue that debate without getting this thread off track.


I think we need to do 3 things:
Focus on training EMS providers to recognize indicators of potential violence.
Train providers to safely REMOVE themselves from such situations.
Have a zero-tolerance policy against assaults on EMS providers.


Suggestions on how to make it happen?

 

[DT4EMS]

Ha! Thanks for the props Jon.... But I have been away teaching at an Arkansas State Conference I wish I could Start a thread this good

 

[EpiEMS]

I'm of the very strong opinion that the Israelis handle scene safety the right way. Magen David Adom (MDA) ambulances (Israel's EMS is handled by MDA) all carry body armor and PPE for CBRN incidents, as well. Not only this, but there are armored ambulances in civilian markings and lots of specialized MCI vehicles. As far as strategies go, they deemphasize responder safety (as far as I can tell) and make a lot of use of bystanders.
They know what they're doing.

The major differences between MDA and American EMS are the volume of mass-casualty incidents, the severity of those incidents, and the training of MDA personnel (perhaps first among the difference in training is that almost all "secular" Israelis are military-trained to some extent). However, these are certainly surmountable differences.

Interesting presentation to look through: http://www.emsaac.com/registration/...S REsponse to Terrorism & Mass Casualties.pdf


http://caep.ca/sites/default/files/caep/files/caep_2012_1.pdf

http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/Education/IsraelRoundsPowerpoint.pdf


As far as TCCC goes, every single police officer, EMS provider, and firefighter should be equipped with the basic tools to stop 66% of preventable causes of death due to combat-style injuries -- tourniquet and the knowledge to manage an airway BLS-style.

 

[DrParasite]

Are the days of staging outside the scene until the all clear over?

I am not suggesting we should be running into unsafe scenes. I am suggesting the times have changed and no scene may ever be safe as we have come to expect again.

This is not new in the world. Several nations have had to deal with this. From stabbings in England, combat medicine in various theatres, Terrorism in Israel and Russia, and revolutions in the Middle East.

As the future of the world progresses, will it be common in the US not only for EMS to enter an "unsafe" scene, but know even prior to going to work every scene you ever enter will be "unsafe" as we have defined it in the past?

I remember listening to the radio traffic from the Movie Theater shootings, and all the cops kept saying was "I got one shot, need EMS to x part of the building." the scene wasn't safe, there was possibly an active shooter still there, and the cops wanted EMS to enter the scene.

We give medals/award out for people who risk life and limb while on the job, yet have written policies and education that says we are not to enter an unsafe scene. Technically, those who are awarded a medal of valor should be terminated the next day for intentionally risking their lives when the rules say not to.

And then we have the idiot politician from the midwest who said he wanted AMR to help a shooting victim before PD got there, and if they wouldn't, then he would find another company that would.

Maybe we should be going into those hot scenes, or potentially hot scenes, to save lives. But if that is what people want, it's not going to be cheap. Individual body armor issued to too staff, additional tactical training for hot scenes, a 3rd EMT/paramedic for all crews, so you had someone to watch your back on those hot jobs, and offensive weapons (your definition might vary) for how to deal with an active shooter when PD aren't on scene, and anything else you can think of, because the public expects it of us. Just a random thought, and if the public can provide us with all that, maybe we should change our underlying thoughts on scene safety?

Do TEMS medics not treat injured by standers?

Short answer, No. TEMS Medics that are assigned to a SWAT team making entry are for the SWAT team only. Once the situation is contained, they may assist other injured personnel, but when the team is doing their SWAT duties, the TEMS medic doesn't treat the civilians.

 

[rescue1]

I think the an important question here is: Are we talking about an active shooter incident or common safety techniques to be used if a "normal" call goes south?

I think that, to start with the latter, we can all agree that provider safety is an issue barely touched on in class. As something we cannot predict, there are really only two ways to deal with it: 1) Have police respond to all calls, or 2) Train and equip EMS to be able to handle a situation or flee a situation if needed.
I personally think 1) is only an option in wealthier communities where the chance of violence is minimal, simply due to the fact that many police departments would be unable to respond to every EMS call in their district without compromising their other operations.
Training EMS in minor defensive tactics and situational awareness seems like a no-brainer. It should be enough to deal with a physically violent unarmed individual, and enough to recognize a situation that may involve a deadly weapon to allow EMS to make a hasty retreat and call the cops. I would also agree that stab or bullet proof vests should be utilized for EMS providers. I disagree with EMS carrying anything more lethal then OC spray or a baton though. I don't believe there exists enough situations where a firearm would be essential to justify the huge risk and liability.


As far as active shooting incidents, I'll admit I've never been part of one. But in my opinion there should be more of a push for tactical training and equipment (as in vests/helmets) for EMS to follow behind LE as they clear a hot zone. I'm not advocating paramedics running immediately in to treat victims before LE arrives, but if they proceed in behind first-in officers they could begin removing and treating patients. I would also suggest that any medic team working thusly be babysat by another armed officer whose sole job is the safety of his EMS team and their patient. Again, I think firearms for these tactical medics is a bad idea. You are there to treat patients, the cops are there to catch the bad guys.
I also agree with training LE in basic trauma first aid. It's cheap and shown to be effective.

 

[Veneficus]

I am curious as to why people think an increase is EMS exposure to violence somehow equates to anarchy and the breakdown of society?

I am also curious as to why many of the responses revolve around medics with firearms?

I never suggested an armed lookout, just somebody who is tasked to be the lookout.

remove the shooter incident.

Commonly at an MCI, the first unit becomes triage and command.

Why could it not be triage and lookout?

What is there to command at this point?

In the fire service, this lookout is referred to usually as the safety officer.

Does EMS not have need of somebody primarily tasked with safety?

 

[bahnrokt]

Suggestions on how to make it happen?

Reality? The highly publicized murder of an EMS crew that was sent unknowingly to their slaughter. One crew member needs to be a pretty white girl and the event must take place in the safe suburbs of a large media market.

 

[DrParasite]

I am also curious as to why many of the responses revolve around medics with firearms?

because in an active shooter scenario, he who has the firearm is in control. until the firearm is neutralized, the potential for the situation to escalate is very real, which is why LEO will usually go in guns drawn. if you don't have PD, you are at a disadvantage.

remove the shooter incident.

Commonly at an MCI, the first unit becomes triage and command.

Why could it not be triage and lookout?

What is there to command at this point?

In the fire service, this lookout is referred to usually as the safety officer.

Does EMS not have need of somebody primarily tasked with safety?

Because on a fire scene, the safety officer isn't inside the burning building with the engine or truck crews. If I'm on a potentially bad scene, I don't want my safety officer outside at his car making sure everything is ok.

Also, fire departments are known for having more supervisory personnel available for safety officer, accountability, etc. your first unit on an EMS call is a 2 person ambulance, one person becomes command while the other triages. If a supervisor/flycar shows up, that person becomes command and the original command assist in triage or becomes operations. We don't have the extra staff to do everything that the FD does. where I work, the FD has a deputy chief, and 3 or 4 battalion chiefs on duty 24/7, as well as a captain or lieutenant on every suppression piece. That same city usually has 2 EMS supervisors on duty, but can go down to 1 due to vacation or sicknesses. and the EMS system handles 4 times as many calls as the FD.

Don't get me wrong, I would LOVE to have that third person on EVERY ambulance. Someone else to watch my back, carry equipment, provide ancillary support for the ICS functions when they are needed, even just to run back to the truck to get something that doesn't leave a provider by himself in a room with potential hostiles. But we are at minimum staffing (2 on an ambulance), and are forced to rely on other agencies/units to do our job properly.

Sadly, I think it all boils down to $$$$, and our lives and safety aren't worth as much as a civilian; or more appropriately, paying for the proper staffing, training and equipment to protect us and keep us safe isn't important, until they need us to save their life and we can't because of what we haven't been given.

 

[mycrofft]

There's no such thing as a safe scene? Really? Remember not to let bad memories of isolated incidents and the excitement of the moment spark the type of "call to arms" we had after 9/11 and are still trying to recover from/sort out.

Many people are not going to work as PEMS because it forces them to be SWAT-oids, same as we lost good firefighters when departments forced them to become EMT's as well.

How about analyzing districts where trouble happens, and types of calls where trouble happens, and maybe even individuals or families where trouble happens, and require armed LE to attend? This would probably exempt most rural and suburban areas.

I am not a softy; I'd as soon watch someone bleed out at the feet of their armed relative a block away than go in and start something. The offender is the killer, not me.

A wrinkle I mentioned in a much earlier thread is being swarmed due to supporters being called in with cell phones.

 

[DPM]

...How about analyzing districts where trouble happens, and types of calls where trouble happens, and maybe even individuals or families where trouble happens, and require armed LE to attend? This would probably exempt most rural and suburban areas.

There was a system in place where I grew up that worked along those lines. Certain addresses (Individual houses up to entire neighbourhoods), Names and phone numbers were red flagged telling dispatch that Police had to be there first.