scene control and safety. extent of problem n dramatic increases have occurred in violent crimes...
TRANSCRIPT
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Scene Control and Safety
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Extent of Problem
Dramatic increases have occurred in violent crimes among persons ages 15 to 34
20 youth homicides/day One in six violent crime
victims requires medical attention
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Before the Call
Preparing for what you CAN control leaves you free to deal with what you CANNOT control
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Before the Call
Occupy waiting time productively•Having nothing to do produces boredom or anticipation
•Boredom is exhausting•Anticipation is exhausting•Exhaustion can lead to errors at the wrong time
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Before the Call
Check equipment, vehicle•Is everything there?•Does it work?•Do you know how to use it?
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Before the Call
Know your response area•Look at the map•Drive the routes•Know changes in traffic patterns with times of day
•Have resources available for special problem areas (apartment complexes, colleges, industrial sites)
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Before the Call
Weather awareness•Temperature•Humidity•Are you dressed for the occasion?
•Are you staying hydrated?
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Before the Call
Maintain your knowledge base•Journals•Videotapes•Internet
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Before the Call
Build relationships•Law enforcement•First responders•Fire department•Emergency department
Coordinate procedures, Standardize terminology
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Before the Call
Devise an action plan
How do we warn each other if one of us spots a hazard?
How do we indicate to each other that one of us believes a scene is becoming unstable or hazardous?
How do we let dispatch know we’re in trouble without letting the bad guys know?
If we’re attacked what kinds of distraction, evasion tactics will we use?
If we’re separated, what is our “rally point?”
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When You Are Dispatched
Have you been there before? Reputation of area? Sensitive location?
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When You Are Dispatched
Type of callDispatch Information = “Ball
Park” ONLY
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Information Communicated
Caller
911 Operator
Dispatcher
Crew
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When You Are Dispatched
“Man down, unknown cause”
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When You Are Dispatched
Stabbing/cutting•Usually NOT self-inflicted•Where is the weapon?•Where is the stabber?
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When You Are Dispatched
Gunshot wound•Not self inflicted
– Police clear scene FIRST
•Self-inflicted– Where is the weapon?– Is it under control?
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When You Are Dispatched
SuicideMedical vs Trauma?
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When You Are Dispatched
Type of CallDomestic Violence
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When You Are Dispatched
Your personal condition?Your partner’s?
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Crew Condition
Fatigue Hunger Thirst Illness Preoccupation Complacency
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Enroute To Scene
If advised of danger•Do NOT approach until police have secured scene
•Avoid use of lights, siren
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Arrival On Scene
Arrive Discreetly•Shut down lights, siren a few blocks out
•Avoid – Drawing attention, crowds– Upsetting family– Disturbing scene
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Arrival On Scene
Acquire as much info as possible•What do you see?•What do you NOT see?•Are there vulnerable places?•Are there places of cover and concealment?
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Cover
Stops BulletsWhat are examples of
cover?What parts of ambulance
provide cover?
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Concealment
Hides you, but does NOT stop bullets
What are examples of concealment?
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Does The Scene Feel Right?
Avoid Tombstone Courage!
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Scene Approaches
Maintain element of surprise
Avoid having to react rather than being in
control
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Scene Approaches
Limit Noise•Remove loose objects from pockets
•Limit “jingling” equipment•Do NOT kick gravel•Turn radios down to lowest volume where you can hear
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Scene Approaches
Limit Light at Night•“Paint” scene instead of showing continuous light
•Hold flashlights away from body
•Swing light side-to-side•In emergency
– Throw light one way– Run other way
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Vehicle Approaches
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Vehicle Approaches Danger signs
•No one in vehicle turns around•Everyone gets out of vehicle, starts toward you
•“Unconscious person” in properly parked vehicle
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Vehicle Approaches Danger signs
•Driver adjusts mirrors – to watch you– to keep lights out of vehicle
•Persons in vehicle appear to be grabbing or hiding items
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Vehicle Approaches
Danger signs•Vehicle, occupants are “out of place”
•Visible signs of violence—arguing, fighting
•Dimly lighted area•Limited access, exit•“Gut feeling” something is wrong
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Vehicle Approaches
At least 15 feet
Cut front wheels all the way to left
Ten degree offset from center line
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Vehicle Approaches
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Vehicle Approaches
Write Down Vehicle License Number
Report To Comm Center
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Vehicle Approaches
Single person approach Minimizes risks Increases chances to get
help if something happens
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Vehicle Approaches
At night•Use PA to tell occupants to turn on vehicle interior light
•Use ambulance lights to illuminate vehicle interior
•Disable door-activated light switch on ambulance
•Do NOT cross in front of ambulance
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Vehicle Approaches
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Vehicle Approaches
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Vehicle Approaches
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Vehicle Approaches
Check trunk lid•If unlocked, push down gently to lock
•Retreat, call for police Stay close to vehicle Do not pass C-pillar until
back seat checked Stay behind B-pillar
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Vehicle Approaches
Where are occupant hands? What are occupants doing? Are any weapons visible? Are there physical signs of
alcohol or drug abuse? Do the occupants have
altered mental status?
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Vehicle Approaches
Danger Locations•Sun visor•Under either side of seat•In glove box•In side-door pockets•In center console•Between bucket seats•Next to driver’s right thigh
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Vehicle Approaches
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Vehicle Approaches
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Vehicle Approaches
If you do NOT detect a threat, tap lightly on the
window, identify yourself.
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Vehicle Approaches
Watch patient handsIf you open door, feel patient’s radial pulses immediately to take
control of wrists
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Vehicle Approaches
Backing Away•High-threat weapons•Occupants become unruly•All occupants exit vehicle, move toward ambulance
•Area entered is police hot zone•Partner incapacitated
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Vehicle Approaches
Backing Away•Provides constant view of scene
•Avoids moving into kill zone as vehicle is passed
•Makes it more difficult for vehicle occupants to follow
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Structure Approaches
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Structure Approaches
Drive past scene View three sides of structure Do NOT park
•Immediately in front of structure
•In driveways
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Structure Approaches
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Structure Approaches
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Structure Approaches
Take unexpected approach Cross yard rather than
coming up walk
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Structure Approaches
Evaluate scene as you approach•What do you see?•What do you hear?
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Structure Approaches
Do NOT walk next to your partner•Spread out•Create TWO targets
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Structure Approaches
Knock•Standing on door knob side•In line with door frame
Identify yourself Wait for occupant to open
door
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Structure Approaches
Contact
Cover
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Structure Approaches
Contact Provider Cover ProviderInitiates, provides direct patient care
Observes scene for danger
Performs patient assessment
Avoids patient care duties that prevent scene observation
Handles most interpersonal scene contact
Performs limited functions such as handling equipment
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Structure Approaches
Enter quickly Do NOT pause in doorway Check behind door Quickly scan entire room
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Structure Approaches
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Are weapons present?
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Are Drugs Involved?
History of location, neighborhood?
Appearance of patients, bystanders?
Comments made by bystanders? Drug paraphernalia on scene?
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Structure Approaches
Have occupant show you to the patient
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Dealing with Patients/Bystanders
Self Control = Scene Control•People copy emotions•Keep your voice down•Control your voice tone•Know your temper level and your partner’s
•Never run on an emergency scene
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Dealing with Patients/Bystanders
NEVER LET ‘EM SEE YOU SWEAT!
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Dealing with Patients/Bystanders
Clear Scene•Quick sweep of inside of house•Turn on lights in ALL rooms•Know who else is on scene•Keep people in your line of sight
•Know who people are; why they are there
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Dealing with Patients/Bystanders
Be conscious of your surroundings•Look for potential weapons•Watch people’s hands•Do NOT get caught with your head down
•Move as a team•Watch your partner’s back
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Dealing with Patients/Bystanders
Reduce distractions•Ask people to turn off radios/TVs
•Adjust light levels•Move furniture•Move patient•Choreograph equipment placement
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Dealing with Patients/Bystanders
Treat people with respect•When in doubt, be a little bit formal
•Use family, friends, bystanders in team effort
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Dealing with Patients/Bystanders
Control helper entry, flow Too many uniforms can cause
problems Warn patients/bystanders that
other units are enroute Personnel on other units should
act like they do when they are first to arrive•Knock, wait to be admitted•Appropriate introductions
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Dealing with Patients/Bystanders Use head to toe survey to
check for weapons•Have code to let partner know you’ve found something
•Where there is one weapon there ALWAYS is another
•If you cannot remove weapon, immobilize patient
•Your own equipment can be used as weapons against you
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Dealing with Patients/Bystanders
Distraction/Evasion Tactics•Throwing equipment•Wedging stretcher in doorway•Using unconventional path for retreat
•Overturning objects in aggressor path
•Using preplanned maneuvers in coordination with your partner
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Dealing with Patients/Bystanders
Signs of Danger•Shouts, increasingly loud voices
•Pushing, shoving•Hostility toward anyone on scene
•Rapid increase in crowd size•Inability of police to control bystanders
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Never let anyone get between you and the way out!!
Do NOT get backed into a corner!!
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If scene become too hot to handle:
Quickly package patient and go! If the patient won’t go with you,
go anyway! Thoroughly document what
happened
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Leaving the Scene
NEVER LET YOUR GUARD DOWN!
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Keys To Scene Control
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Keys To Scene Control
Panic doesn’t help anything
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Keys To Scene Control
It’s the patient’s emergency, not yours
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Keys To Scene Control
You didn’t cause the problem
You’re trying to help after the fact
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Keys To Scene Control
Confusion and anxiety seldom exist in familiar
situationsStudy--Practice--Know the
Rules
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Keys To Scene Control
The more automatic your responses are…
The less likely you are to miss or mishandle
something
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Keys To Scene Control
Everybody has to die sooner or later from
something
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Keys To Scene Control
In a crisis the challenge is NOT to be innovativeThe challenge is to be disciplined enough to FOLLOW THE RULES
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Keys To Scene Control
During any emergency response,
what could have happened,
DID