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Home > Topics > Fire-EMS
November 19, 2012
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The Art of EMS
by Steve Whitehead

L.C.E.S. for car accident scenes

A busy roadway is hands-down the most dangerous environment where we routinely work

By Steve Whitehead

EMT Esteban Bahena's last Facebook post referenced a call he had just completed and ended with the simple phrase, "I love my job." Eight hours later he was dead, struck by a vehicle at the scene of a car accident where he was providing care.

Esteban's story, while tragic, isn't rare. Each year, the news stream at EMS1 is bound to bring us a baker's dozen of stories about EMTs, firefighters, police officers and paramedics hit by passing cars while working on the roadway.  

As the snow starts to fall here in Colorado and the roads get icy, my thoughts turn to busy, accident filled rush-hours and the hours I will inevitably spend on dangerous roadways in awful conditions. And I think of Esteban

A busy roadway is hands-down the most dangerous environment where we routinely work. Let's talk about an acronym we can use to remind us of four elements that can help us stay safe when we are working in the unpredictable environment of a busy roadway.

The acronym is L.C.E.S. If that sounds familiar, it's because wildland firefighters have been using it for more than three decades. Wildland firefighters know a few things about working in dangerous and unpredictable environments. To make sure everyone goes home safe, firefighters use L.C.E.S. You can, too.  Let's walk through it.

L stands for Lookouts
Someone needs to be looking up the road and watching what's coming. Don't assume that everyone is going to yield appropriately. Passing drivers, craning for a look at the scene will do some amazingly dangerous things.

Find the crew member who's looking for something to do and post him in a spot where he can see the whole scene and the oncoming traffic. Let him know that he's responsible for making sure nobody steps into traffic and making a bunch of noise if anything looks wonky farther up the road.

Posting a lookout also serves as a critical reminder to everyone on scene that they are working in a dangerous place.

C stands for Communications
There's no sense in having a lookout if that person can't communicate quickly and effectively with everyone on scene. The lookout should be in shouting distance of everyone operating on scene. If voice contact isn't feasible, the lookout should have a radio in their hand.

Everyone should also know the plan. It doesn't need to be a big production, but all of the elements of LCES should be communicated to everyone on scene. Let folks know who is looking out for them, where the safe operating areas are and where everyone is planning on going if things go bad in a hurry.

E stands for Escape Routes
It isn't enough to know that a car might fail to yield and enter the scene, you need to have a route to safety if one does. The shoulder of the road is always preferable to an alternate lane of traffic. The opposite side of a guardrail is even better (as long as there's solid ground on the opposite side). But you should decide on a place to go before things go badly.

S stands for Safety Zone
Natural and man-made barriers like trees and guardrails are great places to retreat if you need to escape to a safety zone, but I also like to create a safe working area right there on the road.

My favorite working area is about 200 feet down stream of a big, heavy engine. Position those large fire apparatus right in the involved lanes of traffic and angled away from the nearest shoulder.

If you're working in a dicey area and these no engine coming, call one. Even if you don't need the extra hands, you need the protection of the apparatus to create a safe working area.

Once you've created a safe working area, work in it and watch each other's backs. It's easy to get focused on patient care and accidently step the wrong way into an unsafe area. The more serious the accident, the more important it is to watch out for each other.

L.C.E.S. isn't just for wildland firefighters. You can use it effectively in any unsafe environment. With designated lookouts, effective communication, pre-established escape routes and attention to safety zones, we can reduce injuries to EMS personnel on traffic accident scenes.

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at steve@theemtspot.com or at Steve.Whitehead@EMS1.com.
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