“The scene is as safe as we can make it.” — Radio traffic from an Aurora Police Officer on the night of the Century 16 Theater shooting.
I’ve been traveling around doing interviews for a class I’m developing on MCI management. The content is based on the first person accounts of EMS providers who have managed large-scale mass casualty incidents. One of the things I’ve been asking about is scene safety.
Sometimes our training conflicts with the needs of the situation, which can often happen with major incidents like active shooter scenes or commercial transportation accidents. How does one go about making sure that an airplane crash scene is safe? When police are tracking an armed gunman through a movie theater, when is the scene really safe enough to enter?
It’s interesting that, on this particular topic, my chosen experts have been in unanimous agreement: The scene is never safe and we need to stop teaching our EMTs that they only operate in safe environments. Instead of teaching EMS providers to wait until someone else has established their safety, we need to teach them to constantly be vigilant and responsible for their own safety.
We need to teach people that we manage degrees of risk on every scene we encounter. When the risks are managed, proceed. If the risk of harm becomes unacceptable, leave. It isn’t a ‘yes-or-no’ equation.
But surely some scenes can be deemed “safe”, can’t they?
Misreading intentions
In 2004, I responded to the house of an elderly man who was experiencing some confusion. His wife directed us to the back room where he was lying in bed. As I began to assess him, he awoke and became frightened. He didn’t know who I was or why there was a group of strange men gathered around his bed. I tried to reassure him, but he continually scrambled to get away from me.
During the physical struggle, my terrified elderly patient repeatedly rolled away from me to his right and groped the bed sheet and pillow opposite him. Each time he did this I gently rolled him back to me and continued my assessment. Eventually I determined that my patient was most likely septic and I requested that we lift him using the sheet he was laying on and carry him to the waiting pram.
As we prepared to lift him, a fellow firefighter removed the extra pillow on the bed revealing a 9 mm revolver, loaded and ready, under the unused pillow. It took all of us by surprise. I remember us all exclaiming, “Whoa!” in unison at the sudden and unexpected discovery.
The shock really set in when I recognized that our patient hadn’t just been trying to roll away from me, he had been trying to defend himself.
Our elderly patient may have been confused about who we were and what we were doing, but he was not confused about the location of his gun. We all got very lucky. And the event was a great reminder that the scene is never really safe.
Vigilance and the right mindset
So what should we teach about scene safety? We can’t just tell people to go walking in to the scene regardless of the situation. Recognizing that the scene is never safe is not an excuse to disregard safety.
On the contrary, it is a call to vigilance. The recognition that no scene is ever truly safe is also a recognition that we need to be more responsible for constant evaluation of the potential risks on scene, not just in the first ten seconds, but throughout the call.
Why not teach EMS providers to make a risk / benefit assessment similar to the ones that police might make when deciding to pursue a felon, or a firefighter might make when deciding whether or not to enter a burning structure?
We don’t just enter the scene when the scene has been made safe. We enter the scene when the obvious risks have been managed, using the appropriate resources and the benefit of our presence outweighs the risk of injury.
If we taught scene safety as an ongoing risk assessment, we would require our EMS providers to use a greater degree of personal judgment. I know that can sometimes give EMS instructors and employers a great deal of trepidation. Telling EMTs and paramedics that they shouldn’t be on scene if there are hazards present is a simple way to write a policy, but it doesn’t reflect the reality of the job.
Ongoing risk assessment is much more of an art than a science. But if it is practiced with diligence, our overall safety will improve.
