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How to make scene safety a core part of every EMS response

Attacks on EMS providers by the very people we are trying to help are becoming all too common: Review your safety practices and training


Attacks on EMS providers by the very people we are trying to help are becoming all too common. It is time that we make safety a core part of every response.

AP Photo/Mark J. Terrill

This article was originally posted July 15, 2019. It has been updated.

Attacks on EMS providers by the very people we are trying to help are becoming all too common. It is time that we make safety a core part of every response. Here are 5 tips for EMS scene safety.

1. ‘BSI, scene safe’

There are probably not too many of us out there on the streets now that didn’t half-heartedly, robotically hold up our hands and recite “BSI, scene safe” at the beginning of each training scenario in our first responder or EMT classes. It is not a joke anymore and EMS providers must build real scene safety concerns into trainings.

Likewise, students must take them seriously and practice a safety assessment just as much as the primary assessment. Scene safety elements should also be included in ongoing and refresher EMS training. A number of safety-specific continuing education courses are available including the NAEMT EMS Safety course and the EMS1 Academy Scene Safety course.

2. Each and every patient

The notion that we can predict who might try to hurt us or that we could “handle” a particular patient if they took a swing at us must be put to rest as well. It doesn’t matter if the patient is male or female, nor does it make a difference if they are big and hulking or small of stature. Age does not predict ability or likelihood of assault either. A patient who knows how to catch you off guard can do serious damage quickly.

We don’t need to go so far as to assume that every patient is going to try to harm us, but we shouldn’t consider certain patients safe based on their appearance. Keep your safety senses tuned in for every patient.

3. Seek and find

Just as it is your job as an EMS provider to conduct a good assessment to determine what illnesses or injuries the patient may have, it is also your job to be reasonably sure that they do not have any weapons on them before they are loaded into your ambulance. Not unlike the illness or injury assessment, we may not always catch every pocketknife or can of pepper spray, but we should make a point to check. Depending on the situation, this may include simply asking the patient if they have any weapons on them. I often see police officers asking something similar before they frisk people: “Do you have any weapons on you including any knives or needles that could hurt me?”

Am I asking you to frisk people? Not per se, but I am encouraging you to do a more thorough physical exam. We will often skip the head-to-toe on patients who just have a single-system injury or simple medical complaint but why not do a quick head-to-toe to rule out other injuries or medical clues – and at the same time – do a subtle check of the common places that weapons are carried (waist, hips, lateral chest, calves, pockets)? Tell the patient that “the bosses will get on me if I don’t do a good assessment.”

Have a plan in mind of what you will do if you find something during your exam. You will have to use your best judgment about how to handle that based on the patient and the situation. Do you ask the patient to put the item somewhere safe or do you back away and call for law enforcement? I would also use caution if a weapon is found while assessing a patient with an altered level of consciousness (ALOC). It might be best to enlist law enforcement help at that point. Attempting to remove a concealed gun or another weapon from an ALOC patient might be dangerous as they may take unpredictable actions when they feel that weapon being removed.

4. Partner communication

Do you and your partner have a code word or phrase that you could say to each other if something on scene triggers your safety senses? If you suddenly told your partner to come out and help you with the stair chair, would they know to leave all the kits and equipment behind and get out? Consider having some form of signal, but be sure it is something you both can remember and that it isn’t something that could come up in normal, safe communication.

During ambulance transport, can the driver see or at least hear their partner in the back? Don’t rely on a buzzer and don’t assume that they will be able to come up to the little window to talk to you. Keep the music turned down and tune your ears to what is going on in the back.

5. Provider safety legislation

Finally, does your state have legislation that makes it a higher-level offense to assault public safety providers and healthcare workers? Many states are beginning to enact such laws. Check with your state EMS associations or contact your elected officials to get bills started.

Be safe out there.

Additional resources for scene safety

Learn more about assessing and maintaining a safe scene for EMS providers with these resources from EMS1:

Michael Fraley has over 30 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.