SUBJECT: Vehicle Rescue Scene Safety
TOPIC: Patient Protection Guidelines
OBJECTIVE: Review practices and procedures for patient protection at vehicle rescue scenes.
TASK: The rescue team shall review the department's standard operating procedures for vehicle rescue incidents and shall incorporate the concept of "Cover Your Sharps, Do No Harm" into the operational guidelines.
There is a long-standing urban legend that claims that physicians, at the time they officially become doctors, take an oath that states in part, "Do No Harm." While this is not exactly true, the modern version of what is commonly referred to as the Hippocratic Oath does include a statement that reads, "I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous."
How does the Hippocratic Oath have anything to do with extrication? In principle, the concept of "Do No Harm" to a patient is a great one for vehicle rescue responders to abide by. No patient should be further injured by us during their rescue and extrication because of something we did to cause a hazard or something we did not do to protect them from hazards present at the scene.
The National Volunteer Fire Council (NVFC) publishes a quick-reference chart related to general responder liability at fire and rescue scenes (http://nvfc.org/index.php?id=875). It is comforting to see that in almost every state in this country, responders have some sort of immunity from liability at incident scenes. The stark reality, though, is that each state has exceptions to this protection. Arizona responders, for example, are held liable for any personal injury that results from activities at a rescue scene if "willful misconduct or gross negligence" can be proven. Florida law mentions "reckless disregard of the consequences" and Louisiana law speaks of "exhibiting gross negligence."
What is expected by the citizens we serve is that when we arrive on scene and begin activities at a vehicle rescue incident, things will get better. They will be better off because we are there than they would be if we were not present. In Arkansas, responders who act "in a reasonable and prudent manner" will not be held liable for civil damages and that is the expectation we must strive to achieve; to conduct reasonable and prudent activities in all we do.
The philosophy of "Do No Harm" should be an integral component of every vehicle rescue team's standard operating guidelines. The most obvious activity that can make this motto a reality is to "cover" all physical hazards; those resulting from the original collision and especially those physical hazards that we, the rescue team, created during our rescue and extrication work. Broken glass and sharp metal are just two physical hazards that come to mind as being frequently encountered. If we, as trained rescuers, do not protect an injured patient from common hazards such as shards of broken glass or jagged edges of sharp metal, we are negligent, reckless or acting with willful misconduct.
Since even the most basic vehicle rescue class includes dealing with physical hazards on the vehicle itself, we cannot say that we were not aware that glass and metal are hazardous. If our patient is injured during the extrication, it could easily be shown that we acted with a reckless disregard of the consequences. So let's prevent injuries to our members and our patients. Let's all practice the concept of "Do No Harm" by taking positive actions to "Cover Your Sharps." If you break out a window or cut into the windshield, then part of your assignment must be to ensure that the patient is protected before you start, during your work and afterward. If you cut metal or pry something to create a jagged or sharp edge that could injure someone, then it's your responsibility to take care of that hazard before, during and after. No excuses. "If You Make It, You Cover It."
Use duct tape, commercially available protective pads, specially designed fire-resistive blankets or any of the many homemade means of covering these hazards. Your patient doesn't care what you use as long as it works to keep them safe.
In summary, here are three patient protection principles to be thinking about. First, "Do No Harm". Second, "If You Make It, You Cover It." Finally, "Cover Your Sharps." These guidelines should be an obvious part of your vehicle rescue protocols, your training program and your on-scene actions. You figure out how to make them fit into your guidelines. A reasonable and prudent person would.
TASK: The rescue team shall review the department's standard operating procedures for vehicle rescue incidents and shall incorporate the concept of "Cover Your Sharps, Do No Harm" into the operational guidelines.
