When you fight a fire in a structure, you always take into consideration egress points. When working your way through a structure, you should be consciously making notes of exit doors or windows. If you really get lazy, you can just follow the hoseline out. But on EMS calls, there is no hoseline to follow out. Just like in structural firefighting, as you enter the building you should be continually making mental notes of egress points for a quick exit if the scene goes bad. If possible, don't put a hostile patient or family member between yourself and the door. Always leave room to exit quickly without getting into a physical altercation with the person between you and the door.
There is a saying, "The person on the scene with the loaded and pointed weapon is always the incident commander even if they are a civilian." Swallow your pride and don't try to be a hero. You are no longer calling the shots and in charge of the scene. Sometimes, negotiation will get you out of harm's way.
During the Rodney King riots in Los Angeles in 1993, a fire captain successfully negotiated the release of himself and his company after being confronted by a hostile gunman. His bargaining chip was a portable radio that he handed over to the gunman.
If your name tag has your first and last name on it, and you are listed in the telephone book, change one or the other. Sometimes, a patient's condition while in your care will deteriorate. He or she may even die. Not having a medical background, a family member may not realize you did everything you could. Unfortunately, the family member blames you for the loss of the loved one. Not all angry family members visit their lawyer when seeking retribution. For that reason, put only your last name on your name tag or unlist your telephone number.
Whenever I was approaching a structure and there was a fence around the property, I always looked for the little worn path along the fence in the front of the house. The worn path was always a good indication there is a dog somewhere in the yard. The last thing I wanted was to go into the yard and have a dog charge at me from under the porch or in the backyard.
Weapons on a scene, usually from a suicide, can pose a challenge. How do we safely perform our job without disturbing the crime scene? This can be done several ways. First, if the police are on the scene, have them secure the weapon. If they want to leave the weapon in place in order to keep the crime scene intact, have a member of an engine company get a bucket, place it over the weapon and, if necessary, put their foot on top of the bucket until all fire department personnel have exited the scene. The thought here is to place someone in charge of the weapon for safety purposes. In this manner, the gun could not be accidentally kicked or stepped on, creating an accidental discharge.
If you ever respond to a shooting at an apartment building or other multi-family residence, and there are bullet holes in the wall, floor or ceiling, check on the people in the apartment adjacent to where the bullet hole is. Bullets with high velocity can easily penetrate drywall and other construction products and possibly injure or kill someone in another apartment in the building.
Whenever you arrive on a shooting scene and you see shell casings lying around, the person has been shot with an automatic or semi-automatic weapon. Bullets discharged from a handgun with a cylinder will not discharge the shell casings. If the person has been shot with an automatic or semi-automatic weapon, expect multiple wounds and significant injuries, since these weapons usually are more destructive to the human body.
Never take female gang members lightly. It does not take much exertion to pull a trigger and many female members of gangs carry weapons for the gang, usually because they are underage and cannot be charged with a felony for carrying a concealed weapon.
Items that you carry on your body or are part of your uniform can be used against you. I personally never wore a uniform tie that I had to tie. I always wore a clip-on tie. Why? If a hostile patient, family member or bystander ever became physical and tried to grab me by my tie, the tie would come right off. With the other type of tie, they would have been able to pull me in different directions.
A stethoscope in the hands of the wrong person can be used as a weapon. The device can be used to either choke you or hit you with the metal found on the end. Pens sticking out of your pocket can be used as a blunt instrument. Several years ago, while I was teaching a class on scene safety in Florida, a police officer provided me with a picture of another police officer sitting on a stretcher in an emergency room with a ballpoint pen protruding just to the side of her left eye. During a struggle with a prisoner, the prisoner grabbed the pen from her pocket and attempted to stab her in the eye.
And finally, don't hesitate to use words like "thank you," "please" and "sorry." Many times, showing respect will earn respect. By earning respect, many times you can prevent a dangerous event from even occurring.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, serves as the director of emergency services for Jefferson County, MO, located 30 miles south of St. Louis. He retired as chief paramedic from the St. Louis Fire Department after serving the City of St. Louis for 24 years. Ludwig has trained and lectured internationally and nationally on fire and EMS topics. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 314-752-1240 or via www.garyludwig.com.
