Have you ever responded to a call that involved a special rescue situation – extrication, trench collapse, grain bin rescue – something other than the norm?
If so, how prepared were you walking up to the scene?
“BSI, scene safety.” We all know that spiel. What’s often neglected from EMS education programs and new-hire onboarding academies is a focus on the multitude of emergencies that we can be called to. After all, we are an emergency medical service!
Tight EMT class schedules, a rush to get providers on the street or a disconnect in the focus behind the emergencies that we can be called to are all factors behind why we – stand-alone or single-role EMS agencies – have neglected to focus our responder training within these disciplines. Fire-based EMS agencies, in fact, have a clear advantage over nearly all (I would bet 99%) of single-role EMS agencies because of their longstanding focus on being an all-hazards response agency.
Well, if your EMS agency responds to 911 calls for help, you (too) need to focus on the same all-hazards that your fire service colleagues do. After all, you’re responding to the same calls. While you might not be the person suiting-up and entering a hot zone, masking-up and entering a confined space or harnessing-up to perform a high-angle rescue, you sure as heck might be the first crew on these very scenes that needs to act now (and, at the very least, not put yourself into a position to become patients No. 2 and 3).
Embracing an all-hazards approach
Start with safety. What could make the situation worse simply by your mere presence and your attempt to act, to make a rescue in clearly unsafe circumstances?
Do you have the proper PPE (e.g., rescue turnout gear, helmets, puncture-resistant gloves)? How about equipment, things like harnesses and rope, personal flotation devices, 4-gas meters?
I’ll bet that in most agencies, the answer is “no,” and that’s OK. What’s important to recognize in these situations is that if you don’t have the right PPE to safely perform a task, then you simply shouldn’t do it; it’s not safe. Instead, call for more help and clarify what you believe might be needed.
Begin with training
While I’m all for adding an additional 20-plus hours of training into an EMT curriculum to accomplish this, I can see how others may not be. If not here, then the next step in the equation would be to place this educational burden on the employers of 911 responders.
Remember, the first letter in EMS stands for “emergency,” and it’s likely placed before “medical” and “service” for a reason. Having said that, let’s do a better job at focusing on the E in EMS moving forward. That means employers are responsible for setting employees up for success by educating and continually training them on the various types of emergencies that they may respond to within your service area.
Now, that’s not to say that you need to prepare for a situation involving a paraglider who crashes into a grain bin in a downtown urban community, which is next to a cold storage facility that is built over a sinkhole with a hidden tunnel system underground, and the incident happened during a blizzard (even though you live in Florida) during a solar eclipse ... oh, and the patient is thought to be COVID positive.
That’s ridiculous.
What is reasonable, however, is to provide all of your employees with hazardous material medical first receiver training (a hospital-based program which blends awareness and operations concepts) – which focuses on patient decontamination and basic scene size-up. It’s also reasonable to teach your crews about vehicle safety during extrication, cribbing and shoring operations. This also holds true for scene safety around trench collapses, fire scenes, building collapses, etc.
Focus on the basic awareness concepts; not the technician-level material. If individuals have a specific interest in particular topics, connect them with your local resources – yes, the very responders that would be accompanying you on these special hazards/operations calls.
Sizing-up the scene (and communicating it, too)
You arrive on scene; now what?
Once again, firefighters and fire-based EMS agencies are much more accustomed to this concept, the practice of providing a first-in report or relaying a scene size-up to incoming units. Well, it’s time that EMS-based EMS responders become comfortable with this practice, too.
What are your conditions? What are your actions? What are your needs? Providing a “CAN” report concisely communicates just this.
“Medic-1 is on scene of a multi-vehicle collision with one car on its side. Medic-1 will perform triage and determine a patient count. Dispatch, send us two additional ambulances and additional fire resources.”
Clear, concise and simple.
All-hazards ... not on all calls
Let’s face it, the majority of 911 EMS calls are for common medical/trauma situations ... I get it. We don’t need to become technicians in multiple response disciplines (and we shouldn’t). For paramedicine providers that solely work within the interfacility transport arena, embracing this concept won’t apply to your operations. But, for agencies responding to emergencies, then I challenge you to embrace an all-hazards EMS safety approach toward educating and preparing your crews. After all, when the tone drops, none of us knows the full extent of what our scenes entail until we arrive ... and once we arrive, the last thing your crews want is to be unprepared and to unknowingly place themselves into an unsafe environment, or to make the situation worse simply by being unaware.
This article, originally published in March 2022, has been updated.
