The mother of a 13-year-old girl gave me a wake-up call several weeks ago. After her daughter overdosed on heroin, her husband rushed home from work following a panic-stricken call. On the way, he passed an ambulance idling on a roadway several blocks from their home. That same ambulance later arrived to provide care but only after law enforcement appeared on scene. I knew exactly what the ambulance was doing--staging until the scene was safe. Trying to explain this protocol to the mother of a child who nearly died as a result was difficult. She posed a question, “While my daughter lay in her bed dying, your paramedics and firefighters were hiding. So I’d like to know: Is your priority to provide emergency medical services to the people of this community or to stand by, watching out for yourselves while people die?” I have thought long and hard about that phone call.
EMTs learn about scene safety from the very beginnings of their training. The concept is drilled on and tested, often becoming a chant uttered at the start of every practical skills evaluation. Law enforcement learned a game-changing lesson 17 years ago in Columbine, Colorado: If you don’t enter the scene immediately and take action, more people will die. Their time-honored “Surround the building, set up a perimeter, and contain the damage” tactic went by the wayside. Since then, countless lives have been saved in active shooter and other hostile events. EMS may well be 17 years behind the police.
Truth be told, no scene is safe. Any emergency responder with a little field experience can recall a response where a seemingly benign scene turned violent. Law enforcement doesn’t describe scenes as “safe” but rather “secure,” implying that they have some perceived degree of control over the perimeter. To believe that a scene is safe merely because law enforcement is present is delusional. The fact of the matter is that public safety and emergency response are inherently risky and sometimes dangerous. Nothing is this business is predictable.
Law enforcement officers know that their response to an active shooter will require them to immediately enter the premises and, at great personal risk, locate and stop the killer. Firefighters expect that they will need to charge into a burning building, also at great personal risk, to locate and extinguish the fire. EMS providers expect someone else to eliminate any potential risk or danger before they consider it safe to provide lifesaving care. The first priority of EMS providers is not, as my wake-up caller said, to save lives but to protect ourselves–even if it costs someone else’s life. I’m not sure that priority can be sustained in today’s society. Truthfully, it seems horribly and terribly outdated.
The practice of staging EMS resources for every unresponsive patient where drugs or alcohol are involved, every suicidal threat, every elderly nursing home patient who assaults a staff member, every psychiatric-related call, and every response where law enforcement is dispatched needs to stop. Refusing to enter an active shooter or hostile event scene with a police escort to render immediate care to dying victims also needs to end. This paradigm shift will not be easy and cannot happen overnight. It will take time, money, equipment, and training.
I’m not sure how EMS became so risk adverse. Forty years ago when I started working in the streets, we didn’t wait for the police. We stood to the side of the doors we knocked on, parked next door to suspicious scenes, never turned our backs on a patient, and paid a lot of attention to situational awareness. When things looked bad, we left the scene, often with the patient in tow. Over the years, EMS has drifted far apart from our public safety brothers and sisters in our ability and willingness to acknowledge, recognize, and effectively manage the risks we all face. As a consequence, the public is beginning to question our ability to do our jobs.
Situational awareness needs to be resuscitated in EMS. Our providers need training in recognizing and diffusing hostile events, minimizing risks, and preventing injuries when violence erupts. Every EMS responder should be equipped with an active shooter response kit including ballistic protective equipment (BPE) such as a level III steel-plated vests and IIIA helmets. Crews should train and practice with local law enforcement in the Rescue Task Force Concept, Tactical Emergency Casualty Care (TECC), implementation of Casualty Collection Points (CCPs), and common operating language and radio frequencies. All of this takes time, but it can and must be done. When people are dying, they call us for help and expect us to respond. Hiding around the corner is no longer acceptable to the public we are sworn to protect. I know I have a lot of work to do at home.
EMS Editor – Fire Engineering