"We Coulda Got Shot!" A Case Study in Situational Awareness
Dec 27, 2016 16:39:46 GMT -6
sharpjere likes this
Post by Deleted on Dec 27, 2016 16:39:46 GMT -6
We coulda got shot! - A Case Study in Situational Awareness
‘How setting up - and keeping to - a strict routine for certain calls can keep you safe.’
The Guts – Welcome to the circus!
The Patient – Sitting on the front porch, no shirt, gym shorts, shoes. Pt didn’t seem to be aware of all the action happening on the porch less than 10 feet away.
The Scene – Fire, EMS, EMS Supervisor, multiple Law Enforcement Officers (LEO’s), weapons drawn. Also, EMS noted multiple people east of the scene coming out of their houses, walking down the sidewalk toward all the flashing lights and rushing responders.
Assessment – Pt had obvious cut (entry wound?) on R cheek, fatty tissue noted, slight bleeding. No other injuries (bullet holes) noted on patient. Pt’s eyes were open, but not focusing on anything or anyone. Pt was breathing normally, and had a radial pulse.
Initial Treatment – Drag the patient over the rail, onto the stretcher, and hustle to the ambulance. Rapid and secondary assessments performed en route.
The Call/Dispatch – We were attending a ventilator class. If I remember right, my Paramedic partner was looking up the call on his phone while walking out to the ambulance, and noticed that there was something in the notes about someone getting shot. The initial dispatch was for ‘EMS Response,’ upgraded to ‘Gunshot Wound,’ while we were en route. We were still within our response box, but a few miles from the area. We responded emergency, but down-graded once we got off the interstate.
**This would have been the time to switch radio channel to monitor ‘Main Law’ to provide a real-time picture of the scene we were headed toward. A good example of all agencies communicating on 1 frequency, even speaking directly to each other so we’re all on the same page with a ‘game plan’ and expectations when we’re all on scene.
The further information from dispatch was that a man went to a house, knocked on the door, asking for an ambulance because he’d been shot. There was no information from him about where he’d been shot, where he was when he was shot, or how long ago the attack occurred. We then heard our supervisor staging, so my Paramedic partner contacted him by cell phone to find out where he was staging so we could join him at a ‘rally point.’
**This concept may be important for similar incidents. A place to prep (vest up if needed), share information, and create a ‘game plan.’ Rally point for Fire and EMS while scene is being secured in potential volatile situation.
But, as we made phone contact with EMS Supervisor, dispatch relayed that Fire and EMS could respond in.
Arrival On Scene – We proceeded up the street, saw Fire drive across the main road. We bypassed the target street, and my Paramedic partner noticed several LEO vehicles, the EMS supervisor Tahoe, and Fire parked along the street. We turned and circled the block to get a rapid, straight egress route from the target address.
**Probably the only thing we did well to prep for this whole situation.
As we came to a stop, the Fire officer and firefighter were RUNNING toward the ambulance to get the stretcher. As we pushed the stretcher up to the scene, we were told by LEO and the EMS Supervisor to stay away from the windows and door, because the house hadn’t been cleared yet.
**So why were we there?!?!?!?
As we were unbuckling the stretcher straps to get the patient off the porch, we noticed 2 LEO officers, weapons drawn and at the ready, ‘stacking’ at the doorway, preparing to make entry.
**You guessed it. The house wasn’t cleared. They hadn’t even been inside yet!
Our patient extraction and initial treatment were determined 100% by scene safety, 0% on patient condition.
Initial Assessment – The patient was lethargic, not assisting with extraction. He wasn’t resisting, either, while being lifted by 5 strangers and dragged over the side rail of this front porch. We noticed a 2-cm laceration on his R cheek, fatty tissue noted, not much bleeding. The assumption was that this was a bullet wound. No other wounds noted, but we also noted some blood coming down behind his right ear. Once we got him into the ambulance, he still hadn’t said a word. We sat him forward, checked his back, and the back of his head, nothing else found. The monitor showed sinus bradycardia, and his BP was slightly elevated, further evidence of a possible head injury. I then had my Paramedic partner shine a bright light at the outside of the patient’s cheek as the patient opened his mouth wide. This accomplished a couple things quickly. The patient could follow commands, and it didn’t appear to be a large hole in his cheek. Also looked into the patient’s mouth, no blood seen. The patient would only tell us his name, and told my Paramedic partner that he didn’t like needles after the IV was started. My Paramedic partner saw what was a possible bullet wound above his right ear, small wound, no tenderness when pushed on and around.
Treatment – There honestly wasn’t much to do with the patient once we hustled off the street. We had him sitting up, and he was mostly supporting himself in this position. His breathing was normal, we had IV access if we needed to give him anything, but since he wasn’t answering too many questions, we didn’t know if he was in pain. His BP was elevated, he had a pulse, and the monitor showed his heart was still beating. He would open his eyes when we talked to him and asked him questions, but we didn’t get any answers. So, all told, something we could work with, but not much we could really do to improve his condition. It was possible that he still had a bullet in his head that we didn’t know about. And, the black cloud hovering over all of us, was the fact that we were ‘cleared in’ in the first place.
What did we miss? – We couldn’t give the Trauma Team a clear picture of what had happened to the patient. We didn’t know when he’d been shot, or where he was when it happened. We didn’t even know what kind of weapon was used. We could deduce that it was a small caliber pistol due to the sizes of the wounds, as well as a lack of exit wounds. The timeline that we could see rereading dispatch notes was, by the earliest, it had been at least 10 minutes before we arrived on scene. And that’s just when the resident had called 911, so how long had it taken the patient to get to where we found him? I don’t remember seeing any blood on the chair he was sitting in, or on the porch. That’s the medical end.
Tactically, we had multiple chances to protect ourselves, and each other, but we passed them up in order to ‘Get in and Get out.’ The only other responder vested up on scene was the EMS Supervisor, and he vested up after arriving and seeing the chaos at the front door. Looking back on the incident, from dispatch to returning to service, there were so many opportunities for safety checks that were passed up just so we could get it over with.
Aftermath – We are not combat-trained personnel. This is the biggest take-away from situations like this one, where security does get overlooked, and on-scene stresses muddle the decision-making process for all involved.
**Sometimes, the best way to stay safe on scene is to not be on scene in the first place.
That is a difficult reality for some to see, especially when peer pressure can lead us to ‘be a hero,’ not lose face, and have great stories to tell.
*Some of us (EMS and Fire) have military training, even combat experience. But we are civilians working for para-military agencies with a service-based mission. This means we have a command-style rank structure and clear expectations from our leadership to which we are accountable. But our current level of training doesn’t include formal scenario-based discussions or table-top visualizations to ‘game out’ various scenarios and expectations.*
Here are a few tactical take-aways, which can be summed up with 2 principles: First, monitor the right radio channel. Second, quickly establish a rally point, and communicate with other units to prepare for whatever we may encounter on scene.
-We weren’t monitoring the Main Law channel on comms, which would have let us know that the first arriving officers wanted more bodies to secure the scene. Looking back at dispatch notes, the Main Law channel was Restricted 2 minutes prior to responders arriving on scene, and was opened 12 minutes later. Simultaneous to our arrival, officer on scene requested 3 more units to secure the house, ‘Scene isn’t stable. . .Units to the target, to clear the house,’ that we were standing in front of. 2 local schools were locked down, 1 of which was a large high school 2 blocks from the scene.
-No one was on the same page on scene. There was no clear communication with each other. There were a few directions given while on scene, but nothing prior to arriving. The scene was chaotic, and took a few minutes to sort out. Those few minutes weren’t critical to patient survival, so they could’ve been better used to ensure a quick, relatively safe and organized, patient extraction. Making plans on the fly worked here, but what if something required us to remain on scene longer? What if the patient out front was stable, but there was a critical patient inside? We had no idea, because nothing was being shared, and no cautions were relayed except face-to-face on arrival, when it was too late to prepare for the unknown
I ran into the Fire crew a week later on another call. After treating and releasing the patient, I spoke with the officer and crew members about That Call. The Lt. was still furious that we were cleared in to that scene, and he had sent some emails and made phone calls up his chain of command almost immediately after returning to the firehouse. He said that, to a man, his chain of command understood his situation, his frustrations, and supported his desire to see changes made. His crew shared the same sentiments, and was supportive of making sure that something changed within the Responder Culture so that other personnel were not placed in a similar dangerous situation.
Personally, my desire is that we remind each other of the reality we all face when we clock in and start our shifts on the trucks. This is a Big Girl/Big Boy Job, and we do potentially have lives literally in our hands. Not only that, this community does contain people who think differently than we do. Those folks have no qualms about using violence to settle differences, whether it’s taking a swing at someone who does something they don’t want, using a weapon to make their point or to settle a score. Every call we go on has the potential to go sideways.
‘How setting up - and keeping to - a strict routine for certain calls can keep you safe.’
The Guts – Welcome to the circus!
The Patient – Sitting on the front porch, no shirt, gym shorts, shoes. Pt didn’t seem to be aware of all the action happening on the porch less than 10 feet away.
The Scene – Fire, EMS, EMS Supervisor, multiple Law Enforcement Officers (LEO’s), weapons drawn. Also, EMS noted multiple people east of the scene coming out of their houses, walking down the sidewalk toward all the flashing lights and rushing responders.
Assessment – Pt had obvious cut (entry wound?) on R cheek, fatty tissue noted, slight bleeding. No other injuries (bullet holes) noted on patient. Pt’s eyes were open, but not focusing on anything or anyone. Pt was breathing normally, and had a radial pulse.
Initial Treatment – Drag the patient over the rail, onto the stretcher, and hustle to the ambulance. Rapid and secondary assessments performed en route.
The Call/Dispatch – We were attending a ventilator class. If I remember right, my Paramedic partner was looking up the call on his phone while walking out to the ambulance, and noticed that there was something in the notes about someone getting shot. The initial dispatch was for ‘EMS Response,’ upgraded to ‘Gunshot Wound,’ while we were en route. We were still within our response box, but a few miles from the area. We responded emergency, but down-graded once we got off the interstate.
**This would have been the time to switch radio channel to monitor ‘Main Law’ to provide a real-time picture of the scene we were headed toward. A good example of all agencies communicating on 1 frequency, even speaking directly to each other so we’re all on the same page with a ‘game plan’ and expectations when we’re all on scene.
*Random memory – while ‘running hot’ down the interstate, we saw a man, presumed to be homeless, climbing over the center divider. Not something you see every day.*
The further information from dispatch was that a man went to a house, knocked on the door, asking for an ambulance because he’d been shot. There was no information from him about where he’d been shot, where he was when he was shot, or how long ago the attack occurred. We then heard our supervisor staging, so my Paramedic partner contacted him by cell phone to find out where he was staging so we could join him at a ‘rally point.’
**This concept may be important for similar incidents. A place to prep (vest up if needed), share information, and create a ‘game plan.’ Rally point for Fire and EMS while scene is being secured in potential volatile situation.
But, as we made phone contact with EMS Supervisor, dispatch relayed that Fire and EMS could respond in.
Arrival On Scene – We proceeded up the street, saw Fire drive across the main road. We bypassed the target street, and my Paramedic partner noticed several LEO vehicles, the EMS supervisor Tahoe, and Fire parked along the street. We turned and circled the block to get a rapid, straight egress route from the target address.
**Probably the only thing we did well to prep for this whole situation.
As we came to a stop, the Fire officer and firefighter were RUNNING toward the ambulance to get the stretcher. As we pushed the stretcher up to the scene, we were told by LEO and the EMS Supervisor to stay away from the windows and door, because the house hadn’t been cleared yet.
**So why were we there?!?!?!?
As we were unbuckling the stretcher straps to get the patient off the porch, we noticed 2 LEO officers, weapons drawn and at the ready, ‘stacking’ at the doorway, preparing to make entry.
**You guessed it. The house wasn’t cleared. They hadn’t even been inside yet!
Our patient extraction and initial treatment were determined 100% by scene safety, 0% on patient condition.
Initial Assessment – The patient was lethargic, not assisting with extraction. He wasn’t resisting, either, while being lifted by 5 strangers and dragged over the side rail of this front porch. We noticed a 2-cm laceration on his R cheek, fatty tissue noted, not much bleeding. The assumption was that this was a bullet wound. No other wounds noted, but we also noted some blood coming down behind his right ear. Once we got him into the ambulance, he still hadn’t said a word. We sat him forward, checked his back, and the back of his head, nothing else found. The monitor showed sinus bradycardia, and his BP was slightly elevated, further evidence of a possible head injury. I then had my Paramedic partner shine a bright light at the outside of the patient’s cheek as the patient opened his mouth wide. This accomplished a couple things quickly. The patient could follow commands, and it didn’t appear to be a large hole in his cheek. Also looked into the patient’s mouth, no blood seen. The patient would only tell us his name, and told my Paramedic partner that he didn’t like needles after the IV was started. My Paramedic partner saw what was a possible bullet wound above his right ear, small wound, no tenderness when pushed on and around.
Treatment – There honestly wasn’t much to do with the patient once we hustled off the street. We had him sitting up, and he was mostly supporting himself in this position. His breathing was normal, we had IV access if we needed to give him anything, but since he wasn’t answering too many questions, we didn’t know if he was in pain. His BP was elevated, he had a pulse, and the monitor showed his heart was still beating. He would open his eyes when we talked to him and asked him questions, but we didn’t get any answers. So, all told, something we could work with, but not much we could really do to improve his condition. It was possible that he still had a bullet in his head that we didn’t know about. And, the black cloud hovering over all of us, was the fact that we were ‘cleared in’ in the first place.
What did we miss? – We couldn’t give the Trauma Team a clear picture of what had happened to the patient. We didn’t know when he’d been shot, or where he was when it happened. We didn’t even know what kind of weapon was used. We could deduce that it was a small caliber pistol due to the sizes of the wounds, as well as a lack of exit wounds. The timeline that we could see rereading dispatch notes was, by the earliest, it had been at least 10 minutes before we arrived on scene. And that’s just when the resident had called 911, so how long had it taken the patient to get to where we found him? I don’t remember seeing any blood on the chair he was sitting in, or on the porch. That’s the medical end.
Tactically, we had multiple chances to protect ourselves, and each other, but we passed them up in order to ‘Get in and Get out.’ The only other responder vested up on scene was the EMS Supervisor, and he vested up after arriving and seeing the chaos at the front door. Looking back on the incident, from dispatch to returning to service, there were so many opportunities for safety checks that were passed up just so we could get it over with.
Aftermath – We are not combat-trained personnel. This is the biggest take-away from situations like this one, where security does get overlooked, and on-scene stresses muddle the decision-making process for all involved.
**Sometimes, the best way to stay safe on scene is to not be on scene in the first place.
That is a difficult reality for some to see, especially when peer pressure can lead us to ‘be a hero,’ not lose face, and have great stories to tell.
*Some of us (EMS and Fire) have military training, even combat experience. But we are civilians working for para-military agencies with a service-based mission. This means we have a command-style rank structure and clear expectations from our leadership to which we are accountable. But our current level of training doesn’t include formal scenario-based discussions or table-top visualizations to ‘game out’ various scenarios and expectations.*
Here are a few tactical take-aways, which can be summed up with 2 principles: First, monitor the right radio channel. Second, quickly establish a rally point, and communicate with other units to prepare for whatever we may encounter on scene.
-We weren’t monitoring the Main Law channel on comms, which would have let us know that the first arriving officers wanted more bodies to secure the scene. Looking back at dispatch notes, the Main Law channel was Restricted 2 minutes prior to responders arriving on scene, and was opened 12 minutes later. Simultaneous to our arrival, officer on scene requested 3 more units to secure the house, ‘Scene isn’t stable. . .Units to the target, to clear the house,’ that we were standing in front of. 2 local schools were locked down, 1 of which was a large high school 2 blocks from the scene.
-No one was on the same page on scene. There was no clear communication with each other. There were a few directions given while on scene, but nothing prior to arriving. The scene was chaotic, and took a few minutes to sort out. Those few minutes weren’t critical to patient survival, so they could’ve been better used to ensure a quick, relatively safe and organized, patient extraction. Making plans on the fly worked here, but what if something required us to remain on scene longer? What if the patient out front was stable, but there was a critical patient inside? We had no idea, because nothing was being shared, and no cautions were relayed except face-to-face on arrival, when it was too late to prepare for the unknown
I ran into the Fire crew a week later on another call. After treating and releasing the patient, I spoke with the officer and crew members about That Call. The Lt. was still furious that we were cleared in to that scene, and he had sent some emails and made phone calls up his chain of command almost immediately after returning to the firehouse. He said that, to a man, his chain of command understood his situation, his frustrations, and supported his desire to see changes made. His crew shared the same sentiments, and was supportive of making sure that something changed within the Responder Culture so that other personnel were not placed in a similar dangerous situation.
Personally, my desire is that we remind each other of the reality we all face when we clock in and start our shifts on the trucks. This is a Big Girl/Big Boy Job, and we do potentially have lives literally in our hands. Not only that, this community does contain people who think differently than we do. Those folks have no qualms about using violence to settle differences, whether it’s taking a swing at someone who does something they don’t want, using a weapon to make their point or to settle a score. Every call we go on has the potential to go sideways.
