The Gravity of the Situation

In a prolonged situation with law enforcement in charge, what are caregivers’ concerns?


Attack One responds to a report of a police standby. This call began with an unruly customer in a local bar and grill, and just as officers arrived, the man ran from the establishment and climbed up a 35-story crane at a building site next door. The police have asked for EMS assistance as they prepare for a standoff.

The Attack One crew receives a rapid briefing. The man is a murderer who escaped from custody in another state, stole a car and drove to this city. He entered the restaurant, where he ate a meal, drank a significant quantity of alcohol and then ran out to the adjacent construction site. That is the site of a future skyscraper, with about 15 floors already in steel and concrete. The crane serving the site has a horizontal arm about 200 feet above that, or about 350 feet off the ground. It is not being used at this time. The man climbed all the way up the vertical element of the crane, being chased by two police officers. Once at the top, he pulled up a segment of the ladder so he could not be reached directly.

After reaching the top, the man became very hostile, breaking off pieces of the crane and throwing them at the officers on the lower part of the ladder and persons on the busy street below. Unfortunately, when the crane operator had finished work the day before, he’d left the crane’s horizontal arm extended out over the street, allowing the man to drop or throw objects (now including his own waste) on the cars and pedestrians beneath. So the street was shut down, the special operations law enforcement team activated, and the crane left inoperable. As the law enforcement operation ramped up, EMS was called for the safety of law enforcement, bystanders and the hostile man.

The Attack One crew member in charge listens to the original briefing, meets the law enforcement senior officer in command, and notifies the on-duty fire chief to report to the scene. Within an hour, the lead members of the police department and fire-EMS at the site conduct an incident management meeting and start planning a prolonged operation. The man has been increasingly aggressive, moving around, breaking pieces and threatening officers and the crowd that has gathered below. His criminal record indicates he is dangerous, and his current behavior gives every indication he will not cooperate for any rapid resolution of the incident.

The initial incident management meeting results in creation of an incident action plan (IAP) based on a model developed and used daily by the fire-EMS agency. Originally in handwritten form, it outlines the initial critical elements of the incident. A Planning Section will be created and empowered to develop a detailed plan over the next 12 hours. In the meantime, the initial plan briefly outlines these elements:

Law enforcement is in charge of the operation, with an on-scene police major designated as Incident Commander. Leadership will change only if the man finds a way to access the crane operator’s booth and use the crane as a weapon or set it on fire—that would create a life-safety hazard, at which point the senior fire-EMS officer would temporarily take charge of the operation. Otherwise law enforcement is in charge of the operation and investigation, and will be assisted by federal law enforcement agents who have now arrived at the scene.

From the beginning, the major feels this will be a prolonged incident. Based on his experience with determined and desperate criminals in the past, he prepares his forces for an operation lasting three or more days. He suggests fire-EMS set up for a similar duration. He designates three important elements of the law enforcement operation, to rotate on a staggered basis. He will rotate his law enforcement command staff and PIO in 12-hour shifts; his highly trained SWAT members, who will be up on the crane, in 8-hour shifts; and regular uniformed officers on normal 6-hour shifts to provide perimeter control. Investigation staff will be kept on call and summoned only if the incident appears to be coming to resolution.

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