Beyond the Basics: Scene Safety
Of all the tasks we perform as part of the patient assessment process, scene safety is arguably the most important.
Violence Prevention
Violence prevention should be the primary safety goal of anyone responding to a scene.
Observation is key to avoiding danger before you are forced to deal with it. A concept called situational awareness is important for efficient observation. Situational awareness is focusing your senses at an emergency scene to observe and detect violence before it is too late. Because most calls are uneventful and without danger, it can be difficult to believe that the next call could pose a danger. This results in a casual, nonobservant attitude.
There are different levels of awareness or observation. If you are responding to a nursing home for a transfer, you probably expect a lower potential for danger than when pulling up in front of a dark residence in a part of town that has a reputation for a higher incidence of violence. The concept of situational awareness acknowledges that violence could be anywhere (nursing home or a bad part of town) but the probability and type of danger found in one area may be greater than another.
Looking at awareness on a 0-10 scale, 0 is essentially asleep, while 10 is panic, neither of which is appropriate for the field. Responding to any call with an awareness level of about 3 or 4 is appropriate. Remember, you are responding to an emergency, and unpredictable things can happen. As you respond to the call, be alert for signs of danger, including information from your dispatcher that there may be yelling, intoxication or a history of violent calls at the address.
When you arrive at the scene, your observations will also add to your suspicion of violence. Facts to consider are the location, things you see and hear, and any obvious signs of violence or disturbance. Sometimes, unusual quiet is suspicious in itself.
If you arrive on a scene and all appears well, you will exit the ambulance, approach the scene and begin patient care. Maintain a sense of awareness even as you care for your patient, since emergency scenes are dynamic.
If you arrive on the scene and find danger, do not enter. Leave, and request law enforcement to secure the scene.
There are many gray areas in EMS between the safe and unsafe scenes described in the previous paragraphs. In many cases, you arrive on scene and develop a slight sense (sometimes called a gut feeling) that something is wrong. It isn't anything concrete, but it is a sense you can't ignore. This is the true application of situational awareness. On the imaginary 0-10 scale, raise your awareness level. If you decide to approach the scene-and in many cases, there may be no reason not to do so-raise your awareness level to a 6 or 7. Move slowly and carefully. Watch windows and doors. Have the dispatcher call back to the residence and ask an occupant to come out to meet you when possible.
When approaching a scene cautiously, use the following tactics:
- Turn off your lights and siren in advance of arrival. This prevents broadcasting your arrival and drawing larger crowds.
- Take a nontraditional approach to the door. Those inside the residence will expect you to take the walkway. Don't.
- Observe and listen carefully for signs of danger as you approach. Look for motion in windows. Listen for signs of fighting (loud voices, items breaking) or intoxicated persons. Note darkness and unusual silence as a concern at a scene where an emergency is allegedly taking place.
- When standing at the doorway, listen before knocking. Stand on the doorknob side of the door (opposite the hinges) when possible. Never stand directly in front of a door.
Using increased awareness and appropriate approach tactics will result in one of two resolutions: carefully moving toward the scene and discovering it is safe, or identifying a danger early and retreating until law enforcement can secure the scene.
Scene Safety Tactics
When you identify potential danger, or if you find yourself suddenly in a violent scene, there are tactics that will help you respond appropriately and retreat from the danger.
