The first thing an EMS instructor hears when a student enters a skill testing station is “BSI and scene safety.” Generally those words are then not seen or heard again until refresher. BSI (body substance isolation) and scene safety are two of the most important parts of EMS, because they keep us and our families safe. BSI is the first component of all EMS skill sheets, and scene safety always immediately follows. But what exactly are they?
Every EMS provider should know that body substance isolation consists of the appropriate equipment and practices to protect them from patients’ blood and other bodily fluids. The equipment includes disposable gloves, mask and face shields, gowns and disposable booties. It has been my experience that most EMS providers, regardless of their level of training, are relatively cognizant of and practice BSI. But what about scene safety?
I have seen scene safety defined in many different ways. If I had to define it, I would say it is ensuring that you and your partner will be able to operate to your level of training with minimal risk of illness or injury. Here is my reasoning: As a paramedic, I accept there are certain risks with which I will come into contact that are beyond my control. If every scene had to be completely hazard-free, I would never be able to treat a patient. The trick is trying to make the scene as safe as possible for you and your partner to work in.
Below are some tips based on my experiences in urban EMS systems like New York City and Jersey City, as well as a suburban system in Bergen County, NJ.
• Review call data—En route to the call, continuously monitor your MDT or dispatch radio for any updates. Review the location to which you’re responding and determine if you have been there before or if it’s known for problems. If you are responding to a “street job” or call on a roadway, don your ANSI-approved reflective vest. Position your vehicle in the appropriate manner and be sure to look for oncoming vehicles before you exit yours.
• Your partner—Be sure to discuss any feelings or concerns with your partner. In my career I’ve been fortunate to have had great working relationships with my partners and a sort of “sixth sense” of what they were thinking. We were usually more like one large brain in two bodies than two individuals. I was able to read their body language and facial expressions to know if they felt we were in danger, and I know they could do the same with me. Unfortunately, not all EMS providers are lucky enough to have partners like this. My suggestion is to determine a “safe word” one EMT or paramedic can say to the other if they’re concerned without alerting anyone else on scene. This could be as simple as saying your full name to your partner.
• Roadway scenes—If you are operating on a roadway, be alert to the traffic around you and note any warning devices in place. Although patient care is a priority, remember scene safety. Place road flares according to local laws to ensure oncoming motorists see your ambulance. Be cognizant when operating around curves. Be sure to place road flares beyond the line of sight of the ambulance as well.
Do not attempt to cross any roadways unless they are completely shut down and this is confirmed by law enforcement. A good tip is to have the law enforcement agency closing the roadway advise you of the last vehicle they let through. Ascertain the vehicle color, model and plate number. Once that vehicle passes, you know crossing the roadway is safe. It is also imperative that you do not attempt to leap over any gaps in the roadway, as you can easily slip and fall into that gap and become a patient yourself. Consider the stability of the vehicle and roadway where you’re operating. Be sure to don appropriate PPE.