Lower Kiski EMS (LKEMS) provides service to five communities in Western Pennsylvania, spanning 66 square miles with a population of 14,540, of which 17% is over the age of 65.
Medical alarms have been an increasing concern for our crews. LKEMS does not receive a first responder engine on routine medical calls and not all of our communities have 24-hour police departments. This presented us with the need to be capable of forcible entry when faced with a patient who cannot get to the door to allow crews to enter.
For years we trained with the traditional methods of entry including Hooligan bar, flat head axe, K Tool, jam knife, etc. Many of these techniques are tried and true, but require significant training and physical capability. Employing these devices tends to be quite damaging and require substantial PPE as well.
When the situation involved a patient in distress who was able to understand we were going to force entry, the outcome was usually positive, with the damage to property being a necessary result of the need for care. Medical alarms, however, proved to be a very different situation. When crews were dispatched to a medical alarm with no patient contact, it created the dilemma of finding justification to force entry, but also instilled the crew with a fear of delaying patient care due to a locked door. If we found the resident's car in the driveway accompanied by other signs of the resident being home, we often forced entry but discovered the resident to be away with family. Although we were able to show good intent, the damaged property proved to be a public relations issue.
Crew safety also became quite a concern after we responded to a residence for a medical alarm reported with no patient contact. Upon arrival, crews found a resident's car in the driveway and the television on inside. After many attempts to knock on every door and announce ourselves, the crew was faced with locked doors and no easy way into the residence with every reason to believe the patient was inside in need of care. The crew chose to go through the lock with the irons. As soon as the door was breached, the crew announced themselves and were greeted by the resident who had fallen asleep and awoke to the sound of the crew making entry. She assumed it was someone attempting to break in and had armed herself with a hand gun ready to defend her home. Thankfully this ended peacefully with the resident being understanding of our actions, but this also brought to light a potentially dangerous practice.
In discussing operations, we identified that forcible entry was labor intensive, required significant training, required additional PPE and resulted in damage to the resident’s property. There was also no other way to access a patient who was down in the residence or to determine whether someone was home or not on a medical alarm activation. We started to search for the safest way to address these calls, especially when no police were available or on duty and fire may be on a delay.
While attending the Lancaster County Fire Expo, we found the W-Tool from the Weddle Tool Company. This single tool has solved all of these problems and has become our entry tool of choice. When responding to a medical alarm with no contact with the patient, we are able to access the residence, check on the patient or confirm no patient. If no patient is found, the crew can advise dispatch, have PD assist if available, leave our contact information and resecure the residence with little or no damage. When faced with an emergent situation, the battering ram capability of the tool can be rapidly employed. This tool can be operated by the smallest of our personnel and with little additional PPE.
We have begun placing one of these tools on every medic unit, as well as on the supervisor' vehicle. When we responded to one of the local high rise housing units recently, residents advised they could hear someone calling for help, but the door was locked. Nobody had a key to the apartment and facility maintenance was not on site with no available ETA. The crew was able to utilize the W-Tool to access the apartment. This was a steel door in cinder block construction. When the frame was displaced enough to clear the lock, the door was opened just enough to allow the crew to safely identify themselves before entering. The patent was indeed suffering a medical emergency and unable to get to the phone or door to call for help. The patent was rapidly transported to the hospital. Had the crew not been able to use the W-Tool to open the door, there is no way to know how much of a delay would have been incurred or how significantly the prognosis would have been negatively affected. When the resident returned home, the only evidence found of our entry was a small crack in the plaster above the door. This tool was presented to us as a great concept, which has resulted in a great tool allowing us to continue to provide great patient care.
For more information on the W-Tool, see http://www.emsworld.com/company/10210924/weddle-tool-company.