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.
Other scenes—If you are operating in a residence or place of business, remain alert to your environment. An EMS call can change in the blink of an eye. Determine where the exits are when you enter 1) the building and 2) the area where you’re treating your patient. Be aware of other people and where they are. I tend to ask the patient if they are alone to determine this without appearing rude or intrusive. I also suggest having any loose pets locked in another room, no matter how friendly they appear.
Equipment—Although you are always responsible for securing your equipment, there are times when you must retreat from a dangerous environment. If a situation arises where a scene that was initially safe becomes unsafe, you should retreat. If it comes down to you getting injured or leaving your equipment behind, always put your safety over your equipment. Equipment can be replaced.
Police—Some EMS providers are fortunate to have at least one police officer on every call they respond to. I have experienced both ends of the spectrum. While working in the suburban environment, I have never been on a call without a police officer accompanying. My urban experiences are quite the opposite. While I worked in New York City, there were countless times I was on scenes with no police officers present when they should have been. In my rookie years I, like most, took risks I shouldn’t have and transported patients without waiting for the police. These were risks I would never take again, and neither should any other EMS provider.
Extrication—When I think of extrication, I think of getting patients from their current locations to ambulances. Extricate patients from their home, office or vehicle with the utmost caution. Consider when you arrive how you will attempt to remove them. If there are steps, uneven ground or slippery surfaces, it is imperative that you utilize any help you require and communicate accordingly with other responders. When extricating or moving a patient, utilize the appropriate device. Stair chairs are still the best method of moving patients who must be taken up or down stairs (provided clinical finding support their use). Never carry wheeled stretchers up or down stairs, as they can be unstable, heavy and cumbersome.
Remain alert—While transporting the patient to the ambulance, it is important that the EMS provider remain alert to their surroundings. On a roadway, have the police stop traffic so you can load the patient. Pull the ambulance off the roadway to a safe location to continue care if needed. In my experience most roadway accidents are in the left lane, which imperils responder safety. I try to get my patient into the ambulance as quickly and safely as possible, then pull off the road to a safer location such as a parking lot, side street or wide shoulder. Be attentive to the floor or ground; debris may be in your way. This can be in many forms, including oil, glass, metal, toys, animals, rocks and pretty much anything else. You want to make sure you, your partner and your patient do not fall while moving to the ambulance.
BSI is an extremely important part of EMS and something that, in my opinion, we do well. Scene safety, on the other hand, is something at which I still firmly believe we can get better. There are millions of EMS calls each year, threatening millions of potential injuries to EMS providers. Every time an EMT or paramedic responds to a request for help, they put their safety at risk. Although risk and safety concerns cannot be eliminated, they can be mitigated using our basic human senses and the resources available to us.
William “Billy” McDonald, PhD(c), MPA, MICP, has worked in EMS since 1996 as an EMT, paramedic, supervisor, manager and educator. He holds a bachelor’s in emergency management and fire safety and a master’s in public administration, and is a doctoral candidate studying public policy and administration with a concentration on policy analysis. Reach him at firstname.lastname@example.org.