Staging Strategy

This issue sees the debut of Close Calls. This bimonthly column will examine real-life cases in which providers or patients were at risk, and offer strategies to help readers avert danger in similar situations. To submit case studies for possible review, e-mail Nancy.Perry@cygnusb2b.com.

     This issue's close call involves a scene safety issue. An EMT and a police officer both contributed parts of the story.

     The EMT:

     We were dispatched for a subject possibly doing harm to herself at a trailer park. It was a park we go to quite a bit. It is our procedure to stage away from the scene. I was driving and pulled off the road at the park entrance. What I'd never noticed before was that there was one trailer facing the main road. All the others were down the driveway into the park. Someone came to the door of that first trailer and started motioning for us. Who would've thought that first trailer would be the one we were going to?

     I didn't know whether we should leave or try to size it up. I saw a police car sitting across the street. The officer flew across the street and talked to the man. He secured the inside and motioned for us to come in. A woman thought she was pregnant and was stabbing herself in the abdomen.

     The police officer:

     I was dispatched for a possibly suicidal subject in one of our frequent-flyer trailer parks. I was right on top of the place. The backup car wasn't far, so I staged and waited for him. I was sitting in a restaurant parking lot across the street with my lights off when I saw the ambulance pull right into the lot. I couldn't believe my eyes. Then I saw a guy come out of the trailer and frantically wave to the EMS crew. Now I had no choice: I had to go in right away and not wait for backup. If I didn't, the ambulance crew could've been dragged into whatever was happening.

     I walked in and found a woman stabbing herself in the belly. She wasn't happy about being pregnant. I took the knife away from her, but not without a struggle in which she grabbed my hand and bit me.

     My biggest issue with the ambulance was that I could've been placed in a position where I'd have had to use force to quell a situation by myself. Two officers can always do that better and more safely. I also had to go to the hospital and get shots because of the bite. Our policy is to stage for these calls—suicidal people, domestics, fights, all of them. If someone were to overpower me and take my gun, the next targets would be my backup and the ambulance crew.

     It turned out OK. But let's just say I wasn't happy about it.

Discussion
     This is an example of a call where the intentions didn't match the actions. The ambulance crew didn't intend to park in a place where they could be seen by the patient and family members—but they did. Most people don't intentionally put themselves in position for a close call…but close calls happen nonetheless.

     Emergency vehicles attract trouble like a flame attracts moths. Picture yourself as the person who just called because your girlfriend is stabbing herself. You look out the window, see the ambulance and wonder why it's just sitting there.

     As part of that ambulance crew, you are now in a dangerous position. If you don't go to the caller, he will come to you. If he comes to you and you refuse to go to the scene, there is a chance he could become hostile. Bad news, no matter how you look at it.

     The police officer in this case is right: In most jurisdictions officers are instructed to go in with backup. Not waiting for backup has cost officers their lives. This officer went in to save the butts of the EMS crew.

Preventing Close Calls: Staging
     The principle of staging is to keep EMS providers safe until police secure a violent or potentially violent scene.

     When staging:

1. Park out of view of the scene.
2. Leave yourself a buffer—generally at least a block or two—especially with calls involving street violence when a perpetrator may be mobile (by automobile or on foot) in the area. Your rig could be attractive to anyone looking to hide or make a fast escape.
3. Only respond to the scene when police have reported it secure. If the dispatcher tells you "Police are on scene," confirm that they have things under control.
4. There are times when you will have to retreat from a scene that suddenly becomes dangerous. In these cases, use the same principles. Notify police about the situation and move a safe distance away. Be sure you are out of sight and out of range for anyone leaving the scene.

The Final Word
     You can't be safe just going through the motions. Safety—yours, your patients' and that of other responders—takes thought and commitment on every call

Daniel D. Limmer, AS, EMT-P, is a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME. He is the author of several EMS textbooks and a nationally recognized lecturer.