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Reminders

July 27

6 hours to go until the end of my set, it’s been 42 pretty busy hours, not quite stand up, but close. I should be laying down and trying to get a little rest before the tones drop again, but I was reminded about some pretty important stuff on two specific calls this 48 and we can all always use a little reminder every now and again, so I thought I would share them while the biggest safety concern you have is burning your retinas from staring at the computer screen.

Everyone who has ever taken an EMT exam of any kind is all too familiar with the way practicals work and the ritual we all do at the beginning of each one… walk in the room, do your best jazz hands for the proctor while uttering the words – BSI is the scene safe… they are drilled into our heads from day one of EMT class and reinforced every time we go on a call that sets off our spidey sense. We say them so often that they become some sort of absurd joke by the end of classes. Relegated to the back of our mind where all the stuff we have repeated ad nauseam lives, that’s where it’s supposed to be so you don’t have to think about it. Every once in a while I realize I have gotten too comfortable in my role and I take something like scene safety for granted.

What about you? What about those calls where the spidey sense isn’t tingling, the calls that are seemingly innocuous? I mean if you are ever going to get caught with your pants down it isn’t going to be in a rough and tumble neighborhood at 0300 in a dark lit alley – just typing that set off all kinds of warning bells. If you are going to have a problem it’s more likely going to be on a brightly lit street in the middle of the day for a seemingly benign call.

I had two reminders over this set of the importance of scene safety – one I handled very well – in fact I was the person that deemed the scene unsafe and made the “good call” to get PD in and US out… Turned out there was no threat on that call. The other one I didn’t handle nearly as well, and while nothing happened it could have gone WAY bad.  Let’s look at both and pick apart what went right and what went wrong… maybe you’ll see yourself in my actions and come away with a valuable reminder.

Call number 1

Dispatch information: call came in from a medical alarm company, unknown problem with Fire Dept.

Arrival: we were first unit on scene, middle of the afternoon, nice neighborhood – on approach I notice blinds in all the windows are closed except the window next to the front door where they are pulled up. Approaching the front door I notice a keybox hanging from the knob – which is common here when the patient has a medical alarm. I motion for our EMT third rider student to stand behind me on the side if the door and knock loudly announcing our presence, this is repeated a couple of times. After the third try I tell my partner (and the student) I’m going to walk around the house. I start by looking in the window, and while the house has been totally silent I peered through the open blinds and lying on the bed not 3 feet from where I was standing was a hunting rifle, there were no sheets on the bed no other furniture visible and no patient or other occupant that I could see. I relayed the information to my partner who immediately radioed in for PD. He and our student headed for the ambulance while I quickly scanned the yard. Nothing was seen in the yard, so I headed for the bus… EMT student safely inside the ambulance my partner and I in the road behind the ambulance with it between us and the house. We are on the phone with dispatch when the engine arrives… I quickly run down what we’ve found while my partner gets the information on where the key is located from dispatch. He tells me that there is a key under the brick next to the air conditioner… I now have 4 fire fighters on scene to watch windows so I decide to go investigate the key location… there is a brick, there is no key. While turning from there to head back out I must have caught something out of the corner of my eye or heard a faint cry because something compelled me to walk to the back gate and peer through the side that opens and when I did I found our patient lets just call her nanna lying on the ground with her leg shortened and externally rotated.

RIGHT ACTIONS: we parked in a safe location, our approach was solid, our attempt at contact was from a protected position next to the door, I noticed the “threat” identified it to my partner and the student and we all headed for the bus to wait for the calvary to arrive. We investigated again when we had more eyes and ultimately found the patient

WRONG ACTIONS: We didn’t actually leave the scene, we waited in the street. We didn’t actually wait for the calvary to arrive… PD is who should have ultimately found that patient  – not me.

The thing that bothered me about that call was that nanna was crying out for us from the back porch but we didn’t hear her and she laid there suffering for longer than she should have because of that rifle I saw. Do I fault myself for that absolutely not, I know pulling back was the right call but it still bothered me on some level.

Call 2 ~ (the next day)

Dispatch: 90 F with pneumonia

Arrival: Again first on scene – well-lit middle of the day apartment complex that looks like it could have been a hotel at one point. Fairly good neighborhood, although the appearance of the building is rather run down. I park the rig in the parking lot and notice an elderly couple sitting about 25 feet away waving at me on my side of the rig. I glance back over my shoulder and see my partner is heading to the back of the bus for our gear and to fetch our student rider, I start over toward the couple I see sitting there one is a slender male mid 60’s the other is a small female sitting in a wheelchair slightly slumped over. I approach the couple assuming the lady n the chair is the patient. When I get to them the male says its my mom she’s got pneumonia, she’s been real sleepy and feverish since last night, and he starts to walk toward the apartment – I follow. Upon entering I notice a male to my right asleep on the couch head toward the door, his back covered with more “bumps” then I can count, the place is run down and unkept but by far not the worst place I’ve ever seen across the room to my left is a hospital bed with a frail old woman lying in it and my first thought was “OH SHOT” this lady is way sick. I jump right in… she’s breathing and she’s breathing FAST I can hear and see that without even thinking about it so I begin trying to rouse her, verbal – nothing – sternal rub and yelling she opens her eyes, great making a mental note of “V” I grab her wrist as I hear a commotion behind me… It’s my partner, I never turn I just say I need to O2 bag and the monitor, and I go back to assessing… The engine arrives and more commotion behind me I glance back quickly as I am getting the capnography cannula plugged in to the monitor to see two fire fighters carrying the lady who was in the wheelchair when I got there out, My partner is asking is anyone else here sick? and the paramedic on the rig leans into me as I am hooking up the monitor and says there is hep-c, aids, and c-diff in this house as she hands me a cavi wipe and a pair of gloves… I turn care over to the firefighters long enough to wipe my hands get the gloves on and position the cot… My partner (who is the medic) has now assumed care and when I turn around I see the guy on the couch is not there anymore… After an emergent trip to the hospital and safely delivering our patient – I say to the student I made three critical mistakes on that call – can you tell me what they were…

RIGHT ACTIONS: I immediately realised this patient was very sick and was going to require ALS and I took charge of the patient and her care until my partner was able to do so.

WRONG ACTIONS: First I got out of the rig without gloves, assuming I was still going to be talking when my partner got there and handed em to me. Second I left the rig empty-handed – I walked over to who I thought was the patient with no gear or equipment, third when I saw how sick the patient was I lost track of everything else but her.

I found out after the call that my partner (who has worked at this outlying station for a few years) has had several calls to this address and more than once the male sleeping on the couch has had to be “escorted away” in cuffs for becoming threatening to personnel. It took a minute to get him “out of the way”-  my partner had also assumed those were our patients and momentarily had a sense of oh my god where did my partner go. Because I jumped right in I didn’t accurately communicate my findings to my partner (did I mention HE is the paramedic?) the delay to definitive care for the patient was miniscule maybe 20 seconds BUT my partner was playing catch up because HE had to get the scene secured after I ignored it… I knew this was going to be a hot return before he even had a chance to ask me what we had.  Fortunately for all of us myself especially – I would have never been able to live with my negligence causing a fellow responder injury – nothing happened, but there was a mountain of POTENTIALLY unsafe circumstances.

Did the call from the day before affect my judgement, maybe a little but I wont make excuses. I made a mistake. My over confidence in myself and my underestimation of how serious a call this would be is what I blame it on.Fortunately, I was able to not only remind myself of things that should come second nature, but I was able to turn it into a teaching moment for a new EMT and hopefully, she will have learned from my mistake.

Comfort on scene and in your abilities in a good thing  – until you get complacent – as I’m sure one of my Marine Corps drill instructors said over and over – complacency will get you killed son.

I got caught with my pants down today, I’m sharing it with all of you in the hopes that my mistake will help prevent you from getting too comfortable in your EMT skin and getting caught with yours down as well.

Til next time…

 

 

 

 

Posted by on July 27, 2011 in EMS, Scene Safety

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