Why We Need More Training on Scene Management

A few years ago we were dispatched to a cardiac arrest.  It was for a 40 year old woman, and the residence was flagged on our MDT because of  guns and swords in the house.

We pulled up behind our ambulance.  An EMT jumped out of the passenger and ran (literally) into the house.  I walked quickly, but cautiously, behind him and scanned the first floor of the dilapidated house.  Sure enough, there was a cache of guns and swords in the living room near our exit from the house.  We followed the loud voices at the top of the stairs and found our patient in a bedroom.  Her arms were stuck in a bent position and it was obvious she was dead.

Her family members said that our patient appeared fine the last time anyone saw her, and now four rescuers were standing around not doing anything.  “Bring her back! Use the paddles! Do something!” her husband yelled. I looked at his wife, and looked up at him. ” She’s dead, sir.  I’m very sorry.”  I looked him in they eye with a deliberately soft expression on my face.  I wanted to make sure that there was no doubt about what I was telling him, and that there was nothing we could do.  Again, he yelled for us to bring her back, punched a hole in the wall, and stormed out of the room.

I know that is a normal grief response. I also know that a number of upset family members are between us, weapons, and our only way out.  We looked at each other and quickly agreed to leave the residence.  We still needed to attach the monitor and get a strip for our paperwork, but that could wait.  We moved quickly and purposefully out of the house, and stood on other side of our truck while we waited for the police.  They arrived, we went back in, and the rest of the call went fine.

I was trained to do CPR and attach a defibrillator, but was never taught how to manage a scene like this.  It reminded me of how I managed my first call as a brand new EMT, partnered with an equally new CPR-trained driver.  A toddler had partial thickness burns on her face after falling against a grill.  I felt uncomfortable during the 30 minutes we were with her, and it showed.  Her mother called and complained about me.   I may not have done anything wrong, but I certainly didn’t look like I knew what I was doing. I have learned from these and other experiences, but wish I had been better prepared beforehand.

Scenes are dynamic, and repeating “BSI/Scene Safety” in class before a lab scenario or skill station does not prepare people to recognize this.  Teaching EMS students how to talk to people in stressful situations is also neglected.  Even with the new education standards to become an EMT, very little clinical time is required, there are few opportunities to become comfortable talking to patients, and there is no field internship required.   It’s like reading Power Point slides to 16-year-olds about how to drive a car,  give them a written test,  give them a license, then tell them to learn how to drive.  Like EMS, we hope they don’t kill anyone.

One of the services I worked for did its con-ed at a police academy.  When they had a class going on, the recruits had to be “on” the whole time they were there.  Things were rearranged in the building and they were expected to notice it.  Their individual skills were incorporated into larger scenes that require situational awareness, and cadets fail if they do not perform well.  EMS cal learn a lot from this approach to training.

From a safety and public service perspective, we need to take scene management more seriously.  It should start with initial education and reinforced with continuing education.

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