Safety First: Scene Safety


Study Notes:

  1. 1.Scene safety begins before you enter a scene.

  2. 2.Have two ways to call for help.

  3. 3.Make sure your dispatcher knows where you are.

  4. 4.Don’t get separated from your partner.

  5. 5.Maintain a clear exit.

  6. 6.Use your stretcher as a shield and stand beside the door when you knock.

  7. 7.If everyone inside the box is sick or dead – don’t go in.

  8. 8.All family pets want to kill you

“F is for Fire” - Scene Safety


“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

Don’t go where it ain’t safe.

Gloves and goggles are important but they won’t prevent you from being getting hurt. Before we walk into a scene we need to think about ‘scene safety’ as well. This means making sure you are not about to get hurt.

First of all, you should always have at least two ways to call for help. Usually paramedics carry a portable radio and a cell phone.

Make sure your dispatcher knows that you’ve on scene. Ask if there are any known dangers. Have the Police arrived yet?  Has there been any known violence?  Is this address ‘flagged’ as dangerous in the dispatcher system?

When I was a student, we used to walk into our scenarios in lab and say ‘No gas, no glass, no wire, no fire, no obstacles in my way’.  So ‘F’ in the ‘Safety FIRST ...’ mnemonic stands for ‘fire’.

You have to remember that we always exist inside a box of physical space.  In normal life we walk from one safe box to another without really worrying about it, but as a paramedic it is very easy (if you’re not careful) to walk into dangerous boxes and to find yourself in peril. 

You have to maintain an awareness of the structures that surround you, the safety of the environment in that structure, and the danger posed by other creatures that might be in there with you.

First of all, you must be careful about the structures - the boxes - you enter.  Don’t going into damaged buildings or other structures, and be especially careful entering into places like smashed cars.  Leaking gas, airbags, broken glass and exposed metal create more hazards than you might realize.  And speaking of cars, it’s easy to become dangerously casual about walking around in traffic.  Always be vigilant around moving cars.  They’re big and they hurt.

Secondly, you must be careful about the safety of the environment inside any ‘box’ you go into.  Fires produce dangerous gasses like carbon monoxide, even if they are controlled fires, like those in a furnace or car engines.   Be careful too of temperature and weather extremes.  You can dehydrate at fires, or freeze in prolonged extrications in the winter, and lightning can strike you just as lethally as anyone else, whether you’re wearing a uniform or not.

When I trained as a lifeguard we had a scenario in which everyone in the pool started floating face down all at the exact same time.  Of course, all the lifeguard students (including me) jumped right in to ‘save’ the swimmers.  Our Instructor immediately ended the scenario and told us we were all dead.  Why?  Live electricity in the pool.

There’s a basic rule of scene safety that this illustrates: If everyone ‘in the box’ is sick, then you will be too if you go in there.  The corollary to that is that if everyone ‘in the box’ is dead, then you probably will be too if you go in.  So don’t go in.

This means that sometimes you will be standing outside a box watching people suffer inside.  It’s tempting to run in and be the hero, but you mustn't.  There are people that love you waiting for you to come home, and people who are going to have an emergency tomorrow who need you to be there on duty for them.

Your responsibility is to ensure your safety, the safety of your partner, the safety of other emergency workers, the safety of your patient and the safety of any bystanders.  In that order!

Remember too that sometimes ‘the box’ isn’t dangerous when you enter it, but the actions you begin to take in the box can make it become dangerous.  Releasing oxygen into an enclosed space or defibrillating in wet environments can create dangers that weren’t there when you walked in.

Finally once you’ve determined that the box you’re about to walk into isn’t filled with dangerous gas or substances, and that nothing you do in that box is going to risk your safety, you have to start thinking about the other creatures who are in the box with you.

People can be dangerous - not everyone is happy to see you, and mobs don’t think about who they are hurting.  Observe everyone at the scene for body language, be aware of actual or potential weapons that can be used against you, and always keep a clear escape route.  Never let yourself become trapped, and always stay with your partner.

Another basic rule of paramedicine is that all family pets are intent on killing you.  Make sure family pets are locked up before you enter.  Ideally, the dispatcher will have asked the family to do this, but if it hasn’t been done, make sure it gets done quickly.

Ensure your biological safety, ensure the scene safety and then enter ‘the box’ your patient is in.  Now you’re ready to ask your first question.  What do you think that should be? ...