If I asked you what phrase immediately comes to mine when you think of EMT school, paramedic school, working at your job, trainings, etc.? Is that phrase “BSI, scene safe”? In my nearly 20-year career working as a medic I have probably heard that phrase thousands of times. Between taking classes, teaching classes, training at new jobs, testing for national registry, that phrase always gets thrown around. It is reiterated over and over, so for some, it becomes a joke, it loses its meaning. For you, is that phrase just a phrase? Is it just words that you causally spew out, or does it actually mean something to you?
We all know the BSI part. What personal protective equipment should I use? Should I wear a mask, gloves, or a hairnet and booties? Should I wear a gown? Should I wear something else to protect myself? The answer to the BSI question varies from patient to patient. What does not, or should not vary is “scene safe”, is my scene actually safe?
“Every day throughout the U.S., EMS responds to over 100,000 calls for help. EMS responders face threats to their safety on a daily basis as they answer calls for help in their community. Because of the nature of the interactions, some of these encounters will inevitably turn violent.” (Carlson, 2024).
As of 2024: “Nearly 70% of men reported having been physically assaulted, compared to 62% of women. In addition, 92% of male EMS practitioners reported verbal assaults, compared to 88% of women. Also, 80% of EMS workers reported a work-related physical assault. Clearly, violence against EMS workers is a real struggle in the U.S. today.” (Carlson, 2024). We routinely respond to people having mental health issues, assaults, drug related emergencies, and vehicle accidents, so the chances of you encountering an unsafe scene is not a question of “if”, but “when”.
In my nearly 20 years of treating thousands of patients, responding to countless scenes in many different states and different countries, I can probably count on one hand the number of times where “scene safe” did not matter to me. There are probably only five instances or less where I was willing to risk my own personal safety and possibly even my life, because I felt what I was doing, the patient I was trying to help, or the scene I was entering was worth the risk. So out of thousands of patients why I would only be willing to risk my own safety for a handful of patients? Because my family needs me to come home. My family needs me to be intact, mentally and physically. Because I cannot help anyone else if I am injured or killed… and neither can you.
Scene safety encompasses a large number of things including but not limited to:
1 – Pre-arrival dispatch information. Dispatch information is not always accurate. People call 911 with vague information, sometimes by people who are not or were not on scene, so we don’t always know what we are going to roll up on. But if you hear that someone was attacked, shot/ stabbed, bit by an animal, there was some type of explosion or chemical release, you need to be asking some questions or staging until you get some information indicating that your scene is safe. What type of location are you responding to? Is your scene going to be in a roadway, house/ apartment, bar, water or mountain rescue, sporting arena or another large venue, or is it going to be in a field in the middle of nowhere? Due to the location, you might want to pre plan what you need to do, or if you might need the fire department or law enforcement to respond as well.
2 – What do you see when you are nearing your scene? Are there cars driving 70 miles an hour in both directions, do you see any downed power lines, large groups of people, uncontrolled fire, wild animals? Where are your ingress and egress points? Where should you park the ambulance so that you can quickly and easily escape if necessary?
3 – What do you see and feel as you are entering your scene? Does it seem chaotic with things and screaming people everywhere, or are people calm? If there are animals, do they seem friendly or possibly aggressive. Pet owners are usually quick to say “my dog doesn’t bite”, that does not mean that the dog won’t bite you, that means the dog probably won’t bite its owners. Do you see any drug paraphernalia or weapons?
4 – What is the body language and tone of voice like with the people on your scene? Do they seem physically or verbally aggressive, are they yelling, cursing, threatening you or someone else on scene? Does it seem like they are trying to get away from you, wanting to help you, or maybe trying to back you into a corner or separate you from your partner?
5 – When you are treating and transporting your patient, has anything change with their tone, body language, cooperativeness? Do you need to consider physically or chemically restraining your patient? Should you have someone else, like another medic, firefighter, or police officer ride along?
I have heard from many medics over the years that once you get on scene or once you start treating or transporting your patient, you as the medic, cannot leave, you cannot abandon them. This is false. “Scene safe” does not just apply to you initially getting on scene, this applies the entire time you are on a call. From the time you are dispatched until you clear, your personal safety needs to always be your number 1 priority. If you get on scene and determine it is no longer safe you can leave! Get out, get back in your ambulance, and drive away. Immediately contact your dispatch, tell them what’s happening, tell them you need law enforcement. You need to stay away until law enforcement tells you that your scene is now safe, and then you can return. If you are transporting a patient and it is suddenly not safe for you anymore, yell to your partner, tell them to stop, tell them you need help. If you and your partner cannot make the situation safe, get out of the ambulance, contact dispatch, get law enforcement, and then resume doing what you need to do after law has secured it for you.
We have a very dangerous job. We go into potentially life-threatening scenarios on a daily basis, often with little information and limited backup. It can be tempting to rush into a scene because the patient is a child or even another first responder, or someone is screaming for help. Sometimes seconds matter and you don’t want to waste time waiting for someone else to make the scene safe before you take action. I cannot tell you what to do in those situations, but you need to think clearly, not just about your possible patient, but what about your partner, are you willing to risk their safety? Think about your family and friends, will they be ok if something goes wrong and you don’t make it home? Sometimes it might be worth the risk, but most often it isn’t. “Scene safe” is just a phrase, they are just words, but those words are literally referring to protecting your life as well as your partners life.
References
Carlson, C. (September 3, 2024). Understanding Violence Against EMS — and Grant Solutions That Can Help. Lexipol. https://www.lexipol.com/resources/blog/understanding-violence-against-ems-and-grant-solutions-that-can-help/#:~:text=Nearly%2070%25%20of%20men%20reported,a%20work%2Drelated%20physical%20assault.
