Always Safety First!
by Geoffrey Del Mundo Panganiban, RN
Field Medic 542
“The number one priority for me when I start a shift is to be able to finish my job for the day and go home safely… that’s why my first thought is scene safety… and ONLY then… all other issues.”
Scene safety for medics requires us to think 2-3 steps ahead of ourselves at all times and consider all “what if” scenarios and their possible solutions. During our training we called it Scene Size up, or Stop-Look-Listen-Think-Re-assess.
For example, when I arrive at a scene, I’m checking if the ambulance is parked in such a way that I know if things go wrong at the scene, we can drive out forwards and easily if we have to make a quick “get away.” When we walk into a house, I’m constantly assessing where I can move, or what I can do if the patient becomes violent, or if someone else comes into the house. I always try to stay together with my partner or the driver – often it takes more than one pair of eyes to pick up on a problem.
One afternoon shift, we were called to the construction site of now renowned sports hub in the Middle East. We had a male adult with leg trauma from a query fall. With the heightened nerves, we rapidly approached the patient’s workplace and my partner was just about to commence a rapid assessment to a lying conscious patient, when I suddenly stopped my partner. I noticed an uncovered electrical cord dangling from the wall socket. We needed to pull the plug first, and then move the patient carefully to a safer place for treatment. In the history taking we found out that the patient had accidentally come into contact with the open wire connected to the main grid, causing a hard fall from the ladder he was using, resulting in minor abrasions and a sprain. An early lesson for us on scene safety and its importance.
All scenes can turn bad
More often than not, we are allowed to do our job mainly unhindered, and I don’t go to every job being paranoid that I’m going to be attacked. But, as you build up experience, and skills in the area of risk management, you develop an ability to have a subconscious thought process in the back of your mind, that constantly assesses and re-assesses the scene for safety problems, so you don’t get caught out unaware. This way, when only subtle changes occur, something triggers in your mind, to make you realise when the scene is going downhill.
Let me share with you a story from my shift. The crew were summoned to the villa for a possible suicide, a male adult patient. The dispatch channel told them that it was just body weakness – a simple medical house call perhaps. When they arrived on scene, the medic sitting in the front of the ambulance immediately got out and proceeded directly to the door of the villa, whilst the medic in the back prepared the response bag and other equipment. The second medic was about to open the locked door of the rig, when suddenly he saw his partner running from a man with a long sword. It was the patient, who had become violent and paranoid after hearing the sirens and seeing the flashing lights of the ambulance. It may sound a funny story to others, but lessons of safety and security should be taken from it. Assess the Hazards!
Don’t get caught unprotected
Always wear Personal Protective Equipment (PPE). This refers to the use of gloves, mask, goggles, helmet and protective clothing, which includes shoes. We don’t constantly have to use all these things, but come to your shift prepared for anything. It is a misconception to some, that PPE consists only of gloves, mask and goggles for Body Substance Isolation (BSI). We have to always remember that our shoes, belt, vest and jackets are an integral part of it. The clothing is made with high-visibility material, and the shoes should have toe caps and penetration-resistant features. Like soldiers on the battlefield we are exposed and should be protected against harsh environments to complete our duty.
Do some mathematics
The 9/11 attack in New York created many revisions of safety books and emergency text. As part of being safe, we have to calculate time, distance, directions and durations. It is part of our job to assess and re-assess the scene. Sometimes, we have to differentiate toxic fumes from ordinary smoke, and fluids or water to hazardous chemicals. In some cases, we need to be aware of exposure limits, wind directions and the type of incidents. To do this, we don’t have to be an engineer or a chemist, what we do need to have is common sense and presence of mind with the right time, distance and shielding.
Think and think again! Always Safety First! These are our best friends in the field, for us to be effective and efficient healthcare providers in the pre-hospital setting. We are responding to provide care and solutions, not to be part of the problem.
By: Geoffrey Del Mundo Panganiban, RN
Field Medic 542