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Emergency Medical Services: "Let's Be Careful Out There"

Sgt. Esterhaus on Hill Street Blues always ended his briefing with, “Let’s be careful out there.”

In light of recent events, this applies to fire and EMS just as much as it applies to our brothers and sisters in law enforcement and the military.

Pick up any trade journal or log onto any trade website and you’ll quickly find examples of what I’m talking about: Paramedics killed in ambulance crash on slick roads. Fire stations shot at and bombs found outside. National Guard soldiers shot while eating at IHOP. Firefighter killed when floor collapses at a residential structure fire. Volunteer EMT killed when car crashes into accident scene.

And this list, unfortunately, goes on and on.

The fire and EMS profession is dangerous by trade. We run into burning buildings, we drive in poor weather conditions, we are called to provide care to homicidal and suicidal people, we stand in a roadway with cars driving by at 75 mph. And when a person doesn’t know whom else to call, they call us. The risks are the same to all providers, and death doesn’t discriminate between career or volunteer, fire or EMS.

Understanding that these risks are present, we must ensure we’re doing all we can to prevent the risks when possible, prepare our personnel for these situations and protect them the best we can when these risks do rear their ugly heads. This begins on the first day they walk into the station and continues until the final day of their career, when they walk out.

To prevent and prepare, we must be aware of our surroundings. Situational awareness is a key factor in keeping our people safe. What are the weather conditions? What is the fire doing? What is the smoke telling us?

What is the body language of the patient? Is he “telegraphing” his intent? Are there weapons? Is there hazmat?

What about “land sharks?” You know, those cute little furballs with teeth. Situational awareness says you can normally tell the size of a land shark by the size of the bowl on a porch.

We must constantly stress the importance of situational awareness to our people and ourselves, and we must incorporate this into all our training and exercises. It can be difficult to teach, but repetition will make it easier. Talk about the scene after every call. What were the hazards? Did everyone see the same thing? Were we able to prevent an issue because we recognized it early?

We prepare by training our people on how to respond and what to do on arrival. We expand that to then include what to do when the incident goes bad and what tools they need to correct a situation.

Firefighters train on calling the mayday when trapped or lost in a building, and I propose this isn’t just limited to firefighting. Using the LUNAR (location, unit, name, assignment, resources needed) acronym, this information is pertinent to any type of incident. A paramedic can call this on a medical scene just as easily as a firefighter can on a hazmat or vehicle-accident scene.

We protect them by equipping them with appropriate PPE, tools, equipment and apparatus. Establish standard operating guidelines that cover most of the risks they can expect to encounter; then enforce the guidelines. In the wildland environment, we establish a lookout, as part of LCES, to watch over us. Why shouldn’t we do this on every call?

Even doing all of this, we’re still going to run into problems we may not be able to solve. We can’t predict when the individual will walk in and start shooting in the restaurant we’re eating in. Are we a target because we’re in uniform? Maybe.

We can’t predict when a drunk driver is going to crash into our accident scene or when a medevac helicopter is going to crash. The best we can do is to be ready to respond to the aftermath. And if we’re the victim, we can rest easy knowing our extended family will be there to take care of our immediate family.

With all that’s going on in our world every single day, I can’t help but to reiterate Sgt. Esterhaus’s words: “Let’s be careful out there!”

Norris W. Croom III, EFO, CMO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large.

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