Near-Miss Reporting: EMS Scene Safety

The National Fire Fighter Near-Miss Reporting System is more than just a repository of data. It’s the voice of real people talking about real incidents. They provide an opportunity to listen, to learn and to heed a warning that your own folks may or may not be giving you.

Contemporary fire chiefs are busy juggling and balancing budgets, sustaining staffing, upgrading equipment and apparatus, maintaining aging facilities and many other concerns in today’s financially restrictive times.

Submitted reports by rank: firefighters/EMTs contribute the most at 43%.As a firefighter/EMT, I know there’s usually no time to sit with a chief officer and talk candidly about the realities of scene safety, but these reports can help bridge that gap.

What’s at Stake

Just like any other call, medical emergency incidents always have the potential to harm or endanger providers. EMTs and paramedics are called to:

  • Walk blindly into homes and apartment buildings
  • Operate on the side of highways, exposed to vehicle traffic and unforeseen threats from the public environment
  • Rely on their training and instincts on every call
  • Return to the station safely

Near-miss events occur frequently on EMS calls. This column covers two of the most often-cited EMS near-miss events: on-scene violence and exposure to air- and bloodborne pathogens.

Violence and Information

The first case study (Report 05-335) highlights the importance of responders maintaining reliable communication with dispatchers and having a good knowledge of their first-due response area.

The ambulance was dispatched to a young man who wasn’t alert in a neighborhood with a history of violence. The ambulance crew contacted dispatchers for more information, and before entering the scene, they were told that the injury was the result of an assault and that they should stage:

A few minutes later (dispatch) told us that they believed it was the result of an assault. The end result was that our patient was the victim of a stab wound to the chest. He ended up being the victim of a homicide. The alleged perpetrator was still in the house, as was the weapon. Our crews nearly walked into this situation without police backup, thinking it was a simple medical call.

The submitter acknowledged the breakdown in communication with his dispatchers and stressed the importance of knowing your area and understanding the emergency before you arrive on scene, as well as continuing to ask for information until you feel comfortable moving into the scene. Any time a violent incident is suspected, police should be the first to enter the scene and, as this crew did, EMS units should stage away from the scene.

Goggles and Masks

Most EMS providers will tell you that they always use gloves when dealing with patients; however, the use of goggles and masks, although readily available, is much less common.

In this case (Report 11-199), the provider was speaking with a man who had just been assaulted and the provider was exposed to a potentially deadly disease because he wasn’t wearing all his available PPE. This report should remind all of us that sometimes more than gloves are necessary on EMS incidents.

I was assessing a patient who had just been assaulted. He was bleeding very badly and I was trying to make sense of what he was saying had happened to him. He began coughing and choking and spit up blood all over my face. I did not have eye protection and got blood everywhere. We found out later that the patient had hepatitis type C.

When asked what lessons he learned, the provider stated he would always wear his PPE now on EMS runs, because he still is worried he could have contracted hepatitis C. Not wearing all available PPE on a fire scene would never be tolerated, so the same strict rules should be stressed on EMS incidents. Protecting yourself from blood- and airborne pathogens isn’t important just for your safety, but also for the safety of those you may then spread the pathogen to.

Due to the high frequency of EMS calls, many providers get complacent. We must realize that the fireground isn’t the only place fire and EMS department members are in danger. Every EMS call provides an opportunity for members to be placed in harms’ way, so proper training and maintaining situational awareness is an absolute key to avoiding injury.

Now That You Know

Chief officers must be vigilant to these types of near-miss events going on in their departments. They must take the lead in ensuring that effective policies and procedures for firefighter safety are not only in place, but followed.

Chiefs need to ensure that discussions of safety on EMS incidents in their departments are thriving. A good start would be for chiefs to review the complete reports listed above and present their command staff with the following questions:

  • Does your department have SOPs for EMS incidents? When was the last time you and your crew reviewed them?
  • How does your department dispatch EMS providers to a potentially violent or dangerous incident? Are proper precautions taken for EMS responder safety?
  • Have you and your crew become complacent on EMS incidents? How can you reaffirm the importance of situational awareness and crew integrity on EMS runs?
  • Do you train for EMS incidents as frequently as you do for fire incidents? Which are you more likely to respond to if the bells went off right now?

Brian Goldfeder is an intern for the IAFC Firefighter Near Miss Program and a firefighter/paramedic with Prince George’s County (MD) Fire and Emergency Medical Services Department.

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