2. Time to Rethink Scene Safety
“BSI”
“Is the scene safe?”
● Has the practical practice made things worse
of us as providers?
3. Not a Binary Question
● “Yes” or “No” are not the right answer.
● We must learn to continually reevaluate our
scenes for safety.
4. Scenario
Alpha 6 is dispatched to a suburban home for an elderly
female “not feeling right”.
● Arrive to find door unlocked.
● To obvious signs of danger are present
● Patient is in a back bedroom at the end of a hallway
lying in bed.
5. Scenario
● Arrive to find 88 year old female ℅ weakness.
● Patient is pale and mildly diaphoretic.
● Patient reports “chest flutter”.
● Patient presents with SVT.
● Patient states she doesn’t wish to be transported, and
will see her doctor the next morning.
6. Scenario
While explaining to the patient why she needs further
medical attention, her adult son appears out of another
bedroom from off the hallway. The man has a holstered gun
on his hip, and states “You need to stop disrespecting my
mother”.
7. Is this scene safe?
The scene has changed.
● Are we now in a possibly very dangerous
position?
● Is the man threatening EMS?
8. Is this Scene Safe?
Lets change it up.
● No gun is present, but the son is loud and
threatening.
9. Is this Scene Safe?
Concerns with this scenario:
● We have no egress from the room.
● We still have a patient that requires medical
intervention.
10. EMS Needs to Learn New Skills
EMS Providers need to think of the following:
● The difference between attacker vs patient.
● Patient abandonment when scenes are no longer safe.
● Verbal Conflict Management
● Self defense and escaping violent encounters.
● Documentation of encounters involving violence, and
preparing for the legal process that will follow an assault
on a paramedic.
11. EMS Needs to Learn New Skills
EMS Providers need to think of the following:
● Understanding the mental and psychological issues
involved in seeing and dealing with violence.
● Customer service skills such that patients, families and
bystanders perceive paramedics as helpful, non-threatening
responders.
12. Violence is not a part of our job!
EMS providers, and their employers, need to
maintain a zero tolerance policy on attackers.
● We need to change our culture within EMS
as well.
● Coworkers need to support each other, and
not harass those that have been victims of
violence.
13. Agencies must demand change.
● We need to have a realistic discussion about
the need for personal protective equipment.
● Some agencies are compelled to issue soft
body armor to their personnel.
● Some allow but do not require the wearing of
this PPE.
● Some feel that this is unnecessary.
14. “Should we go in?”
The change needs to start in initial training.
● Scene safety is a relative and fluid concept.
● “Should we go in?” gives a more ongoing
idea that scenes can change.
15. “Is the Scene Safe?”
● The concept of “safe” vs. “unsafe” scenes has
to be eliminated.
● All scenes are relatively safe along a
continuum ranging from “not very safe” to
“quite safe right now.”
● A scene that was safe can quickly change.
16. Stay Safe and Be Aware
● Violence against EMS is on the rise.1
● Recognize that no scene is completely and
forever safe.
● As a profession, we are not prepared or
trained to avoid, prevent, respond to or
survive hostile encounters.
17. Stay Safe and Be Aware
Let’s get “Scene safe? BSI?” out of our
vocabulary and start learning how to keep
ourselves safe.
EMS is the most dangerous profession in the
United States, and the world.2
18. Stay Safe and Be Aware
We need to keep ourselves
safe to continue to help our
community, and to go home
at the end of the shift.
