Safety in EMS

Scene Safety BSI.  (BSI is body substance isolation). That’s what we are taught to say at the start of any practical scenario.  You don’t practice Scene Safety BSI, you fail the station.

Two interesting articles recently on Jems.com about EMS safety.

The first, Safety is Third, Not First, and We All Know It Should Be.  (The authors put safety behind 1. Getting the job done and 2. Having fun.

The second, Safety First or Safety Third: Considering Practitioner Safety in EMS, is a rebuttal.

I find the first article provocative in questioning a fundamental tenet of EMS.  It argues that EMS should be about risk assessment as opposed to absolutes.  I will let you read the articles and decipher their arguments. Some of their difference is just semantics.  They both clearly want EMS responders to be safe.  The authors of the first article think they will be safer if they are not blanketed with the Safety First Motto, which can easily loose its significance.  They prefer you think about it when it matters most.

I like the line in the first article “It depends.”  My boss, the EMS medical director at our hospital, does an entire lecture on “It Depends.”  I agree in EMS, where things often aren’t black and white, “It depends,” is often the best answer.

If safety truly was first at all times, EMS would not exist.  What we do -–drive lights and sirens in vehicles with less safety standards than cattle cars, respond to scenes that can become hostile without warning, deal with patients with infectious disease and others with histories of violence, at all times of day and in all types of weather– is fundamentally unsafe.  The physical and mental health risks of our occupation are known to all.  Our job requires that someone respond to traumatic events and that someone is us.  We respond despite the known danger.  We can and should do our best to mitigate our risk.  We can accomplish that better with common sense and risk assessment based on the particulars of a scene than with the “scene safety, BSI” slogan.

When I began in EMS, we were the only responders in the city.  The fire department came out if requested for motor vehicle extrication and the police were there if active violence was reported beforehand.  Other than that it just me and my partner.  We gauged the risks of each encounter.  Some scenes we never entered, some we backed out of, but we never routinely sat in the ambulance waiting for someone else to assess the situation unless it was a clear HAZMAT or a report of man with gun.  I remember many years later, I was precepting a new paramedic and when we got sent to a psychiatric call, he wouldn’t get out of the ambulance until the police had arrived.  He said we had to stage.  This was a new term for me.  “Staging” is commonplace today.  We are told to stage on many calls.  This often ends with us waiting on scene for thirty or minutes while the police investigate.  There have been many times I have been on scene, staging a block away, only to find the police came and went.  I know some crews love to take advantage of these notification lapses to get a break.  I have also been told to stage for an overdose, and waited on the scene for fifteen minutes for the police to arrive only for them to scream for a medic.  A person who could have been revived fifteen minutes before, is now in cardiac arrest.

Recently, in “The Door” I discussed the dilemma of immediately putting defib pads on a cardiac arrest victim or waiting to properly attire myself in all my PPE.  

I am not calling for us to all become dead heroes in the name of glory.  I merely saying we should recognize that what we do is inherently unsafe and we should use our best judgement in each individual scenario to make each scene as safe as we can without turning our backs on the job we have chosen.