Unlike inside a hospital, EMS operates in uncontrolled settings and environments. At any given moment a scene can and does suddenly become unsafe for us while we’re in the process of medically treating a patient.

As an EMS crew is enroute, responding to a 911-Call, if Dispatch informs us PD (police department) or LEOS (law enforcement officers) are also being dispatched, a crime has possibly been committed or the scene may somehow be unstable or unsafe. However, all rescue personnel on scene is responsible for his/her own safety. We can’t depend on PD or LEOS to protect us; instead, we must follow our own protocols and work the scene with all other rescue crews effectively. Regardless if PD or LEOS are on the scene with us or not, safe scenes can and do suddenly become unsafe in various ways with little to zero warning as we’re at the patient’s side giving medical care.

The patient, the patient’s loved-ones, or bystanders can suddenly become violent or their behavior can drastically change due to: mental illness, fear, anxiety, drugs or alcohol, declining medical condition, they’ve committed a crime on scene, they’re a desperate criminal with a concealed weapon, etc. altering the safe scene to a dangerous situation.

I can’t go into detail, but I’ll share the basics of two scenes that turned unsafe for me and my partner: 1) An attempted suicide patient – a prison inmate – grabbed a police officer’s weapon. We physically and then chemically restrained the man without anyone getting injured, but it wasn’t easy or quick. 2) Adult children of a bi-polar patient called 911 because their father became disoriented and agitated. After our arrival, the patient turned aggressive and combative. I called for PD back-up, but instructed them not to use force unless absolutely necessary. I used the talk-down technique to calm him as I also reassured and counseled his adult children. After an intense hour, I finally had the patient physically and chemically restrained in my ambulance.

Hazardous material are another safety concern – if an EMS crew is dispatched without the knowledge haz-mats are on scene, our lives and health are at risk. Immediate recognition of haz-mats and following of procedure is essential, but at times haz-mats are disguised and sometimes a human (for various reasons) is setting up and controlling that disguise. Can you guess why an individual(s) would do this? I’ll give you one idea to get the ball rolling – meth labs (which are easy and cheap to construct) can easily explode.

EMS crews use code phrases to alert each other of danger. One old code phrase: “Let’s get the red oxygen cylinder out of the ambulance.” After speaking a code phrase or hearing it, I evacuate the area, notify Dispatch of the situation, and request for additional resources as necessary.

Severe weather creates a large range of dangers as well as hindrances for anEMS crew, including: hurricanes, tornadoes, earthquakes, floods, blizzards, downpours, intense wind gusts, extreme lows or highs of air temperature, etc. A darkened mile-long tunnel when electricity is not functioning causes additional issues; so does nighttime darkness, especially if the emergency situation is on a back country road with only the half-moon above lighting the scene. Weather related issues can be on-going during a shift and worsen, or occur suddenly with no warning.

The worst weather-related scenario I’ve worked: A multi MVC – motor vehicle collision – at night on a darkened section of a highway. While we were extricating the severely injured and trapped passengers and drivers down a wooded embankment, a downpour suddenly began and refused to let up. The raven’s ground was previously saturated from days of rainfall. Lightening and thunder added to the already dangerous and intense situation.

Fires and/or explosions can and do erupt suddenly while we’re on scene, unstabilizing structures and creating yet another danger for us as well as our patient and any bystanders.

What other scenarios can you think up that would suddenly create an unsafe environment for an EMS crew, and how do you think we handle those situations?

Obviously, as EMS we need to be prepared for anything at all times as well as be able to adjust and respond effectively when our surroundings change on scene