Scene safety

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Facilitator: Greg
Medics:
Patients:
Time: 25 mins; 1950-2015
Actual time:
Learning Objectives:
Materials: Readers for questions during walk, butcher paper for Scene Ass., Scene Ass. During Response

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Introduction to scene assessment

Facilitator says

¹ Both medic buddies watch surroundings and communicate.

• Look for danger.

• Make the scene safer.

• Be prepared for the scene to change.

Facilitator says

Scene assessment encompasses a lot of continuous observations:

• Personal (Ethan's here, he gets seizures).

• Specific (the baby bloc pushing strollers is right next to the Commie bloc chanting about shooting Obama).

• Big picture (open businesses, street grid, weather).

Facilitator says

Always assess scene and stay situationally aware -- especially when things seem calm and no one is injured.

Practice communicating about a scene

Facilitator says

We're going to practice doing scene assessment as medic affinity groups here at camp. An experienced medic will walk around camp with each group, and guide you to see the scene.

Proctors

identify selves.

Students

break into as many groups as there are proctors.

Facilitator says

before you head out, answer these questions:²

• Who are the organizers and logistics people at this camp?

• Is there cell reception in camp?

• Who has a charged phone?

• What is the local emergency number for medical/trauma emergencies? What resources exist for someone in camp who needs help with sexual/domestic violence, STI/blood-borne illness testing/treatment, mental health crisis, poisoning, or addictions recovery support?

• What is our camp evacuation route?

• How long would it take to evacuate one limping (assisted) or unresponsive (carried) person to a rendezvous point? All the way to definitive care?

Groups

Go assess the scene at WRFF for 10 minutes. As they walk around, their proctor asks Dick Reilly-style questions like these:

• Where are your exits?

• Where are your treatment areas?

• Where are the police?

• Where are their bosses?

• Where are the legal observers?

• Where are children and elders?

• Could the weather change?

• Who is most at risk here and why?

• What are the biggest dangers here and why?

• What is the state of food, water, and sanitation?

• Where are alcohol and intoxication clustered?

• Where can someone go to get away from all alcohol and intoxication all night?

• Where can someone shelter-in-place out of weather?

• How can someone leave camp to get care or go home?

• If "...," then what would you do? (...usually signifies something happening that would change the scene, such as cops moving over one way, or a stampede)

• If "...," who else would you involve, where would you refer the person, or who could improve the situation?

Debrief

Facilitator asks

How did communicating about the scene as a group change your individual perception of it?

If your team sees injured protesters

Facilitator says

Look for danger/needs/resources then stop to decide plan and activate back-up. Scene assessment continues while your buddy team:

1. Exits the scene,

2. Uses available resources to control scene (but does not assess patient or provide care),

3. Or controls scene, engages patient, prepares to do advocacy.

Calling 911 to activate EMS

• Know location; In city: exact address if possible, at least cross streets. In backwoods: know name of your area, directions to road-accessible rendezvous point, nearest highway mile marker, GPS coordinates. If you're a medical professional, identify your title, cert or shield number for authority drag purposes (or choose to remain anonymous). Say patient's chief complaint (if known). Follow dispatcher's lead -- stay on phone. Response time depends on 911 dispatcher's assessment of urgency and on availability of responders.

• Some large protests are declared "unsafe scenes." Ambulances will not enter unless/until police "secure the scene." In a life-threatening emergency, getting to an ambulance may require negotiating with cops to get across police lines or to hold ground til EMS arrives.

Scene control options

Get to a safer scene by foot, car, transit, cab, or ambulance

• Get out of cold, rain, wind, or heat.

• Help someone back up from a fight.

• Get to wellness center or hospital.

Stay put; make scene safer around you

• Calm, comfort, reassure: Sometimes the scene is safe but the injured person is so hyped up he doesn't recognize it is safe.

• De-escalate and redirect hostile/nosy bystanders: Use humor, give something to do, be polite, firm, and cheerful.

• Create privacy circle.

Trainers model scene control

Students

get up and come in close to watch trainer buddy pair create privacy circle.

Trainer buddy pair

uses students to create a privacy circle around Lisa patient.

Two trainers playing officers

approach and tell crowd to disperse and clear the area. They are trailed by their sergeant.

Scene/comms trainer buddy

resolves the situation in a way that balances the satisfaction of the sergeant and the safety of Lisa (privacy circle may have to disperse, care may have to be transferred, medic may have to volunteer to be arrested with her).

Two trainers playing city paramedics

arrive and take control.

Patient trainer buddy

Introduces self by name, cert, role; gives bullet point report to medics ("She's been completely unresponsive for the 5 minutes since I arrived; her friends say she's diabetic"); patient-medic intros ("This is Lisa. Lisa, your medics' names are Ramirez and Puglisi. You're going to the hospital").

Advocate; use "authority drag"

Facilitator

briefly lectures on police negotiation and medical advocacy.

Get patient through police lines to safety or definitive care

• Speak with supervisor or incident commander (low-rank officers have no authority; not likely to deviate from standing orders).

• Understand rank: During an incident such as a protest, the the highest ranking cop on scene is the incident commander.

• Be professional: more respectful than they deserve; as firm and persistent as the situation warrants.

Advocate for your patient with EMS (and Emergency Department)

• Stay with patient when EMS arrives to assess. Introduce yourself to EMS with appropriate title/credentials and (if possible) introduce responders to patient (look at their name badges).

• Give a "bullet-point report" (if necessary) with the most important patient info. Be professional whether they appear to be listening to you or not. The worse-off the patient is, the less EMS will listen to you.

• Consider riding in taxicab or ambulance to advocate for patient at hospital.

• Cops can and do get into ambulances. It's a good idea to get names, badge #s, and ambulance #s, and remind patients of their rights.³