Chapter_52_Crime_Scene_Awareness

Chapter 52 Crime Scene Awareness Introduction  Paramedics get severely injured or killed in violent incidents while attempting to reach and treat sick and injured people.  There is no way to anticipate every scenario you may encounter as a paramedic.  The most routine call can quickly turn violent.  EMS work is on par with other hazardous occupations including firefighting and law enforcement.  Actively seek out and encourage your organization to offer self-protection courses that are geared specifically toward EMS providers.  Sound survival skills training will help you identify and avoid potentially dangerous situations.  Once you recognize a violent situation, your goal is to retreat to a safe location and await the assistance of law enforcement personnel. Awareness  Proper awareness begins when you are dispatched to a call.  Look for information in the call notes or radio transmissions from your dispatch center that might raise a red flag (report of a loud party, the address is a known crack house, or the address has known previous underage drinking violations).  If you do not feel the scene is safe, request law enforcement personnel to secure the scene.  Trust your gut instinct. Paramedics Mistaken for Law Enforcement Personnel  In some departments, the uniforms of EMS professionals and law enforcement personnel are very similar.  This can lead to unintentional violence toward you.  Evaluate your services’ uniforms and advocate for easily identifiable characteristics. Body Armor  As EMS systems have witnessed a rise in violence toward their providers, many agencies now choose to provide some form of body armor for their personnel. Studying: Speak with local law enforcement officials or subject matter experts with a strong understanding of ballistics to learn about the details of body armor.  You should know what type of body armor your service provides.  What caliber handgun is your vest effective against?  What type of weapon is it not effective against? Selecting:  Various types of body armor may be resistant to different things. o Bulletproof vests can help absorb some of the impact and decrease the risk of a bullet penetrating your armor. o Stab-proof vests can protect you from a knife or blade attack. o Spike-proof vests can offer some protection from screwdrivers, ice picks, and needles.  Take the time to understand exactly what your body armor is designed to do. Again, local law enforcement agencies may be the best resource to answer your questions. Fitting:

 Body armor serves no purpose if not worn or worn properly. o Ensure your body armor fits you properly. o Adjust the fit of the armor during your check-off at the start of the shift before you attempt to wear it.  Just because you have body armor on, you should not enter areas that you would not normally enter without law enforcement. Indicators of Violence  Maintain a heightened sense of awareness even when responding to a sick or injured patient. o Your actions or lack of action may be enough to trigger a violent outburst from family or bystanders.  Remember to expect the unexpected, and do your best to identify any potential indicators of violence, such as abnormal behavior, body positioning, or harsh language.  Do not become so completely involved with patient care that you develop tunnel vision .  Some agencies or regions have developed standard operating procedures (SOPs) for dealing with potentially violent incidents. For example: o What types of scenes require you to wear your body armor? o How far away should you stage for a barricaded subject?  SOPs and policies will not be able to cover every single possible scenario.  Always use them as the basis for your approach to the scene or patient care, but be prepared to modify them if they interfere with the preservation of you or your partner’s life. Words of Wisdom When you enter a scene that has been secured by law enforcement, do not assume it will remain secure. Violent crimes often involve dynamic scenes where the perpetrator may return to the scene. Always keep your egress routes in mind, carry a radio, and watch each other’s back. Knowledge Check Indicators of higher potential for violence include all of the following except:  Escalating foul and threatening language.  An aggressive posture and stance.  Clenched fists.  Patient complaint of chest pain. Once police have secured a potential crime scene you may assume that the scene is secure for the duration of the call. True False Highway and Rural Road Incidents  In 2013, 86% of fatalities involving EMS were transportation related.  Be mindful of the obvious hazards posed by fast-moving vehicles and curious drivers gawking at the incident.  Also still be aware of potentially violent patients. Approach and Vehicle Positioning  Practice maximum safety.  Do not approach a vehicle if you are uneasy about it.  Request for law enforcement and remain in your vehicle until they declare the scene safe.  If you do approach a vehicle, notify the dispatcher of your location, and the license plate number and state of the vehicle. First to respond: When you are the first to respond to an incident with a single vehicle, position your vehicle a minimum of 21 feet (6 m) behind the stopped vehicle at a 10° angle to the driver’s side facing the shoulder.

 Turn your front wheels all the way to the left so that the wheels and the motor block will provide limited protection in the event of gunfire.  Call for law enforcement and set some flares if they will be delayed. Next to respond:  If you are not the first vehicle to arrive at the scene: o Ask the incident commander (IC) where he or she would like you to park your vehicle. o Try to park downstream of the incident.  Law enforcement vehicles and fire engines are often placed behind the vehicle that was involved in the crash. They can help to provide a buffer in the event that someone inadvertently drives into a stopped vehicle. After dark:  Check if your agency may have specific policies regarding the use of light after dark.  You may use your vehicle’s high beams and spotlights to illuminate the interior and exterior of the patient’s vehicle. o Bright lights can help conceal you as you approach the vehicle. o However, lights may impair the vision of drivers traveling in the opposite direction.  Do not walk between the spotlight and the vehicle because you will provide a silhouette in the patient’s rearview mirror and alert any responsive occupants to your position. Approaching the Vehicle  If responding to an unknown problem, choose a strategic approach rather than a systematic approach.  When there are two or more paramedics in the unit, the person riding in the right front seat makes the approach. o All other members of the emergency response team remain with the ambulance or medical unit in the event there is a problem. Step 1 Proceed to the rear passenger-side trunk area. Consider whether there may be people hiding in the trunk of a vehicle, and check the trunk lid to ensure it is properly closed. If the trunk is open, retreat to your vehicle. Step 2 Using a belly-in movement, proceed to the C post on the passenger side of the vehicle. Moving belly-in toward the vehicle creates as small an image as possible for the occupants of the vehicle to see. Step 3 Stop at the right C post and look in the rear and side windows. Notice the number of people in the vehicle. Pay particular attention to the location of their hands. Any attempt to stab, strike, or shoot will be accomplished using the hands. Look for deadly weapons such as guns or knives, but also objects such as baseball bats, beer bottles, tire iron, or pieces of pipe. If you see or suspect a deadly weapon, retreat to a safe location and call for law enforcement assistance. Never attempt to unload a weapon. Although you will not retreat every time you see a bat or pipe, your awareness that an object is within reach gives you time to react if that object becomes a weapon. Step 4 If the back seat is occupied, do not pass the C post as that will place the back-seat passengers behind you. You will have to divide your attention between the front and rear seats. If there are no passengers in the back seat, move forward to the B post with the same belly-in movement. As with the C post, the B post will conceal you from the front-seat passengers of the vehicle. Step 5 Examine the front-seat area. Where are the occupants’ hands? What are the occupants doing? Are any weapons visible? When you are ready to let the driver know you are there, do so without moving past the B post into the driver’s door area. Law

enforcement personnel refer to this area as the kill zone. Tap lightly on the window of the vehicle to get the driver’s attention and announce yourself: “Paramedic. Do you need help?” Step 6 After the IC declares the incident scene is safe and determines the occupants of the vehicle need medical or other assistance, you should follow the SOPs for your department. Keep your flashlight off until you need it. Hold the light at arms-length and away from your body before you turn it on. Illuminate the scene for only a few seconds during each use. Approaching a Van  To safely approach a van after you exit the unit with the jump kit: o Move 10 to 15 feet (3 to 5 m) away from the passenger side of the van. o Walk parallel to the van until you are approximately at a 45° angle forward of the A post. o Ensure that you remain clear of the side door of the van throughout the approach. Knowledge Check How should you respond if you are the first to arrive at the scene and see or suspect a deadly weapon in the car within reach of the driver?  Retreat to a safe location and call for law enforcement.  Attempt to get a better look to understand what type of weapon it is.  Ask your partner to help you corner the vehicle from both sides.  Go over to the vehicle and try and retrieve the weapon. Retreating from Danger  You might find yourself in situations where unsafe circumstances dictate your retreat to a safe area.  The safest means of retreat is to back away from the danger zone and remain in your vehicle if able. Then call for law enforcement assistance yourself.  The minimum information your dispatcher will need includes: o Your unit identifier or ambulance number o Your location and location of the injured  Additional information you should share with the dispatcher includes: o The number of aggressors involved o The number and types of injuries o The number and types of weapons involved o The make, color, body style, and license number of the vehicle involved o The direction of travel if the vehicle leaves the scene before the law enforcement personnel arrive Knowledge Check On arrival at an incident involving a single vehicle, you should take all of the following precautions except:  Park immediately behind the stopped vehicle.  Park at a 10 angle to the driver’s side facing the shoulder.  Do not approach the vehicle if you have any uneasy feelings about it.  Front wheels should be turned all the way to the left. When utilizing a flashlight at an incident involving a motor vehicle, the flashlight should be held away from your body. True False

Residential Incidents  The standard procedure for responding to any call involving violence is to: o Allow for law enforcement officers to secure the scene and make it safe enough for you to enter. o Continually reevaluate the situation while providing patient care. Approaching a residence:  Information provided to dispatchers may be limited, and a complete picture of the scene may not be available.  If you are with a partner, one of you should approach the house while the other stays a short distance away.  Listen for loud, threatening voices.  Glance through available windows for anything suspicious, such as visible weapons.  After a quick evaluation, make a decision about the relative safety of the scene.  Any time you perceive danger: o Back away to your vehicle. o Call for law enforcement assistance. o Wait for the officers to arrive. Entering a residence:  The front door to a residence can be a point of extreme danger. o Most bullets pass easily through all but the heaviest doors.  Use an alternative path while approaching, rather than using the path to the front door.  Once at the front door, stand to the doorknob side of the door before knocking. o If you stand on the hinged side of the door, any person in the room can observe you by opening the door only slightly, and you would have a limited view of conditions inside the room.  Knock on the door and announce: “Paramedics,” “Fire department,” or “Rescue squad.”  Ask whomever answers the door to lead you to the patient.  If there are no lights on, ask whomever leads you to the patient to switch on the lights so you are not at a disadvantage in low light. Identifying your exits:  Pick a primary exit .  Also choose a secondary exit .  Whenever you are in a building, try to keep at least one means of escape accessible at all times. Scanning for weapons:  As you arrive at the patient’s location, scan the room for weapons. o If there is a gun or knife, back your way out of the residence and call for law enforcement assistance. o Objects like ashtrays, scissors, bottles, fireplace pokers, and knitting needles can also be used as weapons.  Move any potential weapon out of the patient’s reach. Domestic Violence  If a violent or physical dispute is in progress when you arrive at a residence: o Wait for law enforcement assistance before you enter. o Avoid confrontational words or actions that will reignite a patient’s emotions. o Communicate clearly, making eye contact and using appropriate body language to keep tempers from flaring. Verbal attacks:  Sometimes, you may face verbal attacks from a patient.