When I was an EMT (many years ago) we were taught to determine if a scene was secure and safe before we entered to make sure we didn’t become another patient to be treated. There are many potential threats to paramedics, first responders, police officers, etc. Downed power lines (as I sit in Virginia during Hurricane Sandy!), an unstable building damaged by fire or other natural disaster, broken glass and twisted metal in a motor vehicle accident, and let us not forget a major danger are other people. Medical emergencies and sudden traumas are scary situations and many people act irrationally out of their fear. I read an online news report a couple of years ago about a patient who ultimately died because a paramedic felt threatened by the behavior of bystanders and requested a police escort before entering the scene. The bystanders were friends of the patient and were very upset as they watched him choking and gasping for air (he had food lodged in his throat and was unable to clear his own airway). Their behavior became very animated as their level of stress increased. They pushed and pulled on restaurant staff, shouted threats and were generally intimidating to others. They were scared that their friend might die and in attempts to communicate their sense of urgency they instead communicated that they were dangerous and threatening to anyone attempting to offer assistance. It is understandable that somebody would be hesitant to place themselves in the middle of that mixture.

Other times people pose a threat to our safety because they don’t understand what we are trying to accomplish and it appears that our goals are incompatible, which can be a significant source of conflict. It’s possible that even common practices paramedics perform might be a signal of something much more significant to a bystander. Oxygen is used with patients very frequently and as a paramedic you understand that the use of oxygen does not equal a critical scenario, but to a loved one they might automatically make that leap. Even when we are trying to slow things down to get vitals and access the patient, that might appear to a loved one that we are not responding quickly enough – we’re not doing what we need to “fix” the situation and thus we must not care about the patient. When the loved ones experience increased stress it changes their behavior as a result and now suddenly the loved ones pose a more serious threat to you the paramedic.

Those are great examples of times we need to rely heavily on our RADAR:

RECOGNIZE – involves utilizing all our senses to be aware of other people as well as our environment.

ASSESS – analyzing what is happening to yourself, other people, the environment.

DECIDE – make a decision based upon what you recognize and what you have assessed.

ACT – the decision “comes to life” through a verbal or physical response.

REVIEW RESULTS – did you accomplish what you set out to accomplish? If so, great. If not, what is the next step?

Most of the people you will encounter as you step out of the back of that ambulance do not want to hurt you and they realize that you are there to help. The behavior that bystanders and loved ones are using is not personal – even when it feels personal. Take the few seconds it might require to offer an explanation and put to rest some of the fears people have. Remember in the face of fear people will often respond with either fight/flight/freeze. Obviously the fight response can be dangerous for all involved.

Nikki Wince – Mandt System Faculty