WHY BOTHER??A BIG BAD world out thereHeroic VS Self-preservationObjectives: A general discussion on safety issues witha little bit of medicine
ASNSW DISPATCHIs the address/person known to be on thecaution list?Potentially violent/high-risk situation?Is there a weapon involved? Code 1: Ambulance ofﬁcer in trouble requireIs the police on scene? policeHas the police secured the scene? Code 24: Approach scene with cautionIs the assault still in progress? Code 28: Stand-off scene until notiﬁedIs the perpetrator still on scene?Is there potential threat posed?
SCENARIO 1Dispatched to a patient with penetrating trauma: GSW to ?head/neck/chestApproach by roadInformation given en route: GSW victims involved in ashoot-out during a drug bust operationLocation: an underground car-park of a residential buildingOn your arrival: the block was cordoned off, police snipersvisible in some adjacent buildings
WHAT TO DO?Important learning point - switch to local ambulancechannel for ongoing development of the situationThe scene should be conﬁrmed secured upon our arrivalA quick ‘sit rep’ about where/how many causalities/theregress route back to your vehicleThe team should be accompanied and escorted by membersof the police
SCENARIO 2Called by Bankstown Airport control tower: assistancerequested as there were two people with GSW at the airportpub000 call was also madeApproach by road: no visible presence of any emergencyserviceWaved in by someone with a weapon (your SCATparamedic conﬁdently identiﬁed as a plain-clothed policeofﬁcer)
WHAT TO DO?Inform MRU and conﬁrm the appropriatedispatchingRequest police’s presence and establish a rendezvouspointReport to MRU on your progressConﬁrm ‘scene secured’ the best you can after arrivalon scene‘Team decision’ about how to proceed
DISCUSSION POINTSInformation gathering prior to arrival - local ambulance channelmight be only source of informationScene safety - coordinated by the police, ?mature sceneChecking ‘scene secured’ - the team’s responsibility“Stand-off scene till notiﬁed”Situation awarenessApproached with caution, even a seemingly ill patient?PPEHuman factors!!
SCENE SAFETY HOPPersonal safety comes before patient care.Safety is the responsibility of all staff.Never assume that a scene is safe until you have personally assessed itThe experience and training of Aeromedical Paramedics dictates their role asthe team ‘Safety Ofﬁcer’.Due to the specialist or technical nature of some scenes it is essential that youfollow the safety directions of the Combat agency controlling that scene.
7.3.1! Incidents involving patients injured in shootings or stabbings are often rapidly evolving and ﬂuidscenes with a potential high level of risk to emergency crewsTo ensure situational awareness, the crew must ensure that they are on the local operating channel as soon aspossibleThe medical team should not approach the scene directly and should stand off until a Rendezvous Point (RV)has been established.Once there is conﬁrmation from police that a scene is safe to approach the team should determine speciﬁcally:whether the alleged assailant/s are in custody and whether the weapon/s have been secured.The doctor and paramedic should remain together at all times and maintain scene awareness.If any member of the team feels that the scene is not secure the team should return to the RV immediately.In certain situations, consideration should be given to transporting the patient restrained with a police ofﬁceraccompanying in the rear of the ambulance (following ASNSW guidelines).
A LITTLE MEDICINE FOR PENETRATING TRAUMANever assume the depth of the wound or direction ofthe track => over-triage should be the normTime is critical and surgery by appropriate surgeonsis what the pt needs‘Resus room’ mentality with back -up plansHypotensive resuscitation; ?Hybrid resuscitation
DESIGNATED TRAUMA SERVICE IN NSWMajor (Adult) Major (Paediatric)John Hunter Sydney Children’s @ Randwich (POW)Liverpool Childrens’s Hospital @ WestmeadRoyal North Shore John Hunter Children’sRoyal Prince AlfredSt GeorgeWestmead
DESIGNATED TRAUMA SERVICE IN NSWRegionalGosfordNepean TamworthWollongong Tweed HeadsCoffs Harbour Wagga WaggaLismoreOrangePort Macquarie
QUESTIONS?The only problem with communication is the illusion that it has been done.