1. Firearm incidents
Alleged drive-by: bikie gang violence continues
Nick Ralston
Sydney Morning Herald
April 24, 2012 - 12:27PM

2. WHY BOTHER?
?A BIG BAD world out there
Heroic VS Self-preservation
Objectives: A general discussion on safety issues with
a little bit of medicine

3. ASNSW DISPATCH
Is the address/person known to be on the
caution list?
Potentially violent/high-risk situation?
Is there a weapon involved?
Code 1: Ambulance officer in trouble require
Is the police on scene?
police
Has the police secured the scene?
Code 24: Approach scene with caution
Is the assault still in progress?
Code 28: Stand-off scene until notified
Is the perpetrator still on scene?
Is there potential threat posed?

5. SCENARIO 1
Dispatched to a patient with penetrating trauma: GSW to ?
head/neck/chest
Approach by road
Information given en route: GSW victims involved in a
shoot-out during a drug bust operation
Location: an underground car-park of a residential building
On your arrival: the block was cordoned off, police snipers
visible in some adjacent buildings

6. WHAT TO DO?
Important learning point - switch to local ambulance
channel for ongoing development of the situation
The scene should be confirmed secured upon our arrival
A quick ‘sit rep’ about where/how many causalities/the
regress route back to your vehicle
The team should be accompanied and escorted by members
of the police

7. SCENARIO 2
Called by Bankstown Airport control tower: assistance
requested as there were two people with GSW at the airport
pub
000 call was also made
Approach by road: no visible presence of any emergency
service
Waved in by someone with a weapon (your SCAT
paramedic confidently identified as a plain-clothed police
officer)

8. WHAT TO DO?
Inform MRU and confirm the appropriate
dispatching
Request police’s presence and establish a rendezvous
point
Report to MRU on your progress
Confirm ‘scene secured’ the best you can after arrival
on scene
‘Team decision’ about how to proceed

9. DISCUSSION POINTS
Information gathering prior to arrival - local ambulance channel
might be only source of information
Scene safety - coordinated by the police, ?mature scene
Checking ‘scene secured’ - the team’s responsibility
“Stand-off scene till notified”
Situation awareness
Approached with caution, even a seemingly ill patient
?PPE
Human factors!!

10. SCENE SAFETY HOP
Personal safety comes before patient care.
Safety is the responsibility of all staff.
Never assume that a scene is safe until you have personally assessed it
The experience and training of Aeromedical Paramedics dictates their role as
the team ‘Safety Officer’.
Due to the specialist or technical nature of some scenes it is essential that you
follow the safety directions of the Combat agency controlling that scene.

11. 7.3.1! Incidents involving patients injured in shootings or stabbings are often rapidly evolving and fluid
scenes with a potential high level of risk to emergency crews
To ensure situational awareness, the crew must ensure that they are on the local operating channel as soon as
possible
The 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 officer
accompanying in the rear of the ambulance (following ASNSW guidelines).

12. A LITTLE MEDICINE FOR
PENETRATING TRAUMA
Never assume the depth of the wound or direction of
the track => over-triage should be the norm
Time is critical and surgery by appropriate surgeons
is what the pt needs
‘Resus room’ mentality with back -up plans
Hypotensive resuscitation; ?Hybrid resuscitation

13. DESIGNATED TRAUMA
SERVICE IN NSW
Major (Adult) Major (Paediatric)
John Hunter Sydney Children’s @ Randwich (POW)
Liverpool Childrens’s Hospital @ Westmead
Royal North Shore John Hunter Children’s
Royal Prince Alfred
St George
Westmead

14. DESIGNATED TRAUMA
SERVICE IN NSW
Regional
Gosford
Nepean
Tamworth
Wollongong
Tweed Heads
Coffs Harbour
Wagga Wagga
Lismore
Orange
Port Macquarie

15. QUESTIONS?
The only problem with communication is
the illusion that it has been done.