Transcript Chapter 52: Crime Scene Awareness

Chapter 52
Crime Scene Awareness
National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.
Introduction
• Paramedics face
potentially violent
situations.
• Paramedics have
been severely
injured or killed
while trying to treat
patients.
From When Violence Erupts: A Survival Guide for Emergency Responders,
courtesy of Dennis R. Krebs.
Introduction
• Know how to avoid violence and how to
protect yourself when violence erupts.
• Once you recognize a violent situation:
− Retreat to a safe location.
− Await the assistance of law enforcement.
Awareness
• Paramedics may arrive at a scene before
law enforcement.
− If you feel the scene is not safe:
• Contact law enforcement personnel.
• Retreat to your ambulance.
• Wait for them to secure the scene.
Paramedics Mistaken for Law
Enforcement
• Paramedics are
often mistaken for
police officers.
− Aggressive
behavior may be
unintentionally
directed at you.
− Many agencies
have adopted more
casual uniforms.
Body Armor
• Body armor is not bulletproof.
− Does not shield your neck or head
• Consult with your department and local law
enforcement officials to determine if you
need protection.
Indicators of Violence
• Always expect aggressive behavior.
− Identify potentially dangerous situations and
remove yourself, your team, and the patient to a
safe place.
• Continuously evaluate the scene.
Standard Operating
Procedures
• Standard operating procedures (SOPs) may
be in place for dealing with potentially
violent incidents.
− Review the contents, and use them as the basis
for your approach.
Highway and Rural Road
Incidents
• Account for bulk of serious injuries to EMS
• Be aware of:
− Violent patients
− Moving vehicles
− Drivers gawking at the incident
Approach and Vehicle
Positioning
• At a single vehicle
incident:
− Stop 21 feet
behind the vehicle.
− Stop at a 10˚ angle
to the driver’s side.
− Turn front wheels
to the left.
From When Violence Erupts: A Survival Guide for Emergency Responders,
courtesy of Dennis R. Krebs.
Approach and Vehicle
Positioning
• If you are not first vehicle to arrive:
− Ask IC where to park vehicle, or
− Park downstream of the incident.
Approach and Vehicle
Positioning
• You may use high beams and spotlights to
illuminate the patient’s vehicle.
− Some agencies prohibit this.
− Do not walk between the light and the vehicle.
• Do not approach a vehicle if you have an
uneasy feeling about it.
Approaching the Motor Vehicle
• The person riding in the right front seat
approaches rear passenger-side trunk area.
− Check the trunk lid is properly closed.
− Proceed to the C post.
Approaching the Motor Vehicle
• Stop at the left C
post and look in
the rear and side
windows.
− Notice:
• Number of people
• Items on the seat
or floor
• Weapons
Approaching the Motor Vehicle
• Move forward to
the B post if there
are no passengers
in the back seat.
− Let the driver know
that you are there
without moving
past the B post.
Approaching the Motor Vehicle
• After the scene is
declared safe,
follow SOPs.
• Keep flashlight off
until needed.
− Hold arms-length
from your body
− Illuminate for only
a few seconds
Approaching the Motor Vehicle
• Precautions when
approaching vans:
− Move 10 to 15 ft
away from
passenger side.
− Remain clear of
the side door.
Approaching the Motor Vehicle
• Precautions when
approaching vans
(cont’d):
− Walk parallel to the
van until you are
45˚ forward of the
A post.
Retreating from Danger
• The safest means of retreat is to back away
and call for law enforcement assistance.
• If your partner is injured while approaching
the motor vehicle, back away and call for
assistance.
Retreating from Danger
• Provide the dispatcher with the following:
− Number of aggressors
− Number and type of injuries
− Number and type of weapons
− Make, color, body style, and license number
− Direction of travel if vehicle leaves the scene
Residential Incidents
• Procedure for any call involving violence:
− Allow law enforcement personnel to secure the
scene before entry.
− Ensure scene is safe before going in.
− Continually reevaluate the situation while
providing patient care.
Approaching a Residence
• When you arrive at residence:
− Listen for loud, threatening voices.
− Glance through windows for signs of struggle.
− Look for visible weapons.
• Any time you perceive danger, back away
to your vehicle.
Entering a Residence
• Use an alternative
path to approach.
• Stand on the
doorknob side of
the door.
• Knock and
announce yourself.
From When Violence Erupts: A Survival Guide for Emergency Responders,
courtesy of Dennis R. Krebs.
Entering a Residence
• Ask whoever answers the door to lead you
to the patient.
• Pick a primary exit.
• Pick a secondary exit.
Entering a Residence
• As you arrive at the patient’s location, scan
the room for weapons.
− Back out of the residence if there is a gun/knife.
• Call for law enforcement assistance.
• Be aware of objects that can be used as
weapons.
Domestic Violence
• If a violent dispute is in progress, wait for
law enforcement.
• Tempers may flare while you are treating a
patient.
− Use good communication skills, eye contact,
and appropriate body language.
Domestic Violence
• Contact and cover technique
− One paramedic makes contact with the patient.
− The second paramedic obtains patient
information and gauges the level of tension.
• Warns partner at the first sign of trouble
Domestic Violence
• Conduct yourself as a professional.
• Crisis intervention should be left to the
professionals.
• You may be required to report certain
conditions to local authorities.
Clandestine Drug Laboratories
• Methamphetamine
is the most popular
substance
manufactured in
clandestine labs.
• Highly flammable
and toxic
chemicals
From When Violence Erupts: A Survival Guide for Emergency
Responders, courtesy of Dennis R. Krebs.
Clandestine Drug Laboratories
• Some operations
look like a
chemistry lab.
− Large quantities of
over-the-counter
cold remedies
− Gallon containers
of camping fuel
− Sulfuric acid in the
form of lye
Clandestine Drug Laboratories
• Once a clandestine laboratory is identified:
− Remain clear of the area until secured.
− Take any patients with you if you can.
− Patients should be decontaminated before you
approach them.
Gangs
• Approximately 20,000 violent gangs
• Gang activity has migrated to suburban and
rural places.
• Gangs predominately survive through the
drug trade.
Gangs
• Most gang
communication is
more sophisticated
than “gang signs.”
© Nzgmw2788/Dreamstime.com
Gangs
• Contact your local
law enforcement to
ask about known
gang territories.
© iStockphoto/Thinkstock
Gangs
• The last thing a gang wants to see is the
paramedics rescuing the person they just
shot or stabbed.
− Situational awareness is often your only
defense.
Mass Shootings, Active
Shooters, and Snipers
• You may find yourself on the scene with an
active shooter.
− Take direction from law enforcement personnel.
• Whom to treat
• When to treat
• Document any requests or demands to
deviate from your local protocols.
Mass Shootings, Active
Shooters, and Snipers
• Paramedics should
remain in the
staging area until
the scene is
secured.
Courtesy of John Wipfler
Mass Shootings, Active
Shooters, and Snipers
• Paramedics need to know how to use cover
and concealment.
− Cover objects are impenetrable to bullets.
− Use concealment when cover is not available.
Mass Shootings, Active
Shooters, and Snipers
• Paramedics should consider having a
training session with local police to:
− Learn how to assess a shot police officer.
− Address specific topics.
− Establish protocol for who removes weapons
and how.
Mass Shootings, Active
Shooters, and Snipers
• Tactical
paramedics
− Used where there
is actual violence
or potential for
violence
− Primary function:
• Care for law
enforcement teams
making entry into
violent situations
Courtesy of Lawrence Heiskell
Hostage Situations
• Under the jurisdiction of law enforcement
• Hostages are usually held as collateral.
− You can increase your chances of survival if
you can anticipate feelings and actions of
hostage taker.
Hostage Situations
• If you are taken hostage:
− Do not attract unwanted attention.
− Do no stare at your captors.
− Remove badge, collar pins, and patches.
− Ask to help the wounded.
Contact and Cover
• Remember the objects that provide cover
and those that offer concealment only.
− Make your body conform to the shape of the
object as much as possible.
From When Violence Erupts: A Survival Guide for Emergency Responders, courtesy of Dennis R. Krebs.
Using Walls as Cover
• Determine if the type of wall gives you cover
or concealment.
− Brick and concrete are safer than cinder block.
− Most interior walls are not impenetrable.
Evasive Tactics
• Change locations only if new location is:
− Better cover
− Farther from the hostile atmosphere
− Reached without revealing yourself to attacker
Evasive Tactics
• Before changing locations, look out from
your cover several times.
− Look from different heights and angles.
From When Violence Erupts: A Survival Guide for Emergency Responders, courtesy of Dennis R. Krebs.
Concealment Techniques
• Tall grass, shrubbery, and dark shadows
are considered areas of concealment.
− More common after dark than in daylight hours
• In rural areas, tall grass or a cornfield can
conceal you.
Self-Defense
• Consider taking a self-defense course.
• Identify yourself if someone prevents you
from reaching your patient.
− Instruct the person to move away.
− Inform the person that the patient may die.
− Radio your dispatcher and request law
enforcement personnel assistance.
Self-Defense
• If the person in your way does not move:
− Take a side step and repeat the verbal
challenge.
− Inform the person that police will be summoned.
• Always make sure your exit path is not
blocked and you can easily retreat.
Self-Defense in Armed
Encounters
• Distraction
techniques are
used to break the
chain of events.
• Throw whatever is
handy at the
person.
− Gives you long
enough to run to
safety.
From When Violence Erupts: A Survival Guide for Emergency Responders,
courtesy of Dennis R. Krebs.
Self-Defense in Armed
Encounters
• If the patient takes aggressive action during
your initial interview:
− Throw a light object at the nose.
− Turn toward you vehicle.
− Get out of the potential line of fire.
− Run to safety.
Crime Scenes
• Assisting law enforcement personnel to
maintain the integrity of the crime scene
increases the probability that a suspect will
be captured and convicted.
Preserving Evidence
− Testimonial
− Real or physical
© Olivier Le Queinec/ShutterStock, Inc.
• Do not disturb,
damage, or alter
physical evidence
at a scene.
© Jochen Tack/Alamy Images
• Two types of
evidence:
Preserving Evidence
• If you must remove a piece of evidence in
order to treat the patient:
− Place each piece into a brown paper bag.
− If the item is saturated, place the paper bag into
a plastic bag.
Preserving Evidence
• Crime scene
investigators
usually wear fullbody Tyvek suits.
− Every interaction
with a space or
surface entails the
deposition of your
DNA.
© Stephen Chernin/AP Photos
Preserving Evidence
• First responders
are typically the
first to enter a
crime scene.
− Do not:
• Clean up.
• Alter items.
• Move bodies.
From When Violence Erupts: A Survival Guide for Emergency Responders,
courtesy of Dennis R. Krebs.
Preserving Evidence
• The incident be properly documented.
− Much time can elapse between the call and
your testimony.
− Documents may be read by dozens of people.
Preserving Evidence
• Elements of proper documentation:
− What you saw
− What you heard
− What you were told
−
−
−
−
What you smell
What you moved, altered, or disturbed
Chain of custody
Description of the scene
Summary
• EMS can be a dangerous profession, and
your mission is to return safely at the end of
each shift.
• No community, socioeconomic group, race,
or religion is immune to violence.
• Perform a scene size-up for indicators of
potential violence and escape before
performing patient care.
Summary
• Obvious indicators of violence include calls
for shootings, stabbings, or attempted
suicides; body language; and use of
profane language or yelling.
• Be aware of the possibility that secondary
violence can occur during a call.
• Your agency will have standard operating
procedures for dealing with potentially
violent incidents.
Summary
• When you are responding to a vehicle on a
road, park your vehicle a minimum of 21 ft
behind the stopped vehicle, at a 10˚ angle
to the driver’s side facing the shoulder.
• When you are approaching a standard
automobile, use your high beams, but don’t
walk in front of the light. Check the trunk
and inside of vehicle before reaching the B
post.
Summary
• When you are approaching a van remain
clear of the side door of the van throughout
your approach.
• When a dangerous situation develops,
retreat from the scene and alert the
dispatcher of the situation.
• When you are approaching a residence,
stand to the side of the door.
Summary
• When you are entering a structure, always
identify a primary and secondary exit.
• Clandestine drug laboratories are extremely
hazardous.
• Gang activity can present hazards to EMS
crew.
• In situations that involve an active shooter
or sniper, follow law enforcement’s
direction.
Summary
• You may need to use cover and
concealment if a scene becomes
dangerous.
• Consider taking a self-defense course.
• When you are working at a crime scene,
make every attempt not to disturb, damage,
or potentially alter the scene or physical
evidence.
Credits
• Chapter opener: © Damian Dovarganese/AP Photos
• Backgrounds: Blue—Jones & Bartlett Learning.
Courtesy of MIEMSS; Gold—Jones & Bartlett Learning.
Courtesy of MIEMSS; Purple—Jones & Bartlett Learning.
Courtesy of MIEMSS; Red—© Margo
Harrison/ShutterStock, Inc.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for Emergency
Medical Services Systems, or have been provided by the
American Academy of Orthopaedic Surgeons.