Dispatch: Requested emergent to a townhome complex approx. 5 minutes from our station for a 28 y/o fm on a fall. Additional units en route include our Assistant Chief and a police officer in our area.
Crew: Senior Medic and Part-Time Medic (Me) both NREMT-Paramedic level providers and one NREMT-P student (and not a great one, btw).
Upon Arrival: Met by two elderly ladies standing the driveway of the 'model' townhome of the complex, where the leasing office is also located. All the information we received from them was, "She's in there. We haven't moved her. She doesn't look too good." We entered the home and found a female patient against the wall, laying on her knees with her face to the ground (think of the way toddlers sometimes sleep). Initially we were starting down the road of a DOA, that is how poor she looked.
Manual C-Spine precautions in place, we rolled her to do an assessment. Upon rolling, she takes a large, gasping breath. My partner cuts her shirt while I get the monitor fired up. Upon opening her shirt we note a single GSW to the right chest at the nipple line; size indicates small caliber. Additionaly, we have noted signifcant facial trauma to the right side of her face, which we later determined was a second gunshot wound.
At this time our AC arrived on scene and we informed him that it appeared the patient had been shot and no weapons were found nearby. He report a possible crime scene to dispatch. Keep in mind that NO POLICE OFFICER HAS ARRIVED YET and the home has not been cleared. After what felt like forever but was in actually only about 4 minutes, the officer arrived, went past us with his weapon drawn and cleared the home.
I won't bore you too much with patient care details, as they are just not that remarkable. She received large bore IVs and fluids and was in and out of VF the entire way to the hospital. She was ultimately pronounced in the ER.
Total Time on Scene: 10 minutes
I just wanted to share a couple of take-aways we've had as department from this call:
1) Scene Safety: Normally for something like this we would be staged until the officer clears the home, however per the caller to dispatch there was no reason to do so. It is no ones fault really, the caller couldn't have known any better and neither could our dispatchers. Obviously in school we were probably all taught that when we discovered the GSW we should have left the patient and exited the home until police cleared it. However, you and I both know that is an extremely difficult thing to do, especially when your patient still seems viable. We've had a couple of "safety committee" meetings to discuss it. Ultimately, there wasn't much any of us could of done but it has been acknowledge that we took a chance remaining in the home when it was secured.
2) Control Your Crew: A fire engine eventually joined us to assist (we are a third service) and we left the scene with no less than FIVE providers in the back and a Fire Lt. driving us in. While we did need extra hands, we did not need five people. One FF/P joined us without being asked to do so. Furthermore, the AC was the one who looked at the airway for the tube. Normally this wouldn't be an issue, but he has admitted that perhaps he was not the most qualified to be doing the intubation when he had run a total of 2 EMS calls in the last year. The Senior Medic has since told me that he wishes he'd done a better of job of controlling his scene and his crew. Remember:
- Don't take more help than you need, especially on a GSW or a crime
scene. The more people involved, the more versions of the story and the
higher the chance for scene contamination.
- This will be service specific, but unless your admin are also on the
trucks regularly, it's probably advisable to have one of the LINE
paramedics be the one to manage a difficult airway. (This opinion is
shared by the AC and Senior Medic both)
- If you're in charge of the call, be in charge! Remember, you CAN tell
people what to do and what you need. Doll out assignments according to
provider level and as much as possible always maintain an awareness of
what is going on with your scene.
3) Talk it over ASAP: We began our debriefing in the truck on the way, discussing what we remembered about the scene. I have been selective with the details I"ve shared here, but I can assure you I remember a significant amount about that day. This is good because you'll be asked to share it at some point in an official capacity. It's a good idea to go over who did what, where your IVs were, what drugs were given, etc, just in case the member making the report missed something in the fray. Oh and btw, you'll be absolutely shocked at what you'll remember afterwards.
4) Students Are Students: In this particular case, our paramedic student wasn't allowed to do much other than watch. It wasn't nessarily a conscious decision, it just worked out that way. (Partially product of too many providers in back.) But in talking it over with him later, he said that he was still able to get a lot out of standing back and watching us manage a difficult patient and an unusual (for us) circumstance. There were tons of learning points to take away from that experience, and even though he didn't get to do anything "fun" he still made the most of it. If possible, get an idea of where your P-Student is at the beginning of the shift so that when the time comes you'll know what s/he is and is not ready for.
I don't share this story so that you'll think I'm the best provider or that we're the best service or anything of that nature. I just wanted to share what we've learned as department and what I've personally learned as a paramedic from that experience.
Hope that you found this helpful in some way!
Crew: Senior Medic and Part-Time Medic (Me) both NREMT-Paramedic level providers and one NREMT-P student (and not a great one, btw).
Upon Arrival: Met by two elderly ladies standing the driveway of the 'model' townhome of the complex, where the leasing office is also located. All the information we received from them was, "She's in there. We haven't moved her. She doesn't look too good." We entered the home and found a female patient against the wall, laying on her knees with her face to the ground (think of the way toddlers sometimes sleep). Initially we were starting down the road of a DOA, that is how poor she looked.
Manual C-Spine precautions in place, we rolled her to do an assessment. Upon rolling, she takes a large, gasping breath. My partner cuts her shirt while I get the monitor fired up. Upon opening her shirt we note a single GSW to the right chest at the nipple line; size indicates small caliber. Additionaly, we have noted signifcant facial trauma to the right side of her face, which we later determined was a second gunshot wound.
At this time our AC arrived on scene and we informed him that it appeared the patient had been shot and no weapons were found nearby. He report a possible crime scene to dispatch. Keep in mind that NO POLICE OFFICER HAS ARRIVED YET and the home has not been cleared. After what felt like forever but was in actually only about 4 minutes, the officer arrived, went past us with his weapon drawn and cleared the home.
I won't bore you too much with patient care details, as they are just not that remarkable. She received large bore IVs and fluids and was in and out of VF the entire way to the hospital. She was ultimately pronounced in the ER.
Total Time on Scene: 10 minutes
I just wanted to share a couple of take-aways we've had as department from this call:
1) Scene Safety: Normally for something like this we would be staged until the officer clears the home, however per the caller to dispatch there was no reason to do so. It is no ones fault really, the caller couldn't have known any better and neither could our dispatchers. Obviously in school we were probably all taught that when we discovered the GSW we should have left the patient and exited the home until police cleared it. However, you and I both know that is an extremely difficult thing to do, especially when your patient still seems viable. We've had a couple of "safety committee" meetings to discuss it. Ultimately, there wasn't much any of us could of done but it has been acknowledge that we took a chance remaining in the home when it was secured.
2) Control Your Crew: A fire engine eventually joined us to assist (we are a third service) and we left the scene with no less than FIVE providers in the back and a Fire Lt. driving us in. While we did need extra hands, we did not need five people. One FF/P joined us without being asked to do so. Furthermore, the AC was the one who looked at the airway for the tube. Normally this wouldn't be an issue, but he has admitted that perhaps he was not the most qualified to be doing the intubation when he had run a total of 2 EMS calls in the last year. The Senior Medic has since told me that he wishes he'd done a better of job of controlling his scene and his crew. Remember:
- Don't take more help than you need, especially on a GSW or a crime
scene. The more people involved, the more versions of the story and the
higher the chance for scene contamination.
- This will be service specific, but unless your admin are also on the
trucks regularly, it's probably advisable to have one of the LINE
paramedics be the one to manage a difficult airway. (This opinion is
shared by the AC and Senior Medic both)
- If you're in charge of the call, be in charge! Remember, you CAN tell
people what to do and what you need. Doll out assignments according to
provider level and as much as possible always maintain an awareness of
what is going on with your scene.
3) Talk it over ASAP: We began our debriefing in the truck on the way, discussing what we remembered about the scene. I have been selective with the details I"ve shared here, but I can assure you I remember a significant amount about that day. This is good because you'll be asked to share it at some point in an official capacity. It's a good idea to go over who did what, where your IVs were, what drugs were given, etc, just in case the member making the report missed something in the fray. Oh and btw, you'll be absolutely shocked at what you'll remember afterwards.
4) Students Are Students: In this particular case, our paramedic student wasn't allowed to do much other than watch. It wasn't nessarily a conscious decision, it just worked out that way. (Partially product of too many providers in back.) But in talking it over with him later, he said that he was still able to get a lot out of standing back and watching us manage a difficult patient and an unusual (for us) circumstance. There were tons of learning points to take away from that experience, and even though he didn't get to do anything "fun" he still made the most of it. If possible, get an idea of where your P-Student is at the beginning of the shift so that when the time comes you'll know what s/he is and is not ready for.
I don't share this story so that you'll think I'm the best provider or that we're the best service or anything of that nature. I just wanted to share what we've learned as department and what I've personally learned as a paramedic from that experience.
Hope that you found this helpful in some way!
I'm so glad that times have changed.