SCENE SECURITY? WE DON’T NEED NO STINKING SCENE SECURITY!

Well, it has been a busy time of year here, and I have not kept up my end of things on the blog.  Fittingly, DTXMatt, the Fire Captain on my crew is once again picking up my slack.  While he was kind, and said we were off on important business, we were in fact watching the local football team beat up on the division leaders, and all but secure a playoff berth.  Back at the home front, Matt was saving lives, and he ran the call, he can tell the story.  I’ll post my own as soon as I dig out from some year-end duties.  

Let me begin by saying that it is my pleasure to be the first “Guest Contributor” on this blog. Our crew was on duty on Christmas Eve last week, but MedicChris and MedicCat were detained elsewhere on important business. Pity. We had a call where we really could have used them. If you have read this blog at all, you will see many interesting parallels between this call, the one recounted in “A Bird on the table…”, and a few others. This call was interesting because of patient care issues, but was more interesting because of the incomplete or decaying scene security issues that we saw.

The poker game started late, but then again, at least it started. (See the parallels?) In the absence of Chris and Cat, Wayne was driving for me on the engine. In the back I had a rookie (total unknown quantity), Ernie (solid fireman, solid crew member), “Rookie” Dan (who is not so much the rookie anymore- we just call him Rookie Dan to distinguish him from another guy named Dan), and “other” Matt (firefighter, a graduate of our junior department, not called “Mini-Matt” because that name was taken). I hit a high straight on fourth street, second to act, and was getting ready to move a great number of chips when our temporary accommodations (you know, our trailer) erupted with the sound of alerting devices. The dispatch was for an “unknown situation” on “Mare- a – silly” street. Fortunately for everyone, I speak dispatch. The street was Marseille (pronounced Mar-SAY), but butchered by the same school of phonetic dispatch-speak that has previously given us treats like “oh-ACK Street” for the little lane marked “Oak St.”

As you might guess, an “unknown situation” can be anything. On Christmas Eve, it could really be anything. As I walked from the trailer to our gutted firehouse to get on the engine, I was thinking about melted Santa Claus lawn ornaments or malfunctioning inflatable snow globes, but then my pager started to buzz, and the information was for a child at a neighbor’s house screaming about blood or something, and a subsequent 911 hang-up at the actual address. Shit.

We loaded up on the pumper and I marked up on the radio. We were immediately advised that the call would be for a stabbing and that we should stage pending the arrival of the police. I think to myself, “No shit”. I acknowledge on the radio in a tone of voice that conveys “No shit”.

The location of this call is very interesting. It is about 700’ from the location of the shooting in “A Bird on the Table”. That shooting was in the toughest and worst neighborhood in our area; so tough, in fact, that until about three years ago, the police were having trouble safely going in there. When one travels the 700’ between these homes, one travels about a million socio-economic miles. The home in this call is across some railroad tracks (literally- the “right” side of the tracks) and is tucked into a little enclave of about 20 McMansions (beautiful, luxurious, and tricked-out 4000-6000 sq. ft. homes on .15 acres each) which either front or have a view of our local river. The homes are easily worth a million bucks a pop, and I have forever thought that it was hilarious that the residents there have to drive through an industrial park and a ghetto to get to and from their houses. Funny thing, though, nothing ever happens back there. I haven’t been into this neighborhood on a call since a hurricane came through two or three years ago.

As we turned onto the main street leading to the call, we were passed by some number of police cars, running code, running FAST. You know, that late-at-night, no traffic, real-deal call sort of fast. Again, not good. We staged on the far side of the railroad tracks with the thought in mind that we didn’t want to get caught waiting for a train to pass if the police called us in. We had a basic unit and a medic unit coming in from different neighboring stations, but they didn’t arrive in time to stage, as the police called for us to come in to the scene within a minute of our arrival.

The house was easy to identify. It was the one with all of the cop cars parked in a halo around it with the front door open. Bad news. We pulled up as close as we could. I directed the men to bring our EMS equipment up and I walked up to the door. Through the open door, I saw more bad news. Blood dripping off of a kitchen island and smeared down the side of the cabinets. The soles of some dude’s shoes, toes up. A woman frantically mopping blood from the floor next to the dude. Cops looking upset. Once I got into the house and crossed the foyer, I saw what all the fuss was about.

In the middle of a Christmas party of about thirty people, I was presented with a late-20’s to early 30’s Hispanic male, shirtless, barely responsive, lying in a large pool of blood, with a wound in his chest (6cm) under his left arm (5th or 6th intercostal space I’d say). The wound wasn’t bleeding, but clearly had been. It was a nasty cut, and someone there said that he had been run through with a kitchen knife. The wound was consistent with the story. My first thought was “That’s a great way to get stabbed in the heart”.  I called for a helicopter by radio, told Wayne where I wanted the LZ, and he set about conveying the LZ coordinates. The guys took up patient care, and as they were getting set to apply O2, I told them to slap an occlusive dressing on the stab wound. Now, if I were hands-on with this patient, I would have used the wrapper from the O2 mask to make the dressing, but that’s just me. Timing and heat of battle being what they were, the piece of plastic that got used for this task was the plastic wrapper from a pack of soft tortillas. Whatever. Any port in a storm, I suppose. Ernie did the actual dressing, and did a fantastic job. Despite the fact that the patient was utterly covered with blood (like, his torso was reddened by drying blood, his hair was slicked back, etc.) Ernie got the tape to stick, and for the moment, I called that issue “managed”. I was relieved to have the immediate work dealt with in advance of the arrival of EMS units. My relief was to be short lived.

As my guys set about further evaluating the patient, there was a loud crash, a shaking of the house, and a bunch of yelling and boot-stomping from upstairs. As it turned out, our “secure” scene was somewhat less than secure. This house was big enough that the cops felt safe letting us into the kitchen to work on this guy, but didn’t tell us that the assailant was not accounted for and, oh yeah, was thought to be either upstairs or in the garage. A voice from upstairs- “Hey, we need help up here! There is someone else cut!” I leave my crew to check this out. There is a cop at the top of the open foyer, giving the “round third” sign at an upstairs bathroom. Other cops were kicking in closed bedroom doors and performing “tactical” entries and searches. All of this would have been really cool, except that those were real guns that they were using and there was a really dangerous somebody not accounted for.

Our second patient of the evening was sitting on the edge of a tub in the upstairs bathroom. Also shirtless, he had an obvious slice to his left bicep area, and was holding an abdominal wound that didn’t appear to be a full-on puncture of his gut. He was conscious and alert, had good color, and was complaining about how the party had been ruined. There had been some blood loss, but not enough to cause me any huge concern. I took a closer look at his abdomen, and categorized him as BLS in my mind. Assured that he was going to live for a few minutes, I turned my attention back to scene security. It seemed to be better in hand by this point.

I returned to the foyer and as I was coming downstairs, I met the Ambulance and Medic crews. I put the medic unit on the guy stabbed in the chest and guided the BLS unit to the guy in the upstairs bathroom. By now, the police were starting to question all of the bystanders. Many of these people were getting in the way. Some of the people were seated in the dining room eyeing a big tray of chicken. Most of the people were upset, and it was generally a weird vibe. The basic unit asked for one of the medics to come upstairs, as they disagreed with my assessment. I thought to myself, “That’s cool, they got a better look than I did”. One of the providers from the medic unit went upstairs to look at the second patient.

Back to the kitchen, where I watched the assembled fire/EMS people put the first guy onto a backboard and hustle him outside. Most of my guys went out with them, including Wayne, who was by then directly helping out with patient care. The rookie and I were by the front door. THUD!

Patient number three was a 18-24 year-old female who decided that she had seen enough and fell out right there on the dining room floor. The thud had been her head hitting the floor. This same girl had previously been running around trying to tell people what happened, checking on things, and generally making a pain of herself. The police asked someone to come back and take a look at her, and I realized that with the exception of the rookie, I was the only person not hands-on with someone, so I went to take a look. She was lying on the floor with her eyes closed, breathing, and looking upset. My EMT-B initial impression was “bullshit”. She didn’t respond to verbal inquiry, so I did a sternal rub on her, and miracle of miracles, she came around. I left the rookie with her, and left to go outside to find someone else to take care of her. On my way out, the basic unit lead told me that the new plan was to fly patient two. Great. I called for a second helicopter by radio. As I am standing there, one of the older men in the house pulled me aside and told me that patient three had some cardiac history, and had passed out like this before. Great. I called for a second medic unit. Patient two was on his way down from upstairs in a stair chair. The medic caring for him is a top-notch provider, and I stopped thinking about him.

I went outside and found the bulk of my engine crew aboard the medic unit. They were busy assisting the ALS provider with holding things and starting lines, etc. I remember someone saying that the guy’s blood pressure was bad news/lousy, and it was decided that Wayne would go in the back and that Ernie would drive the medic to the now-established LZ. I grabbed Rookie Dan and other Matt to help me inside.

Patient number four was a lady who had been in the study of the house quietly using the internet for most of our visit. She is brought to us by a police officer who noticed her injury as she was being questioned. She had a full-thickness 8-10cm cut on her anterior/medial forearm. It looked horrible, but was not bleeding so badly. Matt started to help her, and Dan and I went off to find the rookie. Turns out that patient three’s recovery had been so dramatic and was so complete that some police officers took her out into the street to try to find the still-not-in-custody assailant. We got back to other Matt and helped him conclusively bind up pt. 4’s arm. Next, I handed off patient 4 to the now-arrived second medic unit, who needed some explanation of how their potentially ALS patient turned into a cut arm. As they worked, this medic unit took a look at the moderately-controlled chaos around them, and sort of understood.

At this point, it was like being at a multiple vehicle accident. I started feeling like the longer we stayed on-scene, the more patients we would develop. Once that second medic unit had patient 4, I gathered my guys, gathered the big pile of EMS gear from the kitchen, and got out of the house. We loaded this ton of crap into the pumper and I drove to the LZ, where we arrived in time to see the second helicopter take off. The EMS folk were high-fiving and quite excited about a job well-done. I was happy with the patient care too, but I was livid with the way the police handled the scene. All things considered, the call went very well. Some elements of chaos and disorder cannot be predicted or controlled. The cautionary note to all public safety providers is to never take your scene safety or security for granted, even if there are 20 police officers with you.

As I write this on December 29, 2005, I have seen that the local paper finally saw fit to do a story about this call. They said that three patients were transported with “non-life threatening injuries”. That can’t be right, but I will take the fact that patient number 1 apparently didn’t die as a good sign.

By the way, Rookie Dan nearly felted me when he hit his flush on fifth street. I didn’t even see that coming. I wasn’t really paying attention to the game. I look forward to everyone’s comments. I will reply in due course. Be safe, everyone!

DTXMATT12