Chapter 52 Crime Scene Awareness. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure

Chapter 52Chapter 52

Crime Scene Awareness

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

IntroductionIntroduction

• 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.

IntroductionIntroduction

• 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.

AwarenessAwareness

• 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 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 ArmorBody 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 ViolenceIndicators 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

• 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

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.




• If you are not first vehicle to arrive:− Ask IC where to park vehicle, or

− Park downstream of the incident.



• 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 VehicleApproaching 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.


• 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


• 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.


• 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


• Precautions when approaching vans:− Move 10 to 15 ft

away from passenger side.

− Remain clear of the side door.


• Precautions when approaching vans (cont’d):− Walk parallel to the

van until you are 45˚ forward of the A post.

Retreating from DangerRetreating 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 DangerRetreating 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 IncidentsResidential 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 ResidenceApproaching 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 ResidenceEntering a Residence

• Use an alternative path to approach.

• Stand on the doorknob side of the door.

• Knock and announce yourself.



• Ask whoever answers the door to lead you to the patient.

• Pick a primary exit.

• Pick a secondary exit.


• 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 ViolenceDomestic 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.


• 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


• 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 LaboratoriesClandestine Drug Laboratories

• Methamphetamine is the most popular substance manufactured in clandestine labs.

• Highly flammable and toxic chemicals



• 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


• 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.

GangsGangs

• Approximately 20,000 violent gangs

• Gang activity has migrated to suburban and rural places.

• Gangs predominately survive through the drug trade.

GangsGangs

• Most gang communication is more sophisticated than “gang signs.”

© Nzgmw2788/Dreamstime.com

GangsGangs

• Contact your local law enforcement to ask about known gang territories.

© iStockphoto/Thinkstock

GangsGangs

• 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.



• Paramedics should remain in the staging area until the scene is secured.

Courtesy of John Wipfler



• Paramedics need to know how to use cover and concealment.− Cover objects are impenetrable to bullets.

− Use concealment when cover is not available.



• 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.



• 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 SituationsHostage 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 SituationsHostage 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 CoverContact 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.


Using Walls as CoverUsing 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 TacticsEvasive Tactics

• Change locations only if new location is:− Better cover

− Farther from the hostile atmosphere

− Reached without revealing yourself to attacker

Evasive TacticsEvasive Tactics

• Before changing locations, look out from your cover several times.− Look from different heights and angles.


Concealment TechniquesConcealment 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-DefenseSelf-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-DefenseSelf-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.




• 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 ScenesCrime 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 EvidencePreserving Evidence

• Two types of evidence:− Testimonial

− Real or physical

• Do not disturb, damage, or alter physical evidence at a scene.

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• 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.


• Crime scene investigators usually wear full-body Tyvek suits.− Every interaction

with a space or surface entails the deposition of your DNA.

© Stephen Chernin/AP Photos


• First responders are typically the first to enter a crime scene.− Do not:

• Clean up.

• Alter items.

• Move bodies.



• The incident be properly documented.− Much time can elapse between the call and

your testimony.

− Documents may be read by dozens of people.


• 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

SummarySummary

• 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.

SummarySummary

• 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.

SummarySummary

• 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.

SummarySummary

• 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.

SummarySummary

• 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.

SummarySummary

• 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.

CreditsCredits

• 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.