Scene Management

Emergencies, by their very nature are complex and dangerous environments. It is for this reason that the role of scene management during an emergency is given to the most senior paramedic on scene. Most emergency incidents require other emergency service agencies, such as police, fire, and rescue. Each of these agencies perform a specific role independently, and may or may not involve or communicate with the multiple agencies on scene.

The following are general concepts that paramedics must take into any emergency scene:

Maintain Safety

At any emergency scene, safety should be paramount for the paramedic, other emergency service personnel, bystanders and patients. This starts well before you reach the scene. Personal Protective Equipment (PPE) should be donned, including: reflective safety vest, helmet, gloves, protective eyewear and supportive boots. As much information about likely dangers on scene should be obtained prior to arrival through the dispatch operators. This may include information about power lines down, violent patients, weapons on scene, fuel, explosives, or structural collapses. As the paramedics approach the scene, both driver and treating paramedic should be alert and vigilent for possible dangers. Park the Ambulance relatively close to the patients, but provide enough room to allow other emergency services through if required, and ensure that the Ambulance is parked in such a way to make rapid egress possible if the an unexpected danger presents itself.

Maintain Communications

Review of many critical incidents or major incidents highlight the value of good communication between the paramedics on scene, command posts, other agencies and dispatch. An early scene assessment and scene report should be the first paramedics on scene’s priority. In Australia, this involves an accurate ETHANE report. The mneumonic ETHANE stands for:

1. Exact location of the event. This should include street location and cross street if known.

2. Type of event, such as “car into truck.”

3. Hazards on scene, such as powerlines down, building or structural collapse.

4. Access and egress, this means best way to enter the scene, and possible areas for egress (how to get out).

5. Number of patients – if this is a large incident, such as a disaster, a basic head count should suffice for first report. Preferably, if possible, patients should be tagged using the recognised disaster tagging system in your area.

6. Emergency services on scene and required. Basic emergency services already on scene should be acknowledged and those still required should be identified.

Establish Command

Initial command should be determined by each agency prior to an emergency event as part of their disaster planning. For example, senior paramedic in first Ambulance to take the role of scene commander. Command must be established immediately!

Paramedics should aim to provide the most good for the most number of people. This is why in a major incident, where resources are scarce, paramedics may not be able to work on all patients, but should aim at treating the patients who are most likely to survive provided your basic treatment.

Managing the scene of an emergency, even for paramedics who are percieved to attend emergencies on a daily basis, often find scene management a difficult role and the most important role at the scene of an accident, emergency or disaster. It is important to take your time, look confident (even if you don’t feel it) and ask for help… you can always cancel resources later, but get them comming until you’re certain that you don’t need anymore.