Firearm incidents

Alleged drive-by: bikie gang violence continuesNick RalstonSydney Morning HeraldApril 24, 2012 - 12:27PM

WHY BOTHER?

?A BIG BAD world out there

Heroic VS Self-preservation

Objectives: A general discussion on safety issues with a little bit of medicine

ASNSW DISPATCH

Is the address/person known to be on the caution list?

Potentially violent/high-risk situation?

Is there a weapon involved?

Is the police on scene?

Has the police secured the scene?

Is the assault still in progress?

Is the perpetrator still on scene?

Is there potential threat posed?

Code 1: Ambulance officer in trouble require police

Code 24: Approach scene with caution

Code 28: Stand-off scene until notified

SCENARIO 1

Dispatched to a patient with penetrating trauma: GSW to ?head/neck/chest

Approach by road

Information given en route: GSW victims involved in a shoot-out during a drug bust operation

Location: an underground car-park of a residential building

On your arrival: the block was cordoned off, police snipers visible in some adjacent buildings

WHAT TO DO?

Important learning point - switch to local ambulance channel for ongoing development of the situation

The scene should be confirmed secured upon our arrival

A quick ‘sit rep’ about where/how many causalities/the regress route back to your vehicle

The team should be accompanied and escorted by members of the police

SCENARIO 2

Called by Bankstown Airport control tower: assistance requested as there were two people with GSW at the airport pub

000 call was also made

Approach by road: no visible presence of any emergency service

Waved in by someone with a weapon (your SCAT paramedic confidently identified as a plain-clothed police officer)

WHAT TO DO?

Inform MRU and confirm the appropriate dispatching

Request police’s presence and establish a rendezvous point

Report to MRU on your progress

Confirm ‘scene secured’ the best you can after arrival on scene

‘Team decision’ about how to proceed

Information gathering prior to arrival - local ambulance channel might be only source of information

Scene safety - coordinated by the police, ?mature scene

Checking ‘scene secured’ - the team’s responsibility

“Stand-off scene till notified”

Situation awareness

Approached with caution, even a seemingly ill patient

?PPE

Human factors!!

DISCUSSION POINTS

SCENE SAFETY HOP

Personal safety comes before patient care.

Safety is the responsibility of all staff.

Never assume that a scene is safe until you have personally assessed it

The experience and training of Aeromedical Paramedics dictates their role as the team ‘Safety Officer’.

Due to the specialist or technical nature of some scenes it is essential that you follow the safety directions of the Combat agency controlling that scene.

7.3.1! Incidents involving patients injured in shootings or stabbings are often rapidly evolving and fluid scenes with a potential high level of risk to emergency crews

To ensure situational awareness, the crew must ensure that they are on the local operating channel as soon as possible

The medical team should not approach the scene directly and should stand off until a Rendezvous Point (RV) has been established.

Once there is confirmation from police that a scene is safe to approach the team should determine specifically: whether the alleged assailant/s are in custody and whether the weapon/s have been secured.

The doctor and paramedic should remain together at all times and maintain scene awareness.

If any member of the team feels that the scene is not secure the team should return to the RV immediately.

In certain situations, consideration should be given to transporting the patient restrained with a police officer accompanying in the rear of the ambulance (following ASNSW guidelines).

A LITTLE MEDICINE FOR PENETRATING TRAUMA

Never assume the depth of the wound or direction of the track => over-triage should be the norm

Time is critical and surgery by appropriate surgeons is what the pt needs

‘Resus room’ mentality with back -up plans

Hypotensive resuscitation; ?Hybrid resuscitation

DESIGNATED TRAUMA SERVICE IN NSW

Major (Adult)

John Hunter

Liverpool

Royal North Shore

Royal Prince Alfred

St George

Westmead

Major (Paediatric)

Sydney Children’s @ Randwich (POW)

Childrens’s Hospital @ Westmead

John Hunter Children’s

DESIGNATED TRAUMA SERVICE IN NSW

Regional

Gosford

Nepean

Wollongong

Coffs Harbour

Lismore

Orange

Port Macquarie

Tamworth

Tweed Heads

Wagga Wagga

QUESTIONS?

The only problem with communication is the illusion that it has been done.