Case Study:Possible fight in progress at the scene of a fire.


Case Study:

A 911 call comes in for a report of a possible fight at the scene of a fire. The caller claims to be across the street from the house where the fire is.  The caller states he can see one man down in the yard with another man on top of him. To him it looks like the one man is attacking the other. The caller sounds young and frantic. Without warning the caller hangs up the phone.

Based upon the information received, dispatch sends Fire/EMS and Police. The police officers are first to arrive on scene and state the scene is secure. Fire and EMS arrive on scene shortly thereafter.

The police state two “buddies were wrestling” in the yard because they train mixed martial arts together and state there was no altercation. Their story is backed up by relatives who arrived after seeing all of the responding units. The officers learn the two males admitted to consuming “some beer”. They are both of legal age and did not commit any crimes per the officers.

The firefighters find the fire is actually a controlled burn. It is well contained within a professionally constructed fire pit. There is no ordinance against the burning and there is no burn ban in effect.

The EMS crew observes some swelling and a cut above the eye of one of the men who claimed it was obtained from an accidental elbow as they were practicing grappling skills. He stated “it rang my bell” and he pats the other guy on the back. The other claimed he has a little pain in a shoulder from escaping a submission hold. The EMS crew asks each of the males if they wish to be treated or transported and they both refuse.

The officers go across the street and speak to the person who made the original 911 call. It turns out the caller is an 8 year-old boy who apologizes for making a mistake. The police officers and the firefighters go back in service immediately and leave the scene.

What about EMS? What do they do now? Here we find the classic person(s) have consumed some form of intoxicating beverage. There are obvious injuries yet the men refuse treatment. This is where the “What-Ifs” get staff hemmed up.

Before we go further, consider this:

The trained professionals for recognizing and dealing with criminal acts were originally dispatched to what was reported as possible criminal activity (some form of an assault).  The trained officers recognized no crime was committed. In doing so, no arrest was made.

The trained professionals for recognizing danger and how to deal with danger from a fire, the professional firefighters, recognized there was no need to drag hose and douse the home and property for a fire that did not pose a danger.

The professionals in their respective fields are trained and “allowed and encouraged” to use their training and experience to know when to and when not to use their training, tools and tactics.

Well, what about the EMSer on this call? You have people who have consumed some form of intoxication beverage, they have obvious injuries, you were dispatched to them. So by textbook definitions… they are your “patient”…and to make it more dangerous…many have been taught that any level of intoxication cannot refuse your     treatment. So in this case what would be the reasonable next step for the EMS crew on this scene? Remember me mentioning the “what-Ifs” ? Your mind is already considering them “What if he has a head injury and dies?” What if he runs into traffic and gets hit by a car?” I have one for you… What if you try and force your treatment on him/them and they decide to attack you? You darn well recognize when a person is so drunk they are a danger to themselves. They are the ones we have to pour onto and off of our stretcher. They can’t protect their airway and are probably comatose or about to be…

I find it ironic that the medical professionals are not “allowed or encouraged” to recognize what is and what is not a patient based upon their training and experience.

This is what we do with our EVE programs. We give providers the ability to recognize when there is a change in relationship. When there is no patient/provider relationship or when it ceases to exist. We are not asking people to refuse to do their job. We are asking them to do their job…safely. While this case study is fictional, every provider both pre-hospital and in-hospital understands the message here. Many are compelled to do something that is unsafe based upon culture.