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What do YOU do, when you're called to someone assumed to lay sick behind the closed front door?

Just had a call yesterday, that left a citizen with a broken window, a crashed flower pot, a lot of firefighter's footsteps in the house and several opened & searched beds/closets. The adrenaline vapor may be vanished meanwhile. :)

So I just thought the whole way back to the station, that this would be a nice small scenario here...

Specifics (just from reality):

  • thursday afternoon, clear sky, summer, but not very sunny, not rainy
  • dispatch gives "sick person laying behind the closed front door" and address (a single brick house with cellar, ground floor, first floor)
  • your team: ALS first responder unit (1 paramedic, 1 EMT) from neighbouring village with ETA 5 minutes (no transport)
  • other, medical: 1 ALS ambulance (2 paramedics) with ETA ~10 minutes on the way
  • other, technical: local volunteer fire department of the same village few minutes away, coming with two engines, 10 staff including local fire chief.
  • other, law enforcement: police tries to find some available officers, next is more than 20-30 minutes away

You arrive short after fire department. Two fire trucks are on the street in front of the fenced garden, blocking the access to the driveway. Some firefighter awaits you and tells you instantly to drive your first responder car further away, because there's an ambulance coming. What would you do from now on...?

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- Tell the fire truck to move, it’s a medical call, not bush week.

- No need for 10 firefighters, tell fire chief to send 3 or 4 to help break in, others can wait at the truck.

- Search the house for open windows, try to ascertain voice contact – if no contact or way in then break ONE window and the medical staff enter the building with maybe one or two firefighters.

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First, ask them to move their fire trucks as you're dumping your jump bags our of your rig. Move your vehicle so it doesn't block the ambulances path. (Be prepared for the macho fire dude to be upset at your arrogance at asking him to allow access to the silly ambulance. This may sound like a cheap shot, but I can't remember a single time that I've asked a firetruck to move that someone actually moved it.) Pick up your bags and then continue with your call...

You have no use for more people than you may need to help get the stretcher out of the house, but the vollys are going nowhere, you can count on that. In fact, unless the body looks dead you can cancel everyone except help to carry and also to witness any damage that may need to be done.

I had nearly this exact call actually...

My partner and I checked all the doors and windows, could see the patient waving us in, or so it appeared, from the bed through a window but she was unable to come to the door.

I holler at a young fireman and say, "Hey man, think you can find a way in there?" He says, "Yeah, if you say so!" as he's running towards the truck. My partner in the meantime says, "Hey! You can't give him permission to damage property!" As I hear the door being pried open, I told him.."I didn't give him permission for anything. I simply asked him a question. His adrenaline is his problem." I'm guessing he learned, like we all do, to settle down and think...

We got in, fire spent half the day repairing the door and all was right with the world.

Short answer. If PD is there I've always just been able to tell them that "I need access" and they get it, either through one of their tools or OK'ing fire to break something. If the police weren't there then fire is always more than happy to break something, though I have seen many firemen come up with some friggin' ingenious ways of gaining access without doing any damage at all.

If neither option is available then I'll choose the quickest, safest, least destructive way in...but I will in fact go in if I truly believe that there is a need for me to be in there. Let the white shirts sort the rest out after patient care is complete.

I would, any day of the week, rather defend being an over zealous patient advocate than try and defend why someone suffered because I was afraid I might get into trouble for breaking a window.

Not exactly sure if that was what you were looking for, but if not, my apologies as it wasn't my intention to hijack your thread..

Dwayne

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OK, let's do this scenario quick, the real life solution wasn't that special to spent too much time on it.

Dwayne, I will follow Timmy's solution because you already "did" a lot more than I expected in the first answers.

- Tell the fire truck to move, it’s a medical call, not bush week.

OK. Did this - very friendly. They moved.

- No need for 10 firefighters, tell fire chief to send 3 or 4 to help break in, others can wait at the truck.

I can't legally say the fire chief what he does with his ressources (as well as he can't say something about mine). So I let them play whatever they wanted. I even may have use for them later. I'm pretty sure dispatch called out only one vehicle, but they simply went with all they have. Didn't say anything about that, they weren't in the way (on another occasion with the same department I had ONE firefighter EACH two meters pointing me to the house, as if just in case I would have been completely blind). Nice of them. :)

- Search the house for open windows, try to ascertain voice contact – if no contact or way in then break ONE window and the medical staff enter the building with maybe one or two firefighters.

OK, you (both) would break a window if no contact was established?

I wouldn't, beeing in such situations often enough. There is no clear evidence of someone beeing in need. I would try to

  1. identify someone in need,
  2. find a solution without damaging property. Once I watched a professional lock & key service opening a massive entry door just as someone with the regular key. They may need some time to get there but if called by EMS/police they are rather quick. Problem remains: the bill...
  3. Wait, till law enforcement is on scene. They can legally advise breaking into someone's property.

Only if there is real evidence of someone in need, I would force entry on my own decision. This may be contact to the person over phone (dispatch), through the door (voice) or visual. I did this on some occasions.

But in the given call I hadn't this decision anymore: the fire fighters broke a window, smashed a flower pot and started running through the house (five or six of them, including chief). Second fire fighter you meet (the first one was the one with the moving request) informs you about this saying "This now broken window is the only way in. They're inside searching!". Your next move?

I here give you some more information (which I had after contacting the fire chief inside the house <- that was my "next move"):

  • a woman identifying herself as the cleaning lady of the person in question. She comes weekly, usually the person opens (she has no keys), but not this time.
  • from outside she saw a prepared snack.
  • she identified the prepared snack on the breakfast table as the one she bought the week before.
  • she states that the person has diabetes and is known to drink too much alcohol from time to time.
  • she called emergency number since she didn't know what else to do.

Search in the house still in progress (imagine running firefighters, heavy boots, ...).

Law enforcement is on the way, but may still need 20 minutes.

(Be prepared for the macho fire dude to be upset at your arrogance at asking him to allow access to the silly ambulance. This may sound like a cheap shot, but I can't remember a single time that I've asked a firetruck to move that someone actually moved it.)

Oh, I simply ignored his request and told him in a friendly way that it's his vehicle that blocks the way, not mine. Worked.

My partner and I checked all the doors and windows, could see the patient waving us in, or so it appeared, from the bed through a window but she was unable to come to the door.

OK, but in my case there was no patient noticeable from the outside.

Not exactly sure if that was what you were looking for, but if not, my apologies as it wasn't my intention to hijack your thread..

No problem here. I will post the solution of the real case after some answers on legal & ethical aspects of breaking into possible patient's houses... :)

Edited by Bernhard
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Well, if it's to be judged by another thread, EMS has no legal/moral/ethical issues with breaking into anyone's home, at any time, and removing them against their will for any reason if, in EMS's judgement they feel that it may be in their best interest...

Does that help? :-)

Dwayne

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Going on protocol alone in my area PD is the only people that can forceably enter a residence. The one caveat is if imminant danger is present, ie house fire w/ a pt trapped then anyone can make entry.

My squad SOP is if we can make verbal or visual contact and are requested enterence we can do what is necessary. The halagan in the rig is our master key :devilish: Usually we have PD with us so normally not a big deal.

Personally I have pushed in a window A/C unit to gain entery so no damage (well cosmetic to the unit) and opened the front door for my team. The PT was spoted unresponsive on the kitchen floor with the phone near the hand through a window so we knew we HAD to get in quickly. My far to ambitious grasshopper wanted to through a chair through the back sliding doors :rolleyes: I stopped him then used his back to reach the window.

I guess it all boils down to what is happening at that moment and what resources are available to you. Remember we are in a dynamic situation field so cut and dry answers sometimes can't be found.

Edited by UGLyEMT
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Does that help? :-)

Me? Always, Dwayne, always. :)

But maybe someone sees it otherwise. However, beside ethics, if speaking alone of scene safety it could be unwise in some US states or other weapon liberal areas. Over here it's rare that someone has a gun in his house.

Immedeately after the incident I met a former deputy chief of another vol. fire dept. (in a completely other business, but I couldn't resist to tell him the story) and he told me, that his department was widely known (and dissed) as the only one waiting for the police instead of breaking into houses. So, it seems, that fire depts. may have a completely other view on private property. Not that this had surprised me.

To finish this small scenario, my steps were from the beginning:

  1. Ignore the silly request to remove my vehicle.
  2. Prepare space for the arriving ambulance.
  3. Contacting fire chief already on scene (which forced me to climb through the already broken window).
  4. Trying to calm the scene and to ensure the complete house was searched in a proper manner ("...you are sure to have looked everywhere if you already trampled through the whole house?").
  5. Finding an alternative entrance (front door was closed) - to be honest, as I mentioned this, it was one of the firefighters who simply opened the porch door, immedeately canceling the need for more people climbing thorugh the window.
  6. Ensure, that law enforcement responds to scene (fire chief did this).
  7. Questioning the initial caller (the cleaning lady) about why she called, possible problems etc.
  8. Remembering I was there already some months before plus the one medic of the meanwhile arrived ambulance remembering having transported the person in question four times this year.
  9. Informing dispatch and requesting a search about possible recent calls to this address.
  10. Canceling all subsequent actions when beeing informed by dispatch, that the person in fact was transported to a hospital some days ago and is still there. :)

In the answers given, I at least missed step #3 (contact other responders already on scene to gather information) and #7 (get more information from the caller, especially when she's present on scene).

So, no patient there, now only a broken window and dirt all around the house (well, cleaning lady already on stage). We left scene, leaving the firefighters there to have things settled with the police department. Would be interested what the owner thinks about this...

Would I feel guilty, when the facts were other ones: really a sick person behind a closed door, not known to us (no verbal/visual contact or other)? Probably no - if he really needs medical assistance within minutes it most probably would be too late anyway. If not, then we would have the time to find another way or beeing advised by police. Bad for the patient, but better than breaking into all houses just for the ideas of someone else (even if in good intention).

However, main problem I see here is that law enforcement took so long to arrive on scene (I even don't know when, I left before).

Nice little scenario, I think I will use it in our first responder training (we have some scenarios provocing such ethical & legal discussions).

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Here is a spin....

You make verbal, but not visual contact with a male, he is in obvious distress. Sounds like either severe pain, or labored breathing, hell maybe both. The house is shut up tight as Fort Knox. He says he can't come to the door, no keys are outside, and he wants you to call for a locksmith.

What do you do?

Assuming you called the locksmith, who has a 45 min ETA, after 10min of waiting you lose verbal contact with the guy? Now what?

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At the end of the day I’d rather have a complaint put against me by an angry resident who wants to claim for minor property damage than stand in front of the coroners court with my pants down trying to explain why I waited 30 minutes for the police or locksmith to arrive while there’s two fire trucks and a couple of ambulances sitting in his driveway.

As luck has it in my state in Australia the Fire Service is covered under the Fire Services Act (approved by parliament), it stipulates that the fire service can reasonably gain access to a premises or any place (public or private) in order to protect property or life. In this situation, if reasonable steps have been taken to raise voice contact but failed, there is no visual confirmation and you have first hand information that this person has pre existing medical conditions then one would assume it is reasonable enough to make a forced entry, you never know when they have hypo’ed in the basement, had an MI on the toilet or may have been deceased for the past week… Who would know…

Just to clarify reasonable forced access to rule out further questions so I don’t give you the impression that the fire service can run around entering anyone’s property at anytime. The fire service can not turn up to a property that has a smoke alarm operating and force access unless there is smoke, flames or another provoking factor, they would have to wait till the locksmith or owners turn up.

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Your all crazy for not using all the Fire Monkeys ... they are like the Borg use all resources available.

1-Dude then they get the wrap for B and E, if no patient located.

2- get a rookie (look for cleanest Bunker Gear) pumped up franticly yelling (waiving hand in air helps)

"OMG someone is dying in there, WHAT should we DO" at this juncture point to a crash axe.

3- Then tell the other 5 goofs stinking of smoke to go get the cot and gear

"don't just stand there" "do something" ! again animated hand waving in air wildly helps.

Clear language is required ... The .... RED bag and the .... BLUE bag and that ......TV looking thing, speak slowly.

Directed adrenaline workers every time"

1- you cancel if no patient located,

2- go for strudel,

3- the police show up to take pictures of damage.

Mission Accomplished :icecream:

No ethical/moral/legal conundrum here when EMS is not any breaking glass, doors and wrecking the place.

Edited by tniuqs
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