Kicking off the EMS news this week is an editorial article I found at the St. Louis Today website on new FEMA proposed changes to EMS guidelines regarding our Scene Safety mantra in emergency medical services. In response to the surge in mass casualty incidents including active shooters, bombings and natural disasters, the Federal Emergency Management Agency would like to see EMS change their rules regarding providing care in so-called ‘warm zones.’
EMS in Warm Zones on Scene
Warm zones are areas that are no completely cleared of danger by law-enforcement so the potential for threat still exists but no immediate danger is present. This would have EMTs and paramedics following police closely in to these situations in an effort to treat life threatening traumatic injuries before the patients bleed out.
The reformers at FEMA say that an example of how this would work is evident at scenes like the Boston Marathon bombing where the doctors and nurses near the finish line sprang in to action while EMS crews staged nearby according to protocol. There is some evidence that the death toll would have been higher if the immediate medical attention had been delayed by standard EMS response guidelines regarding such incidents.
Scene Safety Rules Need Adjustment
Now you know I’m a proponent of scene safety here on the MedicCast since you hear me end the show with that every week, but I do think there is some room for adjustment here. There is certainly a need for immediate treatment like tourniquet application and other hemorrhage control measures that could save lives on the scene in these situations.
When you look at other scenes around the country and look at the response, rapid removal from the scene to the trauma center in the immediate moments after the initial incident by any means available is effective in saving lives. The reports from the Aurora Movie Theater shootings show the effectiveness of these measures where many of the critically ill patients were transported by police cruisers to the trauma centers and ERs before all the ambulances could be mobilized.
It is time to re-examine our scene safety mantra and make some changes. It doesn’t have to be written in stone.
Follow-up on the link for this and other news items as well as all of the additional resource links in the show notes for this episode – Oxytocin EMS Medication Review and Episode 366.