Clear to Enter

Dispatch: “Respond priority 3 to stage for an overdose”

Crew: “Show us en route”

Dispatch: “Your now clear to enter, the RP is advising that the patient is unconscious”

Crew: “Can you confirm if law enforcement or fire is on scene?”

Dispatch: “Negative on both, the patient isn’t violent, you are clear to enter”

Crew: “Copy, we will be staging until law enforcement arrives”

If there is one thing that is more important that anything else in this job, it’s going home safely after your shift. One of the biggest problems with the above scenario is the fact that dispatch relies on the reporting party to give enough information to determine whether or not the scene is safe to enter.

On most calls like this, the patient who overdosed is not the one you need to worry about, it’s the people surrounding them. Whether this patient unintentionally overdosed on street drugs, or intentionally overdosed on prescription drugs, one thing is for sure. They aren’t thinking rationally, and the people they associate with are probably not thinking rationally either. And when you go into a scene expecting irrational people to act rationally, you are setting yourself up to get hurt.

Obviously this doesn’t just apply to just overdoses. Stabbings, shootings, assaults and psychiatric patients are all prime examples of calls where we should be staging until law enforcement arrives. You can call me scared, paranoid, or even accuse me of trying to dodge calls, but I’m going home every night and that’s all that matters. I’m sorry, but after having a good friend of mine get beat unconscious on a “clear to enter” call, and another coworker wind up with a gun pointed at his stomach, I’m done with taking risks.

Your safety doesn’t stop with a law enforcement presence either. When dealing with these types of calls, or any calls for that matter, there are certain steps (and easy ones) you should take to help ensure you, your partner’s and your patient’s safety.

• Always look around you and try to avoid having your back to anyone. Logistically, this isn’t always possible for you to do, but there is no reason your partner or other responders on scene can’t keep a watch on what’s going on. This simple task could be your saving grace in the event that  someone tried to harm you.
• Scan the area for items that may be used to harm you. A quick scan of the area that the patient has immediate access to only takes seconds and can help identify any threats. Don’t just rely on law enforcement personnel to do this.
• When dealing with altered or unconscious overdose patients, pat them down for weapons. This is a habit I developed after learning the hard way and having to wrestle a knife out of someone’s hand that woke up after I administered Narcan. Trust me when I say this pays off.
• When you do find yourself in a position where you need to administer Narcan to an unconscious patient, try to do so on scene or in an environment where you have extra hands in the event that the patient becomes violent. Soft restraints are nice, but they aren’t perfect.

Unfortunately there are bad people out there and no matter how careful we are, there is no way to protect ourselves from 100% of the dangers out there. However, this doesn’t mean that we should let our guard down. There have been plenty of line-of-duty injuries and deaths that could have been easily avoided had the responders taken precautions. Don’t become a statistic. If your not sure the scene is safe, don’t enter. And if the scene becomes unsafe, leave. Remember, at the end of the day, the only thing that matters is going home.