1. August 2009 Calendar Module Near-Miss EMS Incidents Photo Courtesy: Jason R. Henske/fyrfoto.com

2. Incident #1 Call received for a patient with an altered mental status. Call received for a patient with an altered mental status. Crew arrives and encounters an elderly female who appears to be confused. Crew arrives and encounters an elderly female who appears to be confused. Crew begins treatment of patient. Crew begins treatment of patient.

3. Incident #2 Call received for a diabetic emergency. Call received for a diabetic emergency. Crew arrives and finds an elderly male sitting in a recliner. Crew arrives and finds an elderly male sitting in a recliner. Assessment and treatment of patient begun. Assessment and treatment of patient begun.

4. Incident #3 Call received for a patient with difficulty breathing. Call received for a patient with difficulty breathing. Crew finds elderly male in respiratory distress. Crew finds elderly male in respiratory distress. Patient had a history of COPD. Patient had a history of COPD. Home oxygen supply was exhausted. Home oxygen supply was exhausted. Patient requested oxygen therapy only, did not wish to go to the hospital. Patient requested oxygen therapy only, did not wish to go to the hospital.

5. Incident #3 Crew advised patient he needed to be transported. Crew advised patient he needed to be transported. Patient became upset, stated his desire to not be transported. Patient became upset, stated his desire to not be transported. Crew spent nearly an hour with the patient. Crew spent nearly an hour with the patient. Patient calmed down, eventually consented to be transported. Patient calmed down, eventually consented to be transported.

6. Things in Common All: All: were legitimate medical emergencies were legitimate medical emergencies patients were elderly patients were elderly incidents occurred at the patients residences incidents occurred at the patients residences crews handled the incidents without assistance from the police initially crews handled the incidents without assistance from the police initially

7. Questions to Ponder Would you suspect violence in any of the incidents? Would you suspect violence in any of the incidents? Would you request police assistance? Would you request police assistance? If so, would you stage until the police arrived? If so, would you stage until the police arrived?

8. Remember the Basics Scene safety!!!

9. A Review Incident #1 – Confused elderly female Incident #1 – Confused elderly female Incident #2 – Elderly male, diabetic emergency Incident #2 – Elderly male, diabetic emergency Incident #3 – Elderly male, difficulty breathing Incident #3 – Elderly male, difficulty breathing

10. Crew Actions Nothing in any of the incidents gave the crew an indication of potential violence. Nothing in any of the incidents gave the crew an indication of potential violence. Crews did not request police assistance. Crews did not request police assistance. Police arrived on one incident, presumably as part of a routine response Police arrived on one incident, presumably as part of a routine response Crews entered residences without police presence. Crews entered residences without police presence.

11. Your Actions? Would you have done anything differently? Would you have done anything differently? If you answered honestly, probably not. If you answered honestly, probably not.

12. The Rest of the Story!

13. Incident #1 Crew treats the patient for confusion without incident. Crew treats the patient for confusion without incident. They assist her in walking out of the house to the ambulance. They assist her in walking out of the house to the ambulance. She stops suddenly and wants to retrieve something from the corner of the couch. She stops suddenly and wants to retrieve something from the corner of the couch. Crew continues to walk her to the ambulance. Crew continues to walk her to the ambulance.

14. Incident #1 Deputy arrives on location, was asked to check couch for what patient wanted to retrieve. Deputy arrives on location, was asked to check couch for what patient wanted to retrieve. Deputy returns to the ambulance and advises crew he found a loaded handgun under a cushion on the couch. Deputy returns to the ambulance and advises crew he found a loaded handgun under a cushion on the couch. Crew advised it was the same area where the patient had stopped. Crew advised it was the same area where the patient had stopped.

15. Incident #2 Crew begins to treat patient for his diabetic condition. Crew begins to treat patient for his diabetic condition. Patient reaches in side pocket of recliner and pulls out a handgun. Patient reaches in side pocket of recliner and pulls out a handgun. Crew immediately exits the residence without incident and awaits arrival of police. Crew immediately exits the residence without incident and awaits arrival of police.

16. Incident #3 Crew treats patient with oxygen for nearly one hour. Crew treats patient with oxygen for nearly one hour. Tries to convince him to go to the hospital. Tries to convince him to go to the hospital. Calms the patient when he becomes agitated. Calms the patient when he becomes agitated. Eventually transports patient without incident. Eventually transports patient without incident.

17. Incident #3 Crew later receives telephone call from their dispatch center. Crew later receives telephone call from their dispatch center. Dispatch center advised patient became agitated at the hospital and pulled a handgun. Dispatch center advised patient became agitated at the hospital and pulled a handgun. Patient actually discharged the weapon and shot a piece of equipment. Patient actually discharged the weapon and shot a piece of equipment.

18. Follow Up Violence was not suspected on any of these incidents, however; Violence was not suspected on any of these incidents, however; a lethal weapon was produced on each incident and a lethal weapon was produced on each incident and the potential for tragedy was obvious. the potential for tragedy was obvious.

19. Actions of the Crews The crews mentioned in these incidents averted tragedy by The crews mentioned in these incidents averted tragedy by quickly leaving the scene when a weapon was produced; quickly leaving the scene when a weapon was produced; maintaining awareness of their surroundings; maintaining awareness of their surroundings; not allowing patient to retrieve objects; and not allowing patient to retrieve objects; and displaying compassion and concern for the patient. displaying compassion and concern for the patient.

20. Lessons Learned Always remain aware of your surroundings and actions of the patient. Always remain aware of your surroundings and actions of the patient. Trust your instincts. Trust your instincts. A routine call can quickly turn dangerous. A routine call can quickly turn dangerous.

21. Be Safe Out There!!!