We have not left the front lines now since March 2020. COVID-19 has tested our physical endurance and mental toughness. We have taken casualties and lost professional brothers and sisters to that invisible assailant. Because of whom we are and what we do, we are faithful in adversity and respond no matter the politics, the pandemic or the protest. Our mission is to respond and treat, save life and reduce pain. We are neutral and as we seek to do no harm, in return we hope that we can continue to do what we do unhindered and unharmed.
Recently, we have seen that response delayed or denied and worse, caregivers attacked for just being present during episodes of civil unrest. In Virginia Beach, Virginia, EMS responders trying to save a motorcycle crash victim were pushed and kicked by members of a crowd who jumped on their EMS vehicles. In Oakland CA, large July 4th crowds surrounded and climbed on a fire truck conducting a first response to a medical call. The inevitable video that is now a contemporaneous feature of any gathering shows the fire truck being surrounded and individuals climbing up to the top of the apparatus. Columbia, Missouri, made the EMS news recently as an investigation is underway to examine if care was delayed as crews conducted that accepted practice of staging for the call as the scene was secured. This is a long-accepted protocol that ensures scene safety for EMS personnel as law enforcement creates the environment for prehospital treatment.
Sadly, responding to belligerent individuals, unruly crowds, angry mobs and – let us face it – the raw emotional state of those encountered at the scene of a shooting is in fact nothing new to fire and EMS providers across the nation. We embrace the training we have been given and relish the protection of the law enforcement team that usually surround us. That said, it is worth dusting off the general principles that should already contribute to any organization’s culture of safety.
Recently, the U.S. Fire Administration (USFA) and the National Highway Transportation Administration (NHTSA) Office of Emergency Medical Services (OEMS) worked together to compile best practices to assist agencies and individuals as they respond to civil unrest incidents in the community. The document represents a checklist of areas and issues to considered and should be read in full. Here are my essential takeaways:
1. Protecting personnel
Keeping staff safe and secure is the highest priority. Responding to civil unrest may place staff at higher-than-anticipated levels of risk. The following is suggested:
- Review all civil unrest-specific organizational and jurisdictional protocols and guidelines
- Establish a family communication plan to share information with responder families and provide emotional support for personnel and their families
- Work in pairs or teams, carry a radio and lights
- Keep personnel IDs, keys, wallet, etc., on your person or otherwise secured and secure items such as scissors and stethoscopes on your person
- Always carry a radio (be sure to regularly charge/swap batteries)
- Maintain accountability of all staff and develop rally points should vehicles or locations need to be abandoned, and pass on to members/adapt as the situation changes
2. Secure stations and response posts
- Secure and lock parking areas if possible
- Lock personal and emergency vehicles parked outside of stations and keep valuables out of sight. Consider parking facing an escape route (e.g., backed in)
- Lock interior and exterior facility doors and windows, and keep all interior and exterior lights on in buildings and stations
- If the station needs to be abandoned, remove all communications equipment, medications and as much department and personal equipment as possible
- Consider placing all equipment for removal on a vehicle or in a single location, staged for rapid removal
3. Prepare apparatus/vehicles
- Remove non-essential equipment from exterior vehicle compartments and ensure they are secured, and roll up windows
- Have personnel wear full protective equipment, if issued, while travelling during times of potential civil unrest
- Check vehicles, clean glass and wipers, ensure lights work and ensure fuel tanks are full
4. Coordinate with community partners
- Routinely communicate with local leaders and members of the community, and liaise with law enforcement, emergency management and all other emergency response agencies to communicate needs and expectations
- Inform the community of changes to response priorities and manage community expectations
- Monitor social media for information and identify possible/probable locations for large gatherings
5. Activate EOC, IAM and unified command
- Activate the emergency operations center to support the incident area and establish unified command with appropriate law enforcement and other agencies as required
- Develop an incident action plan – communicate, exercise, follow and adapt the plan as needed. Additionally, create a communications plan to communicate between organizational and jurisdictional partners (and if necessary, stand up a JIC).
- Ensure command post security and remain flexible as location might be subject to change rapidly
- Identify hot, warm and cold zones. These must be dynamic and may be based on geographic area or be specific to a single incident
- Establish fueling, maintenance and logistics support for apparatus and personnel assigned to the area of operations/incident staging area. Depending on the duration of the operational period, a catering plan may also be essential
6. Modify EMS operations
- Provider safety remains the highest priority and, when possible, should be addressed
- On arrival, scan the environment for scene safety before exiting the vehicle and continue to size up and communicate the potential for any situation to get worse
- Consider modified response protocols based on the severity of the situation:
- Immediate patient movement out of impacted area (in a cold zone)
- Treatment in place without transport for minor injuries (conducted in secure area)
- Treatment en route versus on scene
- Suspension of requirements for medical direction to perform routine procedures and medication administration
- Consideration should be given for level of care: basic life support or advanced life support
- Work in teams and remain in contact with each other.
- Avoid dead ends, roadblocks and recognize that there may be a need to abandon vehicles and/or equipment
Finally, the current period of civil unrest and social tension may pass, but COVID-19 remains. All response should be conducted with appropriate PPE to safeguard the provider from bacterial assault. Because of the nature of our profession, many have developed the “sixth sense” that detects and alerts when the atmosphere is about to change for the worse. All must continue to maintain situational awareness, as well as the buddy system, to ensure that everyone is looking out for each other and stays safe out there.
Read next: Special Coverage: Protecting EMS providers from violence
Scene safety and responding to civil unrest: EMS ONE-STOP WITH ROB LAWRENCE
For an audio version of this article, listen below.
This article, originally published on July 13, 2020, has been updated.
