For almost all of our calls, some sort of law enforcement presence will be on scene. Usually this is to help EMS by providing a an area to work in free and clear of bystanders, or to provide lane closure on the scene of an MVC, but it could also be the result of a crime that took place, leaving someone injured and needing medical attention. Police are involved in all motor vehicle collisions, in domestic abuse and assault cases, substance overdoses, and more. During each of these situations, EMS priority is the patient, however we must be mindful of the evidence that we (unknowingly) tamper with or destroy.
Burglary gone wrong
You get paged out to a house for a female patient who was involved in an altercation. You happen to be on your way back from the hospital and the house is right down the street, so you make the turn and you beat the police on scene. As you exit the ambulance and approach the house, you notice that the door has obvious damage to it by the lock, like it was kicked in. What next?
Go back to basic class – your first priority is and always will be your safety. This scene is not safe. Did someone break in? Is that someone still inside? Is there a victim? Is that victim holding a gun and currently really scared because of what just happened? There are many unknowns, and we are not trained to handle them. You should contact dispatch immediately to request a unit respond while making your way back to your ambulance. Relay information that you see to dispatch so that they can inform the officers responding. If necessary, you should stage the ambulance a safe distance away from the scene.
Now, think about all that has happened so far. Did you have gloves on yet? If not, you could have finger prints on any number of objects that the intruder might have touched as well. What about your boots/shoes – do you remember where you stepped? You could have inadvertently stepped on top of the one clear boot print left in some mud by the intruder. As you drove down the street and parked the ambulance, did you see any suspicious people/vehicles that were parked or leaving the area?
The police office get on scene and clear the house. They inform you that it is clear and that one patient is up stairs in a very bad condition. The patient has a very weak pulse and breaths of only 2 or 3 a minute.
Obviously you are going to treat the patient to the best of your abilities. You will call for ALS, maybe you will need Tech Rescue to help extricate the patient, or you will need a second rig because there are two or more patients. However, there are conscious choices we as EMS can make that will help the Police Department do their job.
Things to consider
- Limit your interactions with the scene – If your patient is upstairs in the far back room, try to only use one path to get from the ambulance to the patient. Limit yourself and any additional crew members to that path.
- Note your interactions – If you had to move the bed out of the way of the patient, make a brief note about that and let the officers know on scene what you did. Try to keep track of any objects you interacted with, as well as any equipment you bring in or leave. Do not move anything that do not impede patient care.
- Police can declare a patient obviously dead – They know what to look for in a dead body. If you are cancelled by PD, you are cancelled and return to base.
- Limit those involved – Have a crew of four but you believe the patient is deceased beyond resuscitation? Have one EMT check the body prior to having all four members enter the room. This will limit the bodies PD needs to account for.
- Document any conversations you have with a patient. Was she able to provide a brief description of the individual while on your way to the hospital? Did he remember what time he was struck by the car because he had just got a text from his wife? Document, document, document. This could be considered a dying declaration.
- Don’t cut through any bullet or stab wounds in clothing.
- For a patient still bleeding, place a chux pad underneath to collect any evidence
- Do not clean the patient unless necessary
- If able, change your gloves after contact with a new source of evidence
- If you collect a piece of evidence and turn it over to an office, ask if you need to sign a chain of custody form
Patient Care Report
So what should I include in my PCR?
- Patient Position
- Scene Conditions
- Bindings – Ligatures
- Cell Phone
- Blood – Dry/Wet
- Scene Stating – a body put in an unnatural position or staged the scene to try and cover up what actually happened