Look, Listen, and Feel: A Fresh Approach to the Scene Survey

By Robert Delagi

Historically, “survey the scene” was a yes/no activity done while approaching the incident scene. Once the “scene was safe,” emergency medical services (EMS) providers were conditioned to move on to initial and ongoing patient assessment and care and to look for signs of patient decompensation. Little attention was paid to “scene decompensation” and “ongoing scene assessment.” Often, EMS providers are surprised by an unanticipated act of violence against them and hastily retreat in panic mode with injury to the providers.

We are accustomed to staging in a safe area while waiting for additional resources to render the scene or the patient safe prior to assuming EMS operations. We are very good at staging and waiting when there is a known hazard such as violence, assault, domestic, psych/behavioral, chemical, and the like. Once the scene is cleared, we rush in to lay hands on the patient because we are conditioned to measure our treatment times and scene times as markers of success. We are distracted by the intense focus on the need to multitask patient-care activities, paying significant attention to the details of the physical assessment and the use of technology we have grown accustomed to for accurately assessing and treating patients. We generally work on teams with small numbers. The unintended consequence is that we frequently forget to remain vigilant for developing hazards.