Common Misconceptions: Scene Safety and Extraction
Self-sacrifice is a fun narrative trope. Who doesn't love seeing the emotionally constipated character put themselves at risk to save someone they care about but won't admit they care about?
Which is to say, I'm not telling you to write characters who follow the priority schema below. I'm just explaining the schema your first responder character likely learned for your edification and, more importantly, because acknowledging that you are violating protocol to save someone's life adds way more angst.
Disaster Priorities
Me (the first responder and potential victim)
Bystanders (potential victims)
Other victims (potential worse victims)
Patient (potential dead victim)
(ModN was taught even one step further in his EMT: 1) me! 2) still me 3) my partner 4) me again 5) my partner again 6) bystanders 7) the patient.)
But wait! Are you telling me if I stumble upon someone bleeding out in the street, I need to look both ways before running to help them?
To which I say, yes because if you get hit by a car, the next person to stumble upon this scene will find two people bleeding out in the street, which is objectively worse. Also, don't run to them. If you break your ankle, how are you going to get them out of the street?
Scene Safe
When running a drill, the first things a (nerdy) EMT will say are: "BSI, my scene is safe..." This is because the first thing an EMT cares about in every scenario is whether or not they have the necessary body substance isolation (BSI) and whether they can treat their patient safely.
It no doubt sounds counterintuitive. Humans see other injured humans (or just injured things in general—here's a cute video about humans rescuing a beached orca because it's my post and if I want to link to a video about orcas when I'm talking about scene safety, I will; side note, I think orcas probably reduce scene safety). In many cases, it's perfectly natural for a character to run into danger to save someone else, even if it is not proper protocol. Again, you don't need to follow these rules to write your first response scene, but knowing them is helpful.
These priorities also imply the following:
If there's a HazMat situation that involves patients and bystanders, and your character is the only first responder there, they should focus on keeping bystanders out and not treating those already sick (assuming they can only do one).
Your character does not have to treat someone in a dangerous situation, like, say, someone who got electrocuted by a still-dancing electrical wire (check out this post for some CPR information though).
Sometimes, extraction takes priority over treatment.
Extraction
Let's say someone's just fallen off a small cliff into traffic (ModN contests that this is a thing that happens, but we'll go along with it for the sake of argument). Your character determines that they can offer first-aid without putting anyone else in more danger, but first, they need to make the scene safe.
Which of the following is proper procedure:
Worry about the spine and avoid moving the patient until you can do so without injuring them further
Do a primary assessment (more information about primary assessments here) and stop life threats while still in the middle of the highway
Try to figure out a method of extraction that won't exacerbate any existing injuries
Get them out of the highway! Now!
If you didn't pick 4, congratulations, you were wrong. You cannot treat a patient on an active highway. This is because of all the projectile weapons (cars) on active highways. For the record, you also wouldn't treat a patient in the middle of an active firefight.
Remember, the number 1 priority is the first responder. That means the patient needs to not be on the highway (or your buddy can stop the traffic, whichever).
But, I hear you cry, what if I hurt my patient's spine by pulling them out of the highway? To you, I say, can I recommend this relatively spine safe drag? And, if that's not convincing, can I remind you the other option is letting your patient get run over by a semi truck?
But what if I make their injuries worse by dragging them away? Getting hit by a car will also make your patient's injuries worse. Probably worse than getting dragged away.
What if they die while I'm dragging them? You probably didn't have time to treat them anyway. However, because you dragged them away, you have now avoided getting hit by a car, thereby possibly saving the life of the next first responder who arrives at the scene and decides to run into traffic.
Extraction in the real world
Trigger warning for folks: this section is going to discuss actual medical protocol used for active shooter scenarios. If you're not into that right now, skip to the summary section.
There have been two major shifts in active shooter protocol in the US in the last decade. The first is the shift from treating them more as hostage situations (when SWAT stays outside the scene to negotiate at first, and officers may stay outside to wait for better prepared people) to situations that need to be stopped immediately.
The second is the shift from clearing an entire building to extracting and treating casualties as quickly as possible. Areas in a shooting are separated into zones. The hot zone is where we're pretty sure the shooter is. The warm zone is where the shooter could be, soon, but isn't now and probably won't be. And the cool zone is where we're pretty sure the shooter won't be.
Previously, EMS wasn't sent in until the whole area was green (standard EMS still isn't – as an EMT ModN was taught to stay well behind the concrete bullet-impervious barricade until the scene is clear). Basically, people with guns guaranteed the whole scene was safe as could be before medicine started happening. Now, well-protected first responders with special training are sent into warm zones to treat patients as fast as they can and then get them out.
Enter the RESCUE TASK FORCE (RTF).
Rescue Task Force
An RTF is a team of one (or more) armed people who can protect their gaggle of medical responders. The armed people go in first to make sure the medical professionals will not immediately be shot and EMS hurries in behind.
RTFs stabilize patients as they find them (e.g. stop the bleed, opening an airway), not using any triage procedures and skipping over patients who "pass" the primary assessment. This is because the zone of safety is so small, they pretty much need to treat whoever they can get. The goal, however, is to get these patients stabilized so that an extraction team (following close behind) can get them out.
As this article succinctly puts it:
"The job of the RTF is to stop the bleeding, and keep patients breathing."
Extraction Task Force
That's when the EXTRACTION TASK FORCE comes into play. (Or, in some cases, a SECONDARY RESCUE TASK FORCE because we wouldn't want to name these two teams someting different, would we?)
This team comes in armed with stretchers and lots of hands to help get people out fast. This can vary from easy—"Hey, go that way to get out of the building"—to difficult—trying to get unresponsive or actively panicking injured people onto a stretcher and out.
Side note: When I say stretcher, you might be thinking of something like this:
In a case like this, first responders might prefer flexible stretchers, like so:
You can roll the patient onto that and let two to six people each grab a handhold. Because it is made of cloth, the patient ends up coccooned inside, which makes it difficult to fall out and much faster to apply. It's also lighter and smaller to carry.
The extraction team is not worrying about things like broken bones or bruises. The RTF has already stabilized all the victims in the area (bleeding and breathing) and the extraction team is here to get them out.
What I'm trying to get at here is, all that stuff you've heard about "not moving people" and "worrying about spines" kind of goes out the window in situations where the scene is not safe.
Summary
In a disaster, first responders and bystanders take priority.
If you cannot treat your patient where they are, your first priority is getting them somewhere else.
(Orcas are really cool).
Mod E wanted to write about Rescue Task Forces but didn't want to make a post dedicated to them.
The only thing better than one character sacrificing themself for another is when said character knows they are violating protocol to do so. So, writers, violate protocol away. Happy angst writing!