A few years ago I critiqued a manuscript for a friend where one of the characters was shot, the perpetrator was still armed and in the area, but the ambulance crew ran up the hill to take care of the victim with the police anyway. I talked to her about safety protocol and how the scene would actually be handled.

Scene safety is one of the most important things that EMTs have to consider when they go on a call because if there’s a threat in the area, and they get hurt, they can’t take care of their patient. A few of the possible things EMTs have to be aware of include:

Domestic disputes—people ready to throw punches, pull out a knife or gun.

Dogs—Fido may be sweet to his owner, but may not be so thrilled about strangers coming into the house, so we prefer they are shut in another room.

Chemicals, which can include flammables in commercial settings, meth labs, spilled gas or other toxins on the roadside, and in my area, pesticides and other things farmers may spread on their fields.

Suicide attempts, which could be guns, carbon monoxide, or some toxic gas scenarios that have been growing in popularity. There is one method being used lately where the suicidal person gets into their car, seals of the windows so the fumes stay in their car, mixes chemicals, and die within minutes. If rescue personnel, such as a firefighter, breaks the window to get in, and catches a breath of the fumes, they can end up with serious permanent medical problems, and possibly death.

Road dangers including traffic zooming by an accident scene, or vehicles in the accident not being stable if they are left on an incline, or maybe landed on their sides or some other odd angle—more on that another time.

I’m sure I’ve missed something, but I’m going to focus on human dangers this time, and how the ambulance and law enforcement work together to ensure everyone’s safety.

If my department is being called out to a dangerous scene we are generally asked to ‘stage’ at an alternate, but nearby, location. This is usually out of sight, perhaps around a corner or even a few blocks away. Law enforcement (sheriff’s department in my area) secure the scene, and when they have decided it’s safe, they call us to come to the scene. This would be a common procedure in cases of domestic violence, a fist fight at a party or a bar (if we had any bars in my town), or if someone is threatening to commit suicide, and they have a weapon. This may also apply if there were a hostage situation. It’s possible that in a city where they have a full-time EMS staff that they may not have the ambulance stage nearby, especially if there are a lot of other medical emergencies going on right then, but in your story, it’s safe to anticipate having the ambulance on standby.

We can be called out if someone at the scene is hurt, and sometimes as backup in case law enforcement may become injured in the encounter.

On an only slightly related note, my ambulance department also gets called out to standby when we have a building fire to check the firefighters as they empty their SCBA’s (self-contained breathing apparatus)—the air packs they carry when they go into a burning building). In this case we stage nearer to the burning building so we’re convenient for the firefighters, but still far enough away not to be in danger ourselves. After every run into the building, the firefighters have to come to the ambulance and have their blood pressure and pulses checked, and to drink lots of fluids before being allowed back into the building for another go.