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This scenario is a left over from my Captain test prep time, sent in by Richard663. Since I’m now doing the Crossover with Motorcop, I figured this might start a good cross discipline discussion.

You are the EMS Battalion Supervisor dispatched to a reported officer involved stabbing. Since Officers rarely carry knives you are ready to treat a stabbed officer and likely a shot or injured suspect.
Responding with you is a seasoned ambulance crew from across town and a rescue squad from the next town over, ETA 10-12 minutes.  Your ETA is 2-3 minutes.
As you arrive on scene, all 5 officers on duty are at the scene frantically searching for the suspect while the weapon, a large kitchen knife, is in the hands of one of the officers. It is clean.

The watch commander approaches you and tells you his officer is not stabbed, but the blade hit the vest. The officer is resting, but refusing care at this time. You agree to assess him and the watch commander agrees that is appropriate. You get on the radio to slow the ambulance to code 2 and cancel the squad.

The watch commander explodes in anger screaming that his people deserve a code 3 ambulance no matter what you think MIGHT be wrong.

How do you respond?

You make the call.

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57 Comments

  1. Fuerte35 October 8, 2010 2:18 pm

    I would calmly explain to the watch commander that the medical decisions are mine, not his, to make. I would also remind him that driving Code 3 is a heck of a lot more dangerous than driving Code 2, both for the ambulance crew and for the general public. Safety is always paramount. If the watch commander has an issue with my decision then he can take it up with my boss after the fact but right now I am shutting my crew down to Code 2.

  2. Kirsten Bain October 8, 2010 2:18 pm

    It doesn’t matter who you are if the patient is stable, you should’t put other people’s at risk by running code 3. PD or not.

  3. Todd October 8, 2010 2:18 pm

    As long as the knife didn’t penetrate the vest code 2 is fine if the watch commander is in that much of a hurry he can drive the officer to emerg himself

  4. Fuerte35 October 8, 2010 2:18 pm

    I would calmly explain to the watch commander that the medical decisions are mine, not his, to make. I would also remind him that driving Code 3 is a heck of a lot more dangerous than driving Code 2, both for the ambulance crew and for the general public. Safety is always paramount. If the watch commander has an issue with my decision then he can take it up with my boss after the fact but right now I am shutting my crew down to Code 2.

  5. Kirsten Bain October 8, 2010 2:18 pm

    It doesn’t matter who you are if the patient is stable, you should’t put other people’s at risk by running code 3. PD or not.

  6. Todd October 8, 2010 2:18 pm

    As long as the knife didn’t penetrate the vest code 2 is fine if the watch commander is in that much of a hurry he can drive the officer to emerg himself

  7. Flightmedic1 October 8, 2010 2:23 pm

    Stand units down – no injuries on scene, and officer is refusing treatment.

  8. Flightmedic1 October 8, 2010 2:23 pm

    Stand units down – no injuries on scene, and officer is refusing treatment.

  9. Greg Newman October 8, 2010 2:24 pm

    Risk assessment for NOT slowing down the ambulance.

    – what’s the best that can happen if i don’t slow down the ambulance?

    Officer lives.

    – what’s the worst that can happen if i don’t slow down the ambulance?

    Ambulance crashes into family van killing the driver and front passenger.

    – what’s the best that can happen if i slow down the ambulance?

    Officer lives.

    – what’s the worst that can happen if I slow down the ambulance?

    Watch commander complains to fire department, tells his guys not to respond L&S to requests for assistance from paramedics.

    I’m not interested in dealing with this guy complaining to my department, so I’m just going to request the ambulance go L&S.

  10. Greg Newman October 8, 2010 2:24 pm

    Risk assessment for NOT slowing down the ambulance.

    – what’s the best that can happen if i don’t slow down the ambulance?

    Officer lives.

    – what’s the worst that can happen if i don’t slow down the ambulance?

    Ambulance crashes into family van killing the driver and front passenger.

    – what’s the best that can happen if i slow down the ambulance?

    Officer lives.

    – what’s the worst that can happen if I slow down the ambulance?

    Watch commander complains to fire department, tells his guys not to respond L&S to requests for assistance from paramedics.

    I’m not interested in dealing with this guy complaining to my department, so I’m just going to request the ambulance go L&S.

  11. Weggy1978 October 8, 2010 2:31 pm

    I wouldn’t stand anyone down until I’d assessed the patient myself… At the moment, we’re making assumptions based on info given to us by a non medically trained PD commander. We’re told the knife didn’t penetrate but has the vest been removed yet for full survey? Could the force used by the assailant have caused internal injuries?

    • Michael Wilk October 8, 2010 4:07 pm

      Given the vests the PD wears with ceramic plates in them and the fact the knife is clean….and considering this watch commander has probably been on the force 10 yrs plus I would take his work for it that his officer is not hurt and I doubt the officer would refuse treatment or his commander allow him to refuse if he was.

  12. Weggy1978 October 8, 2010 2:31 pm

    I wouldn’t stand anyone down until I’d assessed the patient myself… At the moment, we’re making assumptions based on info given to us by a non medically trained PD commander. We’re told the knife didn’t penetrate but has the vest been removed yet for full survey? Could the force used by the assailant have caused internal injuries?

    • Michael Wilk October 8, 2010 4:07 pm

      Given the vests the PD wears with ceramic plates in them and the fact the knife is clean….and considering this watch commander has probably been on the force 10 yrs plus I would take his work for it that his officer is not hurt and I doubt the officer would refuse treatment or his commander allow him to refuse if he was.

  13. Manda33556 October 8, 2010 2:35 pm

    I like the way you think Weggy1978 🙂

  14. Manda33556 October 8, 2010 2:35 pm

    I like the way you think Weggy1978 🙂

  15. samuelkordik October 8, 2010 2:37 pm

    I agree with Weggy1978; I’d want to do a more thorough assessment. If I could explain to the watch commander that his officer was fine, I’d downgrade the responding units. Most the officers I work with are pretty reasonable.

    However, if he didn’t agree, I’d keep the units coming L&S. I don’t want to risk department relationships.

  16. samuelkordik October 8, 2010 2:37 pm

    I agree with Weggy1978; I’d want to do a more thorough assessment. If I could explain to the watch commander that his officer was fine, I’d downgrade the responding units. Most the officers I work with are pretty reasonable.

    However, if he didn’t agree, I’d keep the units coming L&S. I don’t want to risk department relationships.

  17. Stretcherbearer October 8, 2010 2:39 pm

    You tell the watch commander to get stuffed and concentrate on his job so you can do yours. You don’t tell the police how quickly to come to your requests……

  18. Stretcherbearer October 8, 2010 2:39 pm

    You tell the watch commander to get stuffed and concentrate on his job so you can do yours. You don’t tell the police how quickly to come to your requests……

  19. poloce October 8, 2010 2:45 pm

    Let the ambulance continue in code 3 cancel the squad. You want that watch commander deciding your request for assistance is only a code 2 when you think its a code 3 . Also remember the calming effect removing the injured officer will have on the scene. Play nice in the sandbox.

  20. poloce October 8, 2010 2:45 pm

    Let the ambulance continue in code 3 cancel the squad. You want that watch commander deciding your request for assistance is only a code 2 when you think its a code 3 . Also remember the calming effect removing the injured officer will have on the scene. Play nice in the sandbox.

  21. DaveO October 8, 2010 3:04 pm

    Not only would I slow them to a “code 2” I’d have them stage outside the scene until the PD has found the suspect or cleared the scene, because they’re “still frantically searching for the suspect”………………for that matter what am I doing in an unsecured scene ???

    Next day a meeting would be in order with the watch commander to explain, in a non-emotionally charged atmosphere, what my duties are and how they differ from his…..

    That’s my textbook answer………….in all honesty I’d have told him to pound sand !

  22. DaveO October 8, 2010 3:04 pm

    Not only would I slow them to a “code 2” I’d have them stage outside the scene until the PD has found the suspect or cleared the scene, because they’re “still frantically searching for the suspect”………………for that matter what am I doing in an unsecured scene ???

    Next day a meeting would be in order with the watch commander to explain, in a non-emotionally charged atmosphere, what my duties are and how they differ from his…..

    That’s my textbook answer………….in all honesty I’d have told him to pound sand !

  23. Mark Zanghetti October 8, 2010 3:07 pm

    Cancel the squad and downgrade the rig, you are onscene and should continue examining the patient to insure there are no injuries, ie., removing the vest to verify there was no penetration. In the service I am attached to we don’t have 3 priorities and this would be downgraded to priorty 2, no L&S and if the PD watch commander wants to be upset then deal with that after the fact in a sit down when tempers are cooler. If he continues to be a problem then take what actions are necessary later on down the road. The other fact to remind him of is that he did get a code three response, he got it from you! I am assuming that as an EMS Battalion Supervisor you carry at least BLS Medical Equipment and are willing to use it when needed, if this is not the case then he might be right and the ambulance should continue until medically equipped assistance is onscene just in case something else is happening.

  24. Mark Zanghetti October 8, 2010 3:07 pm

    Cancel the squad and downgrade the rig, you are onscene and should continue examining the patient to insure there are no injuries, ie., removing the vest to verify there was no penetration. In the service I am attached to we don’t have 3 priorities and this would be downgraded to priorty 2, no L&S and if the PD watch commander wants to be upset then deal with that after the fact in a sit down when tempers are cooler. If he continues to be a problem then take what actions are necessary later on down the road. The other fact to remind him of is that he did get a code three response, he got it from you! I am assuming that as an EMS Battalion Supervisor you carry at least BLS Medical Equipment and are willing to use it when needed, if this is not the case then he might be right and the ambulance should continue until medically equipped assistance is onscene just in case something else is happening.

  25. CBEMT October 8, 2010 4:53 pm

    “He did get a code 3 response- mine. If there’s nothing wrong with him, I’ll get the refusal myself.”

    “Dispatch, cancel ALL units, I’ll be onscene documenting a refusal.”

  26. CBEMT October 8, 2010 4:53 pm

    “He did get a code 3 response- mine. If there’s nothing wrong with him, I’ll get the refusal myself.”

    “Dispatch, cancel ALL units, I’ll be onscene documenting a refusal.”

  27. Dkbarrett October 8, 2010 5:02 pm

    until i checked the patient myself i would not slow the ambulance down, after if injury was minor i would slow the ambulance down and explain that code 3 is not needed and for safty reasons ambulance will respond code 2, if that follows your department rules

  28. Dkbarrett October 8, 2010 5:02 pm

    until i checked the patient myself i would not slow the ambulance down, after if injury was minor i would slow the ambulance down and explain that code 3 is not needed and for safty reasons ambulance will respond code 2, if that follows your department rules

  29. Motorcop1 October 8, 2010 6:05 pm

    Your initial assessment regarding us not carrying knives is inaccurate. I have yet to meet one that doesn’t. I keep mine in my boot.

    That aside, I also like Weggy’s opinion, peppered with a little Fuerte. An interseting note for you non-vest wearing types…our ballistic vests stop bullets, not blades. How closely has the officer been inspected…how about that knife? Could the knife been wiped by the layers of clothing beneath the vest, the vest itself, the uniform shirt? Better to air on the side of caution.

    I’m not saying take any shit off the watch commander, but make sure you have what you think you have before cancelling. I’d appreciate it…

  30. Motorcop1 October 8, 2010 6:05 pm

    Your initial assessment regarding us not carrying knives is inaccurate. I have yet to meet one that doesn’t. I keep mine in my boot.

    That aside, I also like Weggy’s opinion, peppered with a little Fuerte. An interseting note for you non-vest wearing types…our ballistic vests stop bullets, not blades. How closely has the officer been inspected…how about that knife? Could the knife been wiped by the layers of clothing beneath the vest, the vest itself, the uniform shirt? Better to air on the side of caution.

    I’m not saying take any shit off the watch commander, but make sure you have what you think you have before cancelling. I’d appreciate it…

  31. Anonymous October 8, 2010 7:26 pm

    Bullet proof vests stop bullets (ya stole my thunder Motorcop! ) not blades. A code 3 response is appropriate, considering that my Code 3 response, no matter who is on the receiving end or what the emergency never involves dangerous driving. There is no reason to put the public at risk-ever. Code 3 doesn’t mean throw caution to the wind. If that were the case, I’d abolish Code 3 altogether.

    • Motorcop1 October 8, 2010 8:06 pm

      All too often, folks misinterpret what Code 3 driving is…sounds like good post material to me!

  32. Anonymous October 8, 2010 7:26 pm

    Bullet proof vests stop bullets (ya stole my thunder Motorcop! ) not blades. A code 3 response is appropriate, considering that my Code 3 response, no matter who is on the receiving end or what the emergency never involves dangerous driving. There is no reason to put the public at risk-ever. Code 3 doesn’t mean throw caution to the wind. If that were the case, I’d abolish Code 3 altogether.

    • Motorcop1 October 8, 2010 8:06 pm

      All too often, folks misinterpret what Code 3 driving is…sounds like good post material to me!

  33. PSilva October 8, 2010 7:48 pm

    I’m with Lt. Morse 100%.

  34. PSilva October 8, 2010 7:48 pm

    I’m with Lt. Morse 100%.

  35. Pdodson October 8, 2010 8:55 pm

    code 2 what is that. it,s lights and sirens or nothing and the police are not in charge of EMS
    the down grade was the right call

  36. Pdodson October 8, 2010 8:55 pm

    code 2 what is that. it,s lights and sirens or nothing and the police are not in charge of EMS
    the down grade was the right call

  37. 510medic October 8, 2010 9:00 pm

    I would calmly advise the watch commander that since the officer is going to be refusing transport (a decision he agrees with) and that since I can perform all the same assessments that the paramedic on the transporting ambulance can, that the officer already has the resources he needs available. I would explain that I’m reducing the transporting unit to Code 2 just as a back-up in case the officer changes his mind or we find something upon further assessment.

  38. 510medic October 8, 2010 9:00 pm

    I would calmly advise the watch commander that since the officer is going to be refusing transport (a decision he agrees with) and that since I can perform all the same assessments that the paramedic on the transporting ambulance can, that the officer already has the resources he needs available. I would explain that I’m reducing the transporting unit to Code 2 just as a back-up in case the officer changes his mind or we find something upon further assessment.

  39. JPINFV October 8, 2010 10:52 pm

    If your officer is not hurt and you don’t know where the suspect is, then what patient is there?
    We can always upgrade the ambulance if something changes.
    Is the scene secure? If not, then the ambulance isn’t going on scene anyways, making this a hurry-up and wait situation.
    Finally, emergency response does not save a clinically significant amount of time.

  40. Joe Paczkowski October 8, 2010 10:52 pm

    If your officer is not hurt and you don’t know where the suspect is, then what patient is there?
    We can always upgrade the ambulance if something changes.
    Is the scene secure? If not, then the ambulance isn’t going on scene anyways, making this a hurry-up and wait situation.
    Finally, emergency response does not save a clinically significant amount of time.

  41. Crsmedic30 October 8, 2010 11:14 pm

    i’d downgrade them to code 1 no lights or sirens no injury and paitent is currently refusing why risk harm to other crew or motorist runing code 2 or 3?

    • JPINFV October 9, 2010 9:40 pm

      Err… what’s the difference between code 1 and code 2 where you work? Where I’ve worked that used the “code” classification classified code 2 as no lights and sirens and code 3 as lights and sirens.

  42. Crsmedic30 October 8, 2010 11:14 pm

    i’d downgrade them to code 1 no lights or sirens no injury and paitent is currently refusing why risk harm to other crew or motorist runing code 2 or 3?

    • Joe Paczkowski October 9, 2010 9:40 pm

      Err… what’s the difference between code 1 and code 2 where you work? Where I’ve worked that used the “code” classification classified code 2 as no lights and sirens and code 3 as lights and sirens.

  43. Russell Stine October 10, 2010 6:52 am

    Why are we having this conversation if he’s declining? No injury, no medical complaint, count your lucky stars it hit your trauma plate and have a good night!

  44. HybridMedic October 10, 2010 6:52 am

    Why are we having this conversation if he’s declining? No injury, no medical complaint, count your lucky stars it hit your trauma plate and have a good night!

  45. Ambulance Amateur October 12, 2010 9:32 pm

    The patient is refusing examination. From your permitted observation, there is no need for an ambulance to come at high speed.

    Explain this to the watch commander in words of one syllable, as if to a juvenile moron. Ask him if he would wish for the same level of response for a suspect – every human being is entitled to the same level of response, even if they don’t act like human beings.

    Ask the watch commander if he would arrest someone simply because you thought he should. (His answer would almost certainly be negative.) Then ask him why he is permitted to practise his profession yet thinks you shouldn’t be allowed to practise yours.

  46. Ambulance Amateur October 12, 2010 9:32 pm

    The patient is refusing examination. From your permitted observation, there is no need for an ambulance to come at high speed.

    Explain this to the watch commander in words of one syllable, as if to a juvenile moron. Ask him if he would wish for the same level of response for a suspect – every human being is entitled to the same level of response, even if they don’t act like human beings.

    Ask the watch commander if he would arrest someone simply because you thought he should. (His answer would almost certainly be negative.) Then ask him why he is permitted to practise his profession yet thinks you shouldn’t be allowed to practise yours.

  47. The Grumpy Dispatcher October 14, 2010 11:00 pm

    Do the initial assessment first before anything, unless the officer specifically refuses even that. You don’t know what you have until you know what you have. Only having a clean knife and a verbal refusal is a very incomplete picture.

    Then, if you get barked at for Code 2 (I won’t open the Code 2 debate), go ahead and go back to “Code 3” but give a patient report at the same time. The other units should be able to read between the lines and will back off a bit, while the commander is also placated.

    When emotions are under control, like, on a different day, bring it up with the commander. How would he feel if Fire requested PD Code 3 for a man with a gun, and the first officer arriving found the “bad guy” was actually a boneheaded prankster with a squirt gun who thought he was being funny and meant no serious harm, sitting on the tailboard of the pumper and apologizing profusely to the pissed-off Fire LT and his minions? How would he feel if we screamed about him slowing or canceling other PD units because we deserve Code 3 all the time?

    Cooler heads and patience…. makes for happier endings.

  48. The Grumpy Dispatcher October 14, 2010 11:00 pm

    Do the initial assessment first before anything, unless the officer specifically refuses even that. You don’t know what you have until you know what you have. Only having a clean knife and a verbal refusal is a very incomplete picture.

    Then, if you get barked at for Code 2 (I won’t open the Code 2 debate), go ahead and go back to “Code 3” but give a patient report at the same time. The other units should be able to read between the lines and will back off a bit, while the commander is also placated.

    When emotions are under control, like, on a different day, bring it up with the commander. How would he feel if Fire requested PD Code 3 for a man with a gun, and the first officer arriving found the “bad guy” was actually a boneheaded prankster with a squirt gun who thought he was being funny and meant no serious harm, sitting on the tailboard of the pumper and apologizing profusely to the pissed-off Fire LT and his minions? How would he feel if we screamed about him slowing or canceling other PD units because we deserve Code 3 all the time?

    Cooler heads and patience…. makes for happier endings.

  49. Pingback: This Week In EMS Blogs: Minors Eating Chilli Is News? | EMS Blogs

  50. Anonymous October 20, 2010 1:57 pm

    My goal or interest is getting personnel and equipment to the scene of an emergency– an assessment needs to be performed before and transport is going to take place. That trained personnel and equipment IS on the scene– you, and your BC car. Once you have performed your assessment you can start thinking about transport or disposition options.
    My decision would also depend on the location and type of nearby hospitals.

  51. Anonymous October 20, 2010 1:57 pm

    My goal or interest is getting personnel and equipment to the scene of an emergency– an assessment needs to be performed before and transport is going to take place. That trained personnel and equipment IS on the scene– you, and your BC car. Once you have performed your assessment you can start thinking about transport or disposition options.
    My decision would also depend on the location and type of nearby hospitals.

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