To Stage or Not to Stage

Mar 9, 2015

While watching an episode of Nightwatch the other night, I got thinking about the concept of staging.  In the call that was presented on the show, the crew of Dan and Titus was sent for a possible stabbing victim.  They responded as normal but shut down and parked a few blocks away from the call to wait for an overburdened New Orleans Police Department to get on scene and report that it was secured for them.  While waiting, they were approached by someone who told them about the stabbing.

I have been in this situation more times that I can count.  It was not unusual to be sent for the unknown third party caller for the psych patient or the suicidal person with instructions to stage for police.  The ambulance would be sent lights and sirens so as to maintain the contract’s requirements of having a truck on scene to all “priority 1” calls in under ten minutes.  Without talking to the patient or having someone looking at them and reporting what was going on, the call was classified as being “unknown” which by some determination made in the dispatch center required that it be “priority 1.”  So the ambulance would respond lights and sirens, and in this case, being on scene meant that they were calling out a few blocks away, putting the truck in park, and waiting.  If all of this happened at “shift change” the wait could be as long as 20-30 minutes.

I have always been one who was leery of the concept of “staging” within itself.  In my Springfield example, who benefits from having an ambulance driving lights and sirens, which has been proven to be far more dangerous than driving without them, seemingly for nothing, because you will not be going into the scene?  From the example in New Orleans, how far away from a scene is far enough to park?  A crew is always at risk of being found, and as former Jackson, Mississippi city councilman Kenneth Stokes taught us in 2010, if a city official can’t understand the importance of keeping an EMS crew safe, how can we expect the general public to understand it?

How far away is too far away?  A few months ago, I helped a friend of mine do some industry research on just that.  We asked around to different departments and took a look at some of the more public sets of standard operating procedures that we could get our hands on.  Without fail, the ones that even had a policy on staging in existence (because not all of them did) stated that crews should park “a safe distance” from the scene.  Rarely, if at all, were we able to find find what a “safe distance” was.

If we are going to keep pushing the issue of scene safety, and feeling the need to stage I think it is time that we need to start looking at changing our response.  In my opinion, if a scene requires police to secure it before the arrival of EMS then the response should be made in non-emergency mode until that scene is determined to be secure.  An ambulance without lights and sirens draws a lot less attention than one with them on, and ambulance that is in motion is a lot harder to approach than one that is not.

Back in my Springfield days, I always struggled with this entire debate.  When it came to the more violent scenes like shootings or stabbings believe it or not, for me I felt much safer being at the scene than I did being a few blocks away if there was one or fifty cops there.  The way that I saw it, in the majority of cases after committing his or her choice crime, the assailant usually got out of the area rather quickly either by foot or by car.  I always felt safer at the scene because despite the fact that there might be some upset bystanders around who you will never be able to please on those calls because we never get there quickly enough, there were also cops around who were commonly at a heightened state of awareness.  My chances of meeting the assailant were greatly reduced, my chances of being approached by a bystander while sitting on the side of the road and being accused of “doing nothing” were greatly reduced, the ambulance showed up a lot sooner, and I was able to get my trauma patient to the operating room a few minutes quicker.

Ultimately though, whatever route you decide to take or whatever your particular service dictates their policy to be for the response to a potential police action, keep your head on a swivel.  “Scene safety” is something that we say at the start of a testing.  It is a security blanket that we clutch to that has little value once we get out of the classroom.  “Scene awareness” is a much better term as it encourages constant vigilance.  A smart EMT instructor would teach their students to make it half way though a scenario and ask, “has anything about my surroundings changed?”  Exercises like that, or others that encourage people to be more aware of their surroundings will go a lot farther to keeping us safe than parking us on a street corner at some undetermined “safe distance.”