Determining Patient and Rescuer Safety
Victims in need of BLS are found in a variety of situations. Although some just pass out on their kitchen floor, some needing BLS are in dangerous situations that can put their life in further risk. In addition, trying to rescue them to perform BLS may put the rescuer in danger of their life, as well. One of the first assessments a bystander or a first responder needs to make is whether the scene is safe. If you are unsure of the safety of the scene, going to help may mean that you also need rescuing.
Scene safety depends on the situation. If someone has collapsed in a crack house, you need to take a good measure of the situation and decide if helping is something you can feasibly do. Everyone wants to be a hero, but the truth is that those who rush into unsafe situations end up getting hurt. Although you want to save the life of the victim before you, your own safety needs to be reasonably assured. Fire, gasoline, downed electric wires, and other forms of threat are all too common at the scene where BLS is performed.
The first consideration that a rescuer needs to address is their own safety. This really depends on the venue you find yourself in when trying to provide BLS. Some are easy: a house, a restaurant, a school, or a mall. Still, even in these seemingly innocuous places, you should be aware of anyone who is threatening, the environment around you, and the feeling of the place. If you are entering a house, you may want to survey who is there, if they are armed, and what the general feeling is about the victim and your presence.
Other situations may be more noticeably dangerous. If you arrive on the scene of a car accident, you need to be sure that the scene is secure, there is no possibility of explosion, and the car is stable. Usually, first responders will see to this, but if you come across a victim before they arrive, you should be careful about jumping directly in to help. The same is true with downed power lines, house fires, and falls. If the victim is in immediate danger, you should not rush into the scene until it has been completely secured by first responders.
Victim Safety and Moving
After you determine if the scene is safe for you, you have to decide if the scene is safe for the patient. In most cases of trauma, you don’t want to move a patient that has been injured. This is because the spinal column may have fractured and could sever the spinal cord. In addition, further movement could make injuries worse. However, if the victim is not safe, you may need to move them to perform BLS. If coming upon a car scene, you cannot move the patient into position for BLS, either, for the same reason.
However, if a patient requires CPR, sometimes these precautions are overlooked or used in a more cursory way. For instance, in car accident cases, the spine can be supported as well as possible while the patient is moved into position for CPR. For this reason, bystanders should not take too many liberties at an unsecured accident scene. If it is unsafe for you, it is probably unsafe for the victim, too. Deciding to move them is a risky decision, but one that certainly can be made to save a life. It is only in extreme circumstances that a patient is removed without spinal precautions in place. Even in cases where the scene is unsafe, these precautions are still kept in mind.
Whether you are a first responder or a bystander, you have to be aware of the situation around you because it can change. What may seem like a safe scene at first can very quickly turn unsafe as the environment changes. This is particularly true in houses where the tempers of the occupants may change with the actions of the first responders. When the scene becomes unsafe, it is time to decide whether to leave the patient or move them.
Again, this isn’t an easy situation. If you are a bystander and by yourself, you should probably leave a situation that has become unsafe. This is exactly what police, fire, and paramedics are trained to deal with, and you should not put yourself in jeopardy. If you are a first responder, despite the scene securing, the situation may change. At this time, you should work on team responses to either clear the area or move the victim. In many cases, you will want to assess, treat, and load a BLS patient as quickly as possible, so a changing scene may not affect you. Still, you need to be aware of the possibility and look to make decisions that keep everyone safe.