EMS Strategy: Situational Awareness By Gary E. Seidel Fire Chief, Retired Emergency response is, by nature, dynamic. Upon dispatch to an incident, responders are immediately in search of their most valued commodity: information. Initially, responders are provided key points from the person reporting the incident and upon arrival, obtain more information surrounding the situation at hand. While treating the patient, additional information to the problem becomes relevant. During these initial phases of information gathering, ensuring the EMS teams’ safety and tending to the patient requires situational awareness. Situational awareness means that responders: Understand their environment. Can determine what’s happening around them. Are able to predict what can/could occur and Can respond to or withdraw from it. We will discuss two concepts within situational awareness, patient generator and ultra violence. Patient Generator The term “patient generator” was coined in the mid-1970s by two paramedics working for the Los Angeles City Fire Department, James P. Denny and Donald Lee. Any incident that requires emergency responders involve a patient who needs assistance, creating a “patient-generated” problem. Upon arrival to the scene, EMS will find two types of patients: those in need of medical care and those in need of emotional or psychological assistance or a calm, kind voice to assist them. When dealing with patient-generated situational awareness, responders must also understand cultural awareness. While providing emergency medical services, responders may think in a linear fashion about the next steps to take. For example, after he patient has passed away, the report needs to be written, the police or coroner should be contacted, the grieving family should be consoled and finally, leave in order for to be ambulance available for the next call. Ambulance services may be new to immigrants and tourists and therefore, some cultures may interpret responders’ quick-thinking actions as hatred or intolerance to their beliefs and values. For some, witnessing responders' actions could be quite unsettling and from the responders’ point of view, onlookers' facial expressions and actions may appear to be quite dramatic and even hostile. Differentiating between hostile intent or cultural actions may be hard to discern in these types of situations. To help ensure all situations are handled appropriately, EMS responders can familiarize themselves with different cultures to understand how to best care for patients. “It is only through reaching out one can truly understand and then truly care for those in need.” (Seidel, Tim., Clinical Operations Manager, National Ambulance, UAE). Situational awareness requires responders to always be aware of their surroundings at all times. Ultra-Violence Ultra- violence is criminal violence that is not only directed toward victims, but also toward emergency service providers. It is defined as the “predetermined use of maximum violence in order to achieve one’s criminal goals, regardless of victim cooperation, the level of environmental threat to the perpetrator or the need to evade law enforcement and capture, resulting in physical or psychological injury or death to the victim(s).” The rationale for employing tactical ultra-violence is predatory control of the immediate criminal environment through the creation of chaos and the infliction of terror, trauma and death on presenting targets. The goal is achieved the moment the criminal act is committed and has no other purpose than to generate multiple casualties. Regardless of the perpetrator's motivation, the outcome usually happens within a short-term period and is, many times, the result of a large-scale operation. Here, the potential for collateral injury to responders is enhanced both physically and emotionally. Situational awareness requires responders to always be aware of their surroundings at all times. EMS providers must not let their guard down by becoming distracted, falling into “tunnel vision” or failing to recognize obstacles, cultures or hazards that they encounter when dispatched to an incident. Bio: Gary Seidel, EFOP, CFO, MPA; is a retired Fire Chief from Hillsboro Fire Department in Oregon and a retired Assistant Chief from Los Angeles Fire Department in California.