Kilted To Kick Cancer

That whole "being-out-of-the-loop-for-two-months" thing really threw me off. 

While the month is nearly over, I'd like to call attention to Kilted To Kick Cancer.  This is a campaign started by Motorcop and Happy Medic to promote awareness of male-specific cancers.  With morbidity and mortality rates of these cancer matching that of breast cancer, these gentlemen have been wearing kilts to spread the word.  It's a great campaign, and a great cause.

All too often, we (that is, men) play Russian roulette with our health.  The public safety field seems to be full of caring and compassionate folks who spend their entire careers worrying about the health and safety of our communities, but we frequently don't pay enough attention to our own needs.

So man up, put on your big boy kilt, and go get a cancer screening.  The life you save may very well be your own!

CSI: Fairview - Shootings

The second crime scene I'd like to address is shootings.  In a perfect world, you'll be dispatched to a shooting and then stage until law enforcement determines that it's "safe" to enter the scene. Motorcop and Happy Medic have talked about scene safety on The Crossover Show in the past, and scene safety means different things to different folks, but I digress.  Once cleared to enter the scene, you can go to work on the patient(s) and save the day.

We don't live in a perfect world, though. Shocker, I know.

I've run more than 50 shootings in my career, and they're typically pretty dynamic scenes.  I've had the unfortunate honor of being on a number of unsecure and unsafe shooting scenes, and made it out safely, but I don't recommend it to anyone sane.  Of course, most of us in Public Safety dance on the line between sanity and insanity, but I still can't really encourage you to be any part of an unsafe scene.

So, once the scene has been made (as) safe (as it'll get), you'll make your entry.  Maybe I'm just unlucky, but I can think of maybe a half dozen shootings that I've ever responded to that happened during the day.  Those of you with wicked maths skills have probably figured out that I'm in the dark most of the time - ha.  Flashlights come in really handy in those dark alleys and parks.

So, armed with your trusty flashlight, you (and probably some number of street cops with their own flashlights) walk into the scene.  You'll need to have your eyes constantly scanning for evidence.  It's not typically like a movie scene, and those nice big yellow evidence markers you're used to seeing on TV are probably gonna end up being folded 3x5 index cards or something similar.  In the initial flurry of activity, shell casings may not even be seen by the first officers on scene, let alone marked.  The last thing you want to do is kick a shell casing or step in some blood droplets.  That valuable forensic evidence you kicked away or turned into to a useless dirty smear probably won't make too many friends in the Detective Squad.

So as you scan for shell casings, blood droplets and pools, narcotics, firearms, and even assailants and suspects, make your way to the patient.  If at any point you have no choice but to destroy evidence, give the police officers the opportunity to see, and, if possible, document, the evidence before you alter the scene.

As you make patient contact, pay attention to their hands.  Even if the patient is a truly innocent victim of violence, their condition may make them prone to hurting responders inadvertently.  The patient may even be armed themselves, so keep that in mind.  A quick physical exam will help reveal both trauma and evidence, so it's a great idea to take a second and do a rapid full body exam.  This can (and probably should!) look like a pat down.  Pay attention to the waistband and pockets.  Should you find weapons, contraband or other potential evidence, make sure to notify the closest officer/deputy/trooper in order to secure the evidence and maintain the proper chain of custody. 

This whole pat down physical exam should only take 15 seconds or so.  As you go, note the normal medical findings, but also take special note of any bullet holes in the clothing and, in the case of close range shootings, the presence of gunshot residue (GSR) and powder marks.  Aside from the obvious clue to penetrating trauma in close proximity to that bullet hole, you'll want to take care to not cut through that hole or GSR when you remove the patient's clothing in the ol' strip 'n' flip.

Because gunshot wounds may or may not be obvious and the patient may not know how many times they've been shot, it's very important to remove all their outerwear.  All that clothing can be valuable evidence as well, so remove it with evidence preservation in mind.  Try to make as few cuts as possible, and if you can cut along the seams, even better.  If you can make a few straight cuts along seams, that shirt or pair of jeans will probably still look like a shirt or pair of jeans in 5 years when the evidence is presented at trial.  But a ragtag piece of fabric that doesn't look like clothing anymore just makes us all look sloppy.  It doesn't really take any longer to do it the right way, so you should really make the effort.

It can be very helpful to know the type of weapon that was used and the caliber of the bullet.  Those shell casings we talked about earlier can be a great indicator of that, but you won't make any friends by picking up the shell casing to look at it.  Under no circumstances should you take a casing to "show the hospital staff." Ask the cops -- this is their sandbox, and you're just visiting.  If shell casings aren't around, it might be pretty hard to tell what the patient was shot with by visual inspection alone.  This is common when the weapon is a revolver, in a drive-by shooting, and in some outdoor environments with lots of ground cover.  If the patient saw their assailant, they may know what they were shot with.  Even if you're unable to determine the size of the projectile, knowing if they were shot with a pistol, revolver, shotgun or rifle can be very important.

Another note about shell casings: especially if you don't know much about guns, a trip to a gun shop, shooting range or even the PD can teach you a lot about ballistic considerations.  It doesn't take much time to learn the difference between a 12 gauge shotgun shell and a .22 casing, and when you can actually see the difference in size between a .22 and a .223, you'll have a much greater appreciation for the difference that muzzle velocity makes in the impact on soft tissue.  Again, the size of the round can have a huge impact on the mechanism and severity of the patient's injury, but don't get caught up in trying to determine the information if it's not readily available.

Also, despite what you may have heard, it can sometimes be almost impossible to tell if a given wound is an entry wound or exit wound.  In truth, it doesn't even matter -- it won't make a bit of difference in how you manage the wound.

Once you've assessed the patient's injuries and initiated the appropriate treatment, you may believe that the time for evidence preservation has passed.  Many times, this is true.  There are some clear exceptions, though.  If for some reason you have the patient's clothes or other potential evidence with you, make sure that it's not disposed of. 

The patient's statements to you may be very valuable as well, especially if the patient is in extremis.  Shocking as it may seem, some shooting victims will refuse to identify their shooter to the police.  This can be out of fear of retaliation, or a desire to inflict their own retaliation, among other things.  If they give you a dying declaration that identifies their assailant, however, that could be the key piece of evidence that takes a violent criminal off the streets.  If the patient opens up to you, do your best to obtain the who, what, when, where, why and how.  The more you get from them, the better.  "Some middle aged white guy" is better than nothing, but "my ex's new boyfriend" is better.  A name, even a street name or nickname, can be better still.  If they don't know their attacker, a good physical description, along with a vehicle description and direction of travel can be very helpful.  You get the idea. 

Like I said last time, it's not EMS's responsibility to investigate the scene or catch the bad guys, but we can be valuable assets to our law enforcement brothers and sisters.  Situational awareness and proper documentation of the scene, circumstances and patient conditions can be very helpful to the investigating officer and agency.  Be aware of the presence and importance of evidence, and be careful what you do out there.  Vigilant situational awareness helps you minimize your impact on the crime scene, so work to maintain it. 

Again, this isn't meant to be all inclusive, and I welcome input from my EMS and LEO brethren.  Stay tuned for crime scene number 3...

Ugh.

All rumors to the contrary aside, I am still alive.

Social media issues at work compounded by unforeseen circumstances at home forced the long, unexplained absence.

Sorry, folks.

We'll return you to your irregularly scheduled postings shortly.