Third Night, Ice, and a Loose Dog

I do not approach yet. There are at least four hazards here and none of them is the patient.

• Traffic: glare ice, a rural two-lane highway, and a vehicle in the ditch. I park uphill and upwind, off the roadway where possible, lights and cones out, and I never turn my back on the lane. Secondary collision is a leading cause of death among responders.
• The vehicle: is it stable? Fuel leak, fire risk, undeployed airbags, battery? A rollover on ice may still be settling.
• The dog: unsecured and circling. I do not step out of the truck into a loose protective dog.
• The bystander: shouting, smelling of alcohol, and physically positioned between me and my patient.

Actions: radio dispatch for RCMP and fire, state clearly that I am staged and why. Ask fire to stabilise the vehicle and contain the dog. Request a second unit - one patient, one hostile bystander, and ice is not a two-person job.

The patient is conscious and holding his neck, which buys me the 90 seconds to make the scene safe. That is the correct trade, and the radio log documents it.

• Do not match his volume. Calm, low, slow, and use his name: 'Sir, I need you to stand by the police vehicle. What's your name?' People who shout usually want to be heard.
• Give him a job if it is safe - hold a flashlight, call a family member. It converts an obstacle into an assistant.
• Create distance: approach from the far side of the vehicle, with fire personnel present, rather than through him.
• Do not argue about whether he has been drinking, and do not physically restrain him. De-escalation is not a wrestling match.
• Take the history while he is calm. He may know the mechanism, the patient's medical history, and whether anyone else was in the car. He is an unreliable narrator, not a useless one.
• Document his behaviour and the time RCMP was requested.
• If he becomes threatening, I withdraw to the truck and the patient waits. My safety and my partner's safety is the precondition for the patient being helped at all - that is not abandoning him, it is the only way he gets a crew that is still functioning.

This is the risk nobody writes on the form.

• It is 23:40 on my third consecutive night - the circadian trough. My reaction time, my traffic scanning, and my tolerance for a shouting bystander are all worse than they feel from the inside.
• My partner is three months in, in week two. Under pressure a new graduate either freezes or over-functions. I need to name roles before we leave the truck: 'You carry the airway bag and the radio. I have the patient. If I say stop, we stop, no discussion.'

What I do:

• Slow down deliberately - the ice imposes it anyway. Verbalise each step and use a checklist for scene size-up and the primary survey, because checklists survive fatigue better than memory.
• Call a second unit on the basis of scene complexity, not just patient condition.
• Self-check: am I rushing because I feel watched? Am I skipping the scene walk because someone is shouting? Those are fatigue symptoms, not clinical judgement.
• After the call: debrief honestly with my partner, and if I am ever genuinely unfit for duty I say so before the next call. That is a professional obligation, not a confession of weakness.