EMS Operations
Scene safety and command
Your first priority is your own safety and that of your crew. Do not enter a scene that is unsafe-traffic, violence, hazardous materials, fire, or unstable structures. Request law enforcement or fire as needed. At multi-patient incidents an incident command system is established, and you report to the designated supervisor.
Legal and ethical essentials
Consent may be expressed or implied. Implied consent applies to an unresponsive patient or a minor without a parent present when life-threatening conditions exist. A patient with decision-making capacity can refuse care; document the refusal, the risks explained, and have the patient sign, then follow local protocol. A valid do-not-resuscitate order changes resuscitation efforts; verify it. Protect patient information and report only to those who need it.
Transport and communication
Give a radio report with your unit, patient age and sex, chief complaint, vital signs, interventions, and ETA-concise and in that order. Secure the patient and equipment, and never allow an untrained person to drive. Use proper lifting technique: feet shoulder-width, back straight, load close to the body, and lift with the legs.
Traps
Do not assume a patient who refuses care lacks capacity just because the decision seems unwise; document instead. Do not enter a hazmat scene to rescue a patient-wait for trained responders. Do not discuss patient details where others can overhear.
Rule of thumb
No scene is worth a responder's life: if you cannot make it safe, stage and wait for the resources that can.