Scene safety: Emergency vehicle placement tips

Ensuring good access, staging and egress will help to make the operation go well

By Robert Raheb
FDNY EMS Lt. (ret), Emergency Response Specialist — FAAC, Inc.

When operating at the scene of an emergency, whether it's on the roadway or in a building, placing your vehicle strategically to maximize accessibility, utilization, safety, and egress is extremely important in making an operation run smoothly.

Roadway safety 
Working on the roadway, whether it’s a rural road or a multilane highway, presents a unique set of hazardous conditions that we must remain cognizant of and it usually requires multi-jurisdictional response.

When pulling up to the scene and before getting out, take an additional 10 seconds and assess your position. Are you blocking enough lanes? Are you far enough back to create a barrier? Motorists are not always paying attention to the road ahead and may not see you.

Most states have "move over" laws in place that fine the motorist who fails to adjust their speed or lane position when approaching an emergency vehicle working on the roadway, but that doesn't physically protect you.

Federal Highway Administration regulations and NFPA standards require the use of high visibility vests with five-point break away features while operating on or near a roadway.

The vest must meet ANSI/ISEA 107-2004 or 207-2006 requirements and have a fluorescent background and retro-reflective material that has 360 degree visibility.

Unfortunately, there have been incidents where different agencies have different viewpoints on how to manage the scene. Highway Patrol sometimes wants to keep the road open regardless of the safety issues it may compromise.

Other times, Fire/EMS may want to stay on the scene longer than necessary instead of pulling far enough off the road.

The National Traffic Incident Management Coalition (NTIMC) sets a goal of three major objectives:

• Responder Safety: first and paramount
• Safe, Quick Clearance: get off the roadway as soon as possible, do non-urgent treatment and paperwork on the shoulder or off the highway altogether. Remember if you can steer it, clear it; 1 minute of lane closure equals 1 mile of delay.
• Prompt, Reliable, Interoperable communications: PD, FD, EMS all have the same goal, but with different objectives and tasks. Pre-planning is vital to ensuring that all personnel understand and honor what the other must do.

For more information regarding NTIMC go to their website at www.timcoalition.org.

Terminology 
While looking in the direction of travel: 

• Identify the direction of travel northbound NB, etc.
• Lanes are numbered from left to right in sequence
• Shoulders are designated either left or inside and right or outside shoulder
• HOV/HOT lanes that are physically separated are numbered the same as travel lanes, but given the designation HOV1, HOT2, etc.
• Line Cycles are measured from the beginning of a skip line to the beginning of the next skip line. On the highway it is a 10 foot skip with 20 feet between them and on an urban road it may be a 20 foot skip with 10 feet between them, it's still a 30 foot cycle.
• Traffic before the collision is traveling upstream and traffic after the collision is moving downstream.

When working at the scene of a collision, units must be positioned to afford the greatest protection to the personnel and patients. The first arriving unit should position themselves upstream and off center of the collision to protect the site; if this is an ambulance it must be moved downstream prior to loading patients into it.

All units should park at a 45 degree angle, facing the front wheels outward and setting the parking brake; in the event of a collision, your vehicle will absorb most of the impact and be pushed away from the scene.

Emergency lighting should be kept to a minimum; usually the first vehicle approached upstream leaves their lights on as too much lighting can become disorientating to the motorist.

Flares serve two purposes:

• Advanced warning to other motorists that an incident is ahead, which is very important on limited sight distance areas.
• Delineates temporary lane patterns.

When using flares to shut lanes of travel down, consideration needs include:

The amount of traffic traveling

• Flares should extend upstream a minimum of 300 feet from the collision zone for traffic speed of 50 mph and further for speeds greater than 50 mph.
• Less traffic means shutting more lanes of traffic to divert fast moving vehicles further away from the incident.
• Congested traffic needs fewer lanes shut down since traffic is moving slower; at a minimum, you should always have at least 1 ½ lanes between you and the traffic.

The type of incident involved 

•  A Medivac will most likely require shutting all lanes of traffic in either one or both directions.
• Rescuers working at collisions involving only the center lanes of the roadway should consider extending the barrier to one of the shoulders; rescuers should not be working in a crash zone with traffic moving on both sides of them.
• Hazardous materials spill and/or flammable fluid spills require larger safety zones, and other approved devices such as cones should be utilized.

Any special mitigating circumstances

• Limited sight distance such as hills and curves should have the flares start at the top of the hill or the start of the curve to give motorist advanced warning.
• Flammable fluids? Use cones or other approved devices instead of flares.

Fireground Operations 
When EMS is operating on the fireground, ambulances should stage away from the operation and in one area. Setting up Staging, Treatment and Transport sections that provide a good flow of both vehicles and patients is important to the operation.

Officers should be assigned to each sector to coordinate with the Command Post.

Points to remember:

• When responding, remember that additional units may be responding from different directions and may cross the same intersections as you.
• Ambulances are not the primary vehicle of operation, stay out of the fireground away from hydrants.
• Avoid driving over hoses and only do so when using hose ramps and at the direction of fire suppression officers. Never drive over couplings.
• When setting up staging ensure, you have good access and egress from the scene.
• Gather your equipment from the ambulance and notify the Command Post of your presence.

Medical emergencies 
When fire pumpers, trucks or other medical response units respond to medical emergencies, remember to park past the residence and leave the space in front for the primary transporting ambulance, so the patient has a shorter trip through the rain, heat, snow, etc.

Nobody wants to do compressions halfway down the block because no one left room for the ambulance.

If pulling into a driveway or a narrow dead-end street, back into it so that egress can be accomplished faster and safer when pulling onto the main road.

Backing into the assignment first will give you a spotter, while afterwards all other personnel may be involved in doing patient care.

In summary, ensuring good access, staging and egress will help to make the operation go well. A quick scene survey upon arrival and the proper utilization of flares and barrier vehicles along with inter-departmental communications can help keep the crew and patient safe, which is paramount.

Always follow your department policies and procedures. Be safe and drive like your life depends on it.

Part 1 of a 3 Part series

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