[What Would You Do?]House Fire With Confirmed Entrapment

[EMTbravo 312]

Scenario submitted/developed by:x635

You're the Paramedic Lt. of a Paramedic truck company. You are responding to a structure fire, report of 1 subject entrapped. Upon arrival, you notice an older three story wood balloon frame Victorian-type structure with fire showing from the left side of the structure. As you exit the vehicle, you are approached by a hysterical female screaming that her elderly father is still inside, probably in his bedroom, on the right side of the structure up the stairs. She states everybody else (her, her daughter, and her son) got out through the front door and her husband is at work. As you and two firefighters approach the front door, you noticed it is locked. You force entry to the structure, and start your primary search. You notice fire on your left on the first floor, go up the stairs, and go towards your right, As you enter the last bedroom at the end of the hall, you see an elderly male sitting in a chair, looking relaxed. As you say, “Sir. Lets get you out of here” and put your hand on his arm to help guide him out, he sternly tells you to “get the heck off of me, I'm not going anywhere!!” and pushes you away. You try persuading him to comply with you and go, but he still refuses and is becoming increasingly hostile with you. The room is starting to fill quickly with smoke and you know the fire is close behind. Your truck operator has just positioned the bucket of your truck outside the window after hearing you’re “found” call and seeing you open the window. As a paramedic, you do a quick assessment and find him mentally competent and showing no signs of medical distress. You hear the Engine Lt. over the radio report the fire is in the walls “big time” and request additional lines stretched. What do you do?

[Guest DFFD227]

ohh boy...Well, I didn't want to do this, but for my own safety, the crews safety, and for the elderly mans safety, I would have to use physical force on him. Because when you are in that situation you can't negotiate. That is unreal in a fire. I would have my crew pin him down, and carry him off in force. And If I couldn't go down the stairs due to fire, I would prepare the truck co. that we will be coming down with one elderly male, possible alter mental status (because we really don't know what his deal is, his background etc..). I would make sure there are enough men on the ladder to take him on the bucket into safety. I mean what more can you really do to an elderly man? knock him out? LOL, It's like a ticking time bomb, anything can go wrong with an elderly man. :flamed:

[TRUCK6018 50]

On the medical side, being that he is "mentally compatant" he can't be forced to receive medical care. I don't think signing an RMA is appropriate at this point. That's when you forget your a medic and remember to protect life and property and forcefully remove him.

[mfc2257 464]

I at that point would have no choice to assume that he is EDP and remove via force. The alternative is to go outside and tell his daughter that her pops didn't want to come out so you left him there. I don't think that her or her legal counsel are going to like it if you left him there with a bucket right out side the window.

[x635 4,066]

This is actually a double edged sword. Sure, it can be claimed that anybody putting themselves into that situation is an EDP. But,being that you determined he is mentally competent, if you remove him with force, you can be charged with felony assault, battery, and possibly kidapping, although I do not know if the charges would "stick". If you don't remove him, you can be sued by his family, because how can you properly document his actions and get a witnessed release (by PD) in that situation? And by doing this as well, you place yourself in a greater physical danger.

Do you lie and say he wasn't mentally competent when you went to remove him? Although it seems quite simple, underlying, it's a big ethical and legal dilemma.

I too, probaly would radio to have PD ready for assistance upon removal, also radio my situation to the IC, and try to extricate the gentleman as gently and calmly as possible. If I had time, I would prefer to place him in a stokes, since you do not want to handle a combative person through the window and in the bucket. I'd worry about any reprocussions later.

But, I've submitted another element/twist to this story.......It's gonna be a bit obscure, but it's good to think about.

[EMTbravo 312]

From where we left off and the members responses so far......

( I know this is extremly obscure, but anythings possible nowadays)

Although he is elderly, he states he is 70, appears in quite good physical shape and you have learned he runs and lifts weights daily. He is a prominent lawyer who you now reconize, especially since he has succesfully sued your FD for negligence.

As you go to physically remove him, he pulls out a Glock 9mm pistol. He says you were given the oppurtunity to leave, but didn't. He orders you to stay still, and when you accidentally make a sudden move, he fires off a warning shot. He orders you to remove your airpacks and radios and drop them out the window on the other side of the room, opposite where the bucket is. It is now just you and the rookie on the truck, since the other FF with you had to leave due to a turnout gear problem. Your contemplating attacking him with the pack as your weapon, but you can tell you will be shot if you do approach him. He states he is doing this because firefighters coudln't save his wife from a fire several years ago, and its "eye for an eye, tooth for a tooth, payback".He says that he wasnt going to keep you intially, but changed his mind when you stayed to "harrass" him. He states he doesn't want to shoot you if he doesnt have to, because you need to know what his wife went through. The room is filling slowly with smoke. What do you do? Are you stuck, or can you think of a movie-star move? Or can you think of firefighter survival skills or other things you are taught that can save you...and him?

[Guest DFFD227]

wow, I wouldn't touch that situation with a 60 foot pole! :poke: :rolleyes2:

[Guest alsfirefighter]

Any EMS legality issue doesn't apply here. You are in an IDLH atmosphere in a condition where conditions are still deteriorating (which I'll get to in a minute). There would be no assessment, which would be hard anyway with your mask on. Compentent or no compentent he would be coming with me. They could try whatever they want, but in order to be "charged" with something a prosecutor would have to take the case, even if that happened the judge would immediately toss a case like that. There aren't very many "compentent" people whom would stay once that heat started (and excuse me for a lack of a better term) creeping up their a$$. He pulls out a handgun...he can roast...or the marine will come out of me and I will advise him where that gun may go if he doesn't knock off the BS. Keep in mind that Carbon Dioxide is the best anesthetic out there, so with you SCBA and that fire downstairs 2 things will occur, his respiratory system will fail, or steam smoke and super heated gases will fill that room up the stairs and obscure his vision and then its lights out for grandpa.

As far as the conditions, there is no way I would allow a crew to up the stairs with visible fire on the first floor where the stairwell is unless the handline was in the process of being charged, not stretched...charged. This type of fire presenting screams for VES (vent enter search) from the outside, or I would have to be confident that a ladder was going to be there by the time I got there. Now have I ever bolted up stairs to look for a reported vic, yup. But speaking from a leadership stand point its wrong. No control over the interior stairway is critical problem and keep in mind most of the LODD's not of cardiac origin occur on the floor above.

[Mofire24 27]

This is a very tuff situation i am not a medic or emt but a firefighter you as a seasoned firefighter are responsible for your probie there isnt too many ways you can make it out of this alive. You can hope while you are down low to the floor the smoke is rising and the man starts choking and gaging on the smoke and being blinded and if you pull your nomex hood over your face and you might keep from taking in too much smoke and you might be able to crawl your way out of the room or as the smoke is over coming him bum rush him take his gun and either force him out of the house or just leave him in the house its either you or him and i am sure most will agree they want to be able to go home to there families. But also i am sure his daughter and family want to see him again too this is just a tough call

[WAS967 97]

Pre-Gun-Pulling response: First of all, competency goes beyond a person being C/A/Ox3/4/whatever. In fact it's only the first part of a good mental status survey. Not many people have heard of this acronym: OMIJA. It was taught to us by our good friend Dr. Emil Nigro at Phelps Hospital. For anyone who has never been to one of Dr. Nigro's call audits, I highly recommend it. But be prepared to be called on to answer some tough questions! Anyways, OMIJA. Orientation, Mentation, Ideation, Judgement and Affect. Orientation - Your usual C/A/Ox3 - Oriented to person, place, and time. Mentation - "thinking that is coherent and logical". Many a drunk knows who, what and when. But are the really competent? Ideation - "The process of forming and relating ideas." Suicidal Ideation is a good example of BAD ideation. Judgement - Can the patient make proper decisions? (Yes, a great many people exhibit poor judgement, but thats no reason to tie them up and transport against thier wishes). Affect - How is/does the patient react to a gven situation. (If you ask the patient what they want to do after they RMA, and they say they want to go ski Mount Everest wearing nothing but a pink tu-tu, then they are demonstrating poor affect (and probably judgement as well).

In this case, the patint, regardless of his orientation, is demonstrating poor JUDGEMENT (even if he thinks he will be okay, you as a trained firefighter know better, you don't have time to explain, and he needs to get out NOW).He demonstrates suicidal IDEATION, as chances are he knows the house is on fire by now, and staying will only have one end result. His AFFECT is totally off kilter, as any normal person would see fire and run.

The use of a mind altering substance (Alcohol, drugs, etc) falls under the judgement category, as anyone under the influence MAY be orientated, but thier judgement is impaired by a substance. Psychiatric patients can fall under any of the categories, but ideation seems to be the most common.

As for the gun scenario, I'd turn tail and run. Even without the gear on, statistically a shooter only has a 1 in 10 chance of hitting you if you run away. And with a huge air tank on your back, he might as well be shooting at you through a refrigerator.

[FF402 133]

You never know what you're gonna get.

Accident Victim Fires Handgun While Nevada Firefighters Work To Free Him  

 

TIM SZYMANSKI, PIO

Las Vegas Fire & Rescue  

Las Vegas firefighters had a close encounter late Tuesday afternoon, after an accident victim they were treating in a single car accident fired a handgun he retrieved from under the dash. Firefighters were able to wrestle the gun from the victim and give it to police. No one was shot as a result of the gun being fired. Charges are expected to be filed against the individual by Las Vegas Metropolitan Police.  

Firefighters of Las Vegas Engine 210 had just been released from a business fire on Western Avenue and were dispatched to a single auto rollover on Paratore Way between W. Charleston Blvd and Valley View Blvd. at 4:39PM. When firefighters arrived, they found one SUV on its roof on the side of the road. They discovered one single victim inside the car, a male who needed treatment. Two firefighters entered the car to begin treatment when they heard a bang. At first they thought an airbag device might have gone off, but they soon discovered the victim had a 45cal automatic pistol in his hand and he just discharged inside the vehicle. The gun was pulled from the victim's hand by the firefighters and thrown outside the vehicle to a Metro Police officer who was on scene. Firefighters continued to perform medical treatment to the victim, which consisted of a head injury and transported him to a hospital. His injuries did not appear to be life threatening.  

The incident is being investigated by Las Vegas Metropolitan Police. None of the firefighters were injured during the incident.  

 

[Guest]

donn't try and mix up this with fire vs ems. this is a fire situation. as well as common sense. the man is in a house that i on fire just get him out. what ever way needs to be employed to extricate him from the house. no person who is in his right mind would stay in the house in that situation.

also if you really want to pull out any reason. say he is hypoxic and not thinking clearly due to the smoke. a no brainer

[FF402 133]

Wouldn't a physical conflict comprimise your safety, not to mention your protective gear, in this situation? If there is only two of you, and he puts up a good fight, how would you safely get him and yourself out?

[x635 4,066]

a no brainer

IMO, as simple as something may seem, nothing in this line of work is a "no brainer".

[RWC130 594]

I'd make an Aggressive Interior Attack and give him 125 PSI of H20!

Just kidding, Yup... Very sticky situation folks!