Command-Commandment #1
(Know thy enemy)
Incident Command Priorities for Police and Fire (Part 1 of 10)
This 10 part series will take inspiration from Sacramento Metro Fire Battalion Chief Anthony Kastros’ teaching of his “10 Commandments of Command” and applies those principles to complex emergency situations beyond that of a structure fire. Each of Kastros’ commandments are adapted to present an emergency where both police and fire must engage in activity at the same time, in the same place.
Lights flicker, exposing the paint peeling from the wall. Rust permeates the side of the cast iron sink from years of a steady drip. The stench of an un-mopped floor rises as Justin enters a stall, slides the lock with an unsteady hand, sets his backpack on the floor, and pulls out a sock filled with supplies and carefully peels apart a new syringe.
A student athlete only a year ago, Justin can’t bare to look at himself: seeing what he has become. As a star linebacker, he had his sights on the NFL draft in two years when a player rolled up on his right leg: both tibia and fibula severely fractured. He toughed through the pain at first but eventually succumbed to the many offers for narcotic pain medication. The descent was quick from that moment on. Periodic relief from the Oxycontin led to a visceral need to continue that euphoric feeling. Heroin was the next logistical step. Classes were skipped, friendships lost, and Justin has now devoted every day for the last two months pursuing his addiction.
It has been three days since he last shot up. Justin feels the vicious withdrawals coming on. “I can double the dose this once since it has been so long” he reasons. Justin ties the tourniquet, finds a battered vein and injects everything he has. Before he can finish depressing the plunger, Justin drifts off — the soothing wave drifting over him.
Police, fire and EMS are called to the bar 10 minutes later to find Justin unconscious and barely breathing. Brandon, a paramedic with the fire department, takes one look at him and immediately begins the process of starting an IV. “This is a narcotic overdose. He needs Narcan right away.” Brandon estimates Justin to be near 280 pounds and makes a decision to give him a larger dose of Narcan to insure he starts breathing again. Brandon draws up the double dose and turns to his colleagues: “before I deliver this medication, we need to talk.”
KNOW YOUR ENEMY
This emergency has a real potential to go very badly if police, fire, and EMS agents on scene do not work together as a team to get to know the enemy. If Brandon pushes the Narcan without coordination, Justin will immediately wake up and become extremely violent. He will quickly overpower the members on the scene. Police — who may have a limited knowledge of what is happening — may be forced to revert to their training for subduing a hostile person. An individual the size of Justin acting this violently could incite an escalation in response from the police that may well cause injury. Brandon knows the enemy: the drug, not the person. He understands the dynamic of this complex problem and makes sure that all members involved know the enemy before proceeding. Brandon insures the following:
Unified activity: Brandon takes 30 seconds to pause and advise all agents that the Narcan he is about to administer will immediately reverse the effects of the Heroin in Justin’s system causing him to enter into violent withdrawals. He may fight violently but it is not malicious. He will have no idea what is happening to him.
Fire activity: Brandon breathes for Justin while he is lifted on to an ambulance cot and secured with soft restraints. Brandon then slowly delivers the medication — a little bit at a time — seeking only to improve the respiratory rate, and not incite withdrawals.
Police activity: All police officers put on medical gloves and prepare to stabilize Justin on the cot should he become violent. They now know to assist with restraint only to insure that the responders on scene and Justin are not injured.
Result: Justin is revived, transported to the hospital without incident and voluntarily enters into a treatment program. The watershed moment of his near death experience serves as a launch point to changing his life for the better.
Justin and Brandon’s experience is but a small example of daily emergencies all over America. Heroin overdose emergencies are often managed in the two ways noted above. While the benefits of Brandon’s approach are relatively benign in the global sense, making a habit of them will pay dividends when the emergency is much larger. If emergency responders take that 30 seconds to talk over what the incident priorities are and act as a unified team on those daily incidents, the large, multifaceted, complex event will often proceed just as smoothly. Knowing the enemy, stopping, talking, and acting as a team, will vastly improve your response capability.
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About Me
I am a Firefighter, Paramedic, Lieutentant, and OEM Coordinator with the City of Aurora, CO. I see the passion of all emergency responders in this industry and seek to cultivate it to take our response to the next level. Join me in this team effort.
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