Safety at Scene—A Manual for Paramedics and Immediate Care Doctors

Abstract

I wish this excellent little book had been in print when I was working on the Helicopter Emergency Medical Service some six years ago. It might have spared me the minor embarrassment of nearly being electrocuted by the live rail while attending an incident where a woman had thrown herself under a tube train. Vic Calland's book contains a wealth of background information about the technical aspects of accident scenes of a kind that is difficult to acquire except through personal experience. He is to be congratulated for distilling his expertise into a readable and informative text. Most doctors practise within the safe environment of the surgery or hospital. Within this setting we are accustomed to being ‘team leaders’, to making the critical decisions on priority and management, and to being in control. Outside hospital the position is very different. Accidents by their very nature present dangers to emergency service personnel, as re-emphasized by the deaths of many New York firefighters and policemen when the World Trade Center towers collapsed. In the early stages of a major incident or even a medium-size road traffic accident, chaos reigns. In such circumstances, ‘first responders’ must be constantly aware of the risks to their own safety and avoid becoming casualties themselves. The rapid re-establishment of control is the key to a successful outcome. Within this framework, doctors are not team leaders but team members who come under the control of other emergency services, usually the police or fire services. An understanding of this principle and an acceptance of an initially subordinate role of the medical services is crucial to the smooth and safe management of an accident scene. In keeping with the frequency of road traffic accidents in the UK, about half the book is devoted to incident management, vehicle safety, casualty extraction and risks of hazardous substances at the accident scene. The remainder of the text contains much valuable technical information on specific scenarios, such as chemical and radiation hazards, the basics of aircraft, rail and underground safety and even hostage situations. Having been written before autumn 2001, the section on biological agents does not cover the now feared microbes such as anthrax, plague and smallpox, but we can hardly expect the author to be clairvoyant. That said, the section on chemical decontamination procedures is comprehensive and applies equally to biological threats. My only criticism concerns the lack of a chapter on the effects of bomb blasts—familiar to many in Northern Ireland and, to a lesser extent, to the emergency services of London and other major cities in the UK. In view of recent events, this is an area of practice we may all need to revise. This concise and easy-to-read text is sensibly fitted with a laminated cover to protect against stains from coffee, blood and oil, all familiar to the immediate care practitioner. I recommend it to anybody with an interest in prehospital medicine.