Picture this: You are dispatched to a motor-vehicle collision with pedestrians struck at 10:20 p.m. on a Friday evening in the heart of the thriving downtown area. Your unit is an ALS response unit, staffed with you and one other paramedic. You are only two minutes from the scene and are the first-arriving EMS unit. No other information is available for this dispatch.
As you arrive on scene, you observe a white minivan positioned through a guardrail, with what looks like bystanders rushing around. Your senses are heightened; there appears to be multiple casualties on a bridge over a major river. You radio back to dispatch your observations and request for additional units. What do you do next?
With your senses heightened, you don your department-issued ballistic PPE (vest and helmet). Imagine exiting your unit and being immediately barraged with wounded and their loved ones. One victim screams for your help to save her husband, who was struck and thrown from the bridge into the river below.
Off in the distance you hear the sound of gunshots. The gunshots are later found to be from police officers engaging terrorists, but at the time, there is no way to know who is shooting at whom.
You instantly recognize you are in the hot zone. You and your partner take defensive postures but quickly realize, from the number of injured and the large and growing gathering of bystanders, that there is no exit from the scene.
You and your partner have trained for this situation. You crouch back to back to create a 360-degree area of visibility while continuing triage. The only things to do is to treat the wounded, communicate your observations to dispatch, including the reported man over the bridge, and prepare the incoming units for the scene they are about to enter, including information for the boat crew for the river rescue.
This real-life scenario played out for the London Ambulance Service (LAS) on June 3, 2017.