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CASE REVIEW or worsen the situation? What can be done to prevent anything worse or precipitate a crisis, like the man jumping off the crane? The Finance Section will develop a budget for all elements of the operation. The media presence increases rapidly, especially with the man yelling obscenities and throwing objects at the crowd below. The Joint Information Center is set up, with the law enforce- ment PIO as its lead. Incident management meetings will be conducted every two hours until 6 p.m., then every four hours. As rotating in charge of that patient at that time? What if he is very ill or injured? Where will he be transported if he is ill, injured or burned? High-angle rescue crews are brought to the scene, and a joint fi re-EMS operational plan is established. Over the next four days, the man stays on the crane, establishing places to sleep, shield himself from the sun, scream at the crowd below, and have short and hostile conversations with negotiators. He has no food, and the only water he ingests is from some brief rain showers on otherwise warm Learning Point: EMS activity at police standby operations is not infrequent. EMS units and personnel must be prepared for many aspects of care, and for immediate changes and medical challenges in the operation. Participation in law enforcement incidents requires skillful use of an incident management system. In prolonged incidents EMS crews will need to rotate. This presents an ongoing need for consistency in planning and communications. Incident resolution may involve complex medical care, including care of penetrating trauma, blast injuries and burns. Special planning needs to take place for the care of patients who are known to be dangerous, are restrained in police custody, and may be very uncooperative. crews are brought to the scene, they will be briefed at the next meeting. Any updates to the operational plan will be shared at those meetings, unless a crisis meeting is required due to a rapidly changing condition. Each discipline present needs to assign a member to the Planning Section, so that plans can encompass everyone’s needs. The fi rst Planning Section meeting will be held in one hour. EMS personnel are responsible for the Medical Branch. Fire-EMS members are to prepare for injuries or illness for all groups present, and have a precise operational plan as the incident comes to resolution, as the media will be recording every detail. The Medical Branch will develop a plan for all possible medical events, and prepare local hospi- tals. The plan will include contingencies for injured police offi cers and the perpe- trator, including trauma management of someone falling or jumping off the crane. It also will include management elements for care of the perpetrator should he be sedated or injured in an altercation on the top of the crane. It needs to be precise as to what will happen if police need the perpetrator restrained: Who is 30 JULY 2011 | EMSWORLD.com and sunny days. The busy street below remains closed down. Over time, the man’s behavior gener- ates international media interest, and various plans are considered to end the standoff. At times he threatens to jump. This generates a fi rm plan by law enforcement that they will do nothing to prompt irrational behavior or incite him to do anything dangerous. The technical rescue crews and selected law enforcement personnel who can tolerate working at high altitude establish a “rescuer” area on the upper surface of the crane, and bring supplies up a little at a time (by hand) that will be used to bring the man down safely. The man’s strongest drive is his thirst, and law enforcement uses that in an attempt to get him to surrender. They display large bottles of water, drink some of it in front of him and ask him repeatedly to step toward them to get some of it. They devise a safety restraint system so the man can be immobilized, secured and lowered to the ground once in custody. On the fi fth day, the team knows the operation is coming to a resolution. The lack of water begins to affect the man, and he becomes less hostile and more willing to discuss the bottles of water on display with the police offi cers. Medical Branch physicians are fairly sure dehydration will be the most infl u- ential medical issue, and that restraints will have to be physical, for fear that any chemical restraints or sedation could be unpredictable and dangerous. On the evening of the fi fth day, all plans to bring the man off the crane are fi nalized. The Attack One crew is serving on top of the crane. The suspect becomes more agitated, and police negotiators believe he can be tempted to come to the middle of the crane platform by placing more bottles of water there. When the man comes to get them, they can safely secure him using an electronic stun gun on a platform area where he can’t fall. The operation is successful: The barbs hit the man in the legs and immobilize him, and he is secured in handcuffs. The Attack One crew does a rapid medical assessment while the technical rescue crews set up to secure the man in a basket, to be lowered by hand and pulleys. This will take 20 to 25 minutes. The man has damaged the crane so much that it can’t be used to lower him, or the public safety personnel and their equipment, to the ground. The man, handcuffed and restrained, is given a small amount of water by mouth and a primary EMS assess- ment. He is sunburned, dehydrated, tachycardic and still uncooperative. The barbs are removed from his legs without causing signifi cant injury. It will not be safe to start an intravenous line on him when he will need to be lowered by rope, by himself, over the long distance. That will be left to EMS crews on the ground. The man is secured fi rmly in the basket, given a couple mouthfuls of water to make him more comfortable, and then the technical rescue crew initiates the lowering process. Once he’s down, the waiting EMS crew on the ground then carries out its elements of the plan. They remove the man from the basket; law enforce- ment personnel read him his rights,