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CASE REVIEW then handcuff and secure him on an ambulance stretcher. EMS personnel recheck his vitals, start an IV line and give him a modest bolus of saline. The man is not nauseated, so he drinks some electrolyte solution offered to him. The EMS cot is placed in a secured ambulance, and two police offi cers accompany the crew to a prede- termined hospital, where ED staff has been notifi ed the man will be taken. A complete EMS team remains at the scene to ensure safe coverage as remaining personnel and supplies are brought down off the crane. Command staff completes a debriefi ng and incident wind-down, and the area is left secure for investigators to complete their work the next morning. Hospital Course The patient is stable on arrival in the ED. He is provided rehydration with electrolyte solution and calories through a carbohydrate-rich snack. He has no abnormalities of electrolytes. He is discharged to jail with instructions for a gradual return to a balanced diet. Case Discussion EMS functions will be unique when working in different incidents within the public safety arena. What are implications of working with law enforcement in incidents where they are directing the operation? In many of their incidents, there is no patient on EMS arrival, but a potential for one or many patients, including law enforcement personnel. On arrival at such a scene, it will be important to determine who is in charge of the incident. At some point, an incident requiring signifi cant time and dedica- tion of resources will necessitate imple- mentation of an incident management system. Prolonged incidents will neces- sitate development of an incident action plan. This will crystallize the responsi- bilities of leadership and set a path of cooperation for safety and effectiveness. Important issues to be addressed in a prolonged law enforcement standoff include: Who is in charge of which elements of the operation? What would cause leadership to change? If something is suddenly blown up or catches fi re, or there are multiple critical injuries, who will make critical life safety decisions? How will manage- ment occur over time? Some operations extend over multiple days or even weeks. Will leadership pass from law enforce- ment to fi re offi cer and then back to law enforcement, depending on priorities? How will the Planning Section address contingencies? What’s the worst that could happen? What will be done about it? What will improve or worsen the situation? What can be done to prevent anything worse or that might precipitate a crisis? What impact For More Information Circle 14 on Reader Service Card 32 JULY 2011 | EMSWORLD.com