L.C.E.S. For EMT’s

Some of you who are familiar with wildland firefighting are already well versed in the safety acronym L.C.E.S. It was developed in 1981 and continues to be taught in wildland firefighting curriculum as a handy checklist of things we should have in place when operating in dangerous environments where conditions can change fast.

L.C.E.S. came about when retired U.S. Forest Service Superintendent Paul Gleason looked at fatal fires over the previous 20 years and identified the four elements most likely to save your butt when stuff goes really wrong. The acronym he created is simple and it works.

In wildland firefighting changes in weather and fuel sources can mean that the operating conditions can go from good to “everybody run” in the blink on an eye, so L.C.E.S. is practiced pretty religiously.  One area of EMS where I feel is has tremendous application is when we’re working in traffic on accident scenes. I’d like to see us EMS folks adopt the L.C.E.S. mindset any time we’re working in the street or on the roadside.

If there’s any doubt in your mind regarding how dangerous working on the side of the road can be, you need to check out the PA officer struck by a vehicle while helping an injured man or the dash-cam video of the Ohio police officer struck by an out-of-control car. Working in traffic is, quite simply, one of the most dangerous things we do.

Here’s the L.C.E.S. acronym and how you can use it to help protect yourself and your crew.

L – is for Lookout:

You know that dude who’s standing on scene watching everyone else work? Make him a lookout. Post him somewhere where he can see the oncoming traffic and the crews working. He is now the de facto safety officer. His job is to watch the traffic and yell loud if anything starts to look squirly. (Yes…I said squirly)

He’s also going to watch everyone on scene and he’s going to yell at anyone who steps to close to an open lane of traffic. Let him know that if someone gets clobbered, he’s responsible. Lookouts work.

They also have an unspoken effect on everyone”s attitude. When you assign a person as a lookout, you send an unspoken message to everyone else on scene. “This is a dangerous place to be, watch your back.”

C is for Communication:

The individual in charge of the incident needs to communicate the plan of operation. (This is true even if there are only two people on scene. I don’t care how long you’ve worked together.)

No big production here, just state the basic plan. “Sharron is watching traffic. If anything goes bad we’re all going to bail over this guardrail. We’ll shut down all lanes of traffic before we load the patient. Lets get the passenger c-spined first.”

The lookout also needs to be able to communicate with everyone on scene at all times. preferably by voice, or by radio if that isn’t possible.

E – is for Escape Routes:

Watch the video of the officer dash cam and see how much time he has to decide on a plan of escape. Decide where your escape route is and then move anything that gets in between you and your route to safety. When things go bad, there won’t be time to move people or objects. Do your best to maintain a clear, unobstructed route to safety at all times.

S – is for Safety Zone

Without a safety zone, you’re not really escaping, you’re just running away. An escape route doesn’t mean anything if it doesn’t lead to a protected safety zone, preferably an area beyond a guardrail or barrier, but big, heavy things work too.

Another good option is to try to create a safety zone with an apparatus. Positioning a fire engine upstream in traffic blocking the scene is a great way to create a large safety zone to work within. With several protected lanes, your lookout will just need to ensure that everyone stays inside the safe area.

If you work in traffic for any amount of time, you’re bound to have a close call with a moving vehicle. You just can’t predict how each passing driver will react to your scene. If you have L.C.E.S. in place, you’re far more likely to walk away uninjured when the unpredictable driver passes by.

Once you’ve practiced the L.C.E.S. mindset you’ll find it’s useful for many other high-risk situations. From dangerous medical scenes to swift water rescue the acronym has an abundance of useful applications.

Side Note: Since the early 1990’s people have been trying to add an “A” to the L.C.E.S. acronym to form a more tidy-sounding LACES acronym. I haven’t found a better or more useful acronym suggested by the LACES advocates, but they never seem to go away.

Adding to the confusion, now that the “A” is up for grabs, nobody can seem to decide what it should be. Awareness is a top contender but others want it to be accountability while still others insist on anchor-points. Personally I think the ten standing orders and 18 watch-out situations have already demonstrated that more isn’t necessarily better. I like my L.C.E.S. like it is and I wish we could just leave it alone.

What do you think?: Maybe you can think of a few more EMS situations where L.C.E.S. could be useful in EMS. Try it out and tell us what you think.

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Rapid Diagnosis: Vomiting Blood

The Art of The Pulse Check

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