Slumper Car

“Ambulance 1, code 10 to eastbound Main Street east of Broadway.”

“Main and Broadway, 10.”

“Down party, slumper in a vehicle.  Fire’s going, police have it but nobody is assigned yet.”

I hate to run on slumpers in a vehicle.  A lot.  Hate.  They are one of my least favorite calls, as a matter of fact.  I hate slumpers in a vehicle for two main reasons.

First, slumpers never work out to be a medical problem requiring EMS.  In my experience, slumpers are people who fall asleep, DUI drivers, and people broken down on the side of the road.  The logic behind running emergent to a slumper doesn’t hold up – sorry, but people don’t die in their car without crashing into something.  They take their foot off the brake and roll forward until something stops their car.  Waste of a response.  I don’t have stats to back up my experience, but I stand by my opinion.  You can probably come up with that “…one time, five years ago, when that one guy was sort-of hypoglycemic…” and I still don’t care.  I’ve run dozens of slumpers since then, all with nothing really wrong.

Second, slumpers are dangerous.  Not many paramedics and EMTs recognize the danger in approaching a car.  It is similar to a traffic stop, with the added fun of waking someone up.  People wake up confused.  According to the FBI, almost 100 police officers were killed and more than 4,000 were assaulted during traffic stops between 2001 and 1010.  Even when a person isn’t specifically trying to hurt you, you can get hurt approaching a slumper car.

Imagine falling asleep in your car at a traffic light.  You aren’t doing anything wrong, you’re sober, just tired after a long day.  Suddenly, you are woken by tapping on your window.  Or the car door being pulled open.  There are bright flashlights and authoritarian voices.  People panic and do stupid things.  Some people floor it.  Some people fight.  Some people grab the pistol between the driver’s seat and the center console.

Traffic stops suck.  No, really, they suck.  Suh-huck.  

So, to me, running a slumper in a vehicle is the worst of both worlds.  Bad things happen, and the most common outcome is that I shouldn’t have even been there.  I’m not a police officer and I resent it when I am expected to act like one.

There are things that we can do that help to mitigate our risk on these calls, however.   I divide up the process into two phases – Before contact and making contact.

Before contact.  This is when you pull up behind the slumper in his crappy sedan, parked at the light.  What should you be doing and what should you be thinking about?

• The first step is to realize that approaching a slumper in a vehicle is not a run of the mill job.  Pay attention to your safety and the safety of other team members.  Start with the right mindset. 
• This is not a routine call!
• You are essentially performing a traffic stop!  Ever been trained to perform a traffic stop?  Nope, me neither.
• Like with a traffic stop, you don’t know who is in vehicle, what is in vehicle with them, what their intentions are, and how they will react to your presence.  Add into the mix that people know when they are pulled over that a police officer will walk up to their window.  Half-drunk guy who fell asleep at the traffic light isn’t expecting to see you.
• Position your vehicle well.  Look at police cars at traffic stops.  The cruiser is usually placed so that it is closer to the road than the stopped vehicle.  This is to give the officer room to work at the side of the stopped vehicle.  Our process should be similar.  Take a lane to work in, and more if you need to.
• Get yourself plenty of light.  Turn on everything.  Add spotlights and flashlights.  Light helps you see.
• Consider the small details.  How many people are in the vehicle?  Is it running?  Is a window down? 
• Update dispatch on what is going on.  Include a description of the vehicle with the make, model, and color.  Give out the license plate and describe the vehicle’s occupant as best you can. 
• Position yourself well.  Do not stand in front of the vehicle.  You will be run over if a foot comes off the brake, or if the confused person inside decides to take off.  Do not stand behind the vehicle.  Same reason.  Stand on the sides of the slumper car.
• Never stand between two vehicles.
• As you walk past the trunk, press on it to make sure it is closed.  This is important to cops, for some reason.  I don't really understand it, myself.  But it seems like a ton of cops have made this a habit.  So it must be important on some level, right?
• Stay behind the rearmost person in the vehicle, as much as you can.  If there is only a driver, use the B-pillar to mark your furthest forward point.
• Use your flashlight and see what is going on before you begin an interaction.  Take a few seconds to check where the person’s hands are (and what’s in them).  Are the keys in the ignition?  How do the doors unlock (slide things or little posts at the windows).  Are there weapons visible?

Contact.  This is when you ‘break the egg.’  You are going from looking at a dude in his car to contacting the dude.  Unfortunately, in the worst cases, he is locked in a car with all the windows up.

• Let dispatch know that you are approaching and if you don’t check back in within 60 seconds, they should call out everyone.  Cops, more medics, National Guard, jets flying over, swimming ducks, dogs and cats living together, everyone.  If I have not checked back in, dispatch had better get friggin’ Seal Team 6 fast-roping into the intersection cause things have gone sour…
• You and your team should have three main goals.  Hands. Ignition.  Out. 
• Hands means to know what is in the patient's hands - nothing, gun, penis, whatever.  Optimally, I would like to control the slumper’s hands. Don’t let them go for waistbands, shift levers, or the gap between the seat and the console. 
• Get the ignition shut off, along with putting the car in Park.  Cars roll less when they aren’t running and are in Park.  When cars roll less, they run over fewer people.
• Finally, get the slumper out of the car so we can revert from a police-type call to an EMS-type call. 
• To me, the trick is to make sure that everyone on my team knows my goals.  We can all work toward the same end points.  In order to get to hands, we need to get the car open.  If a window is down, the first action should be to unlock all the doors.  Once we start, the process needs to be pretty smooth and rapid. Car door open, get hands, partner shuts off car from the passenger side, say reassuring things to the confused person, get them out of the car.
• Break a window? Probably best to get the cops there for that, unless I can overtly see that there is obviously a medical problem going on.

If nothing else, I hope this post makes you think about the fact that approaching a slumper in a car is not a run of the mill thing.  What do you do if they try to drive away?  (I let them – I don’t endanger myself by trying to stop them.)  What do you do if they are drunk, but only drunk?  (Not a medical problem – now I have to wait on the cops.) 

These are not routine calls.  Make sure to keep yourselves safe.

Seriously, I am not paid enough to do this in the real world.
By U.S. Navy [Public domain], via Wikimedia Commons