Saying it was because of not having a safe system of work sounds despicable. Saying it was because it was so dangerous has got more going for it.

SteveDM makes a valuable point - don't make yourself into a casualty - but this principle can be difficult to apply in practice. And I speak with some expertise on this subject, having spent 12 years in a previous existence as an NHS ambulance emergency technician working on emergency crew. I well remember one "shout" where we found ourselves racing another crew to be first at the scene of an incident - an incident in which it had been reported that somebody had "gone berserk with an axe". As I remarked to my colleague - as we screamed through yet another junction on lights and sirens - we really needed to have our heads examined! Experienced personnel were fully aware of this delicate balancing act between providing assistance and becoming a casualty, and we were always careful to ensure that younger staff did not allow their enthusiasm to distort their judgement. But sometimes, as I once explained to an irate Station Officer, it all comes down to the man on the scene making an informed decision. In this particular case he was a tad upset because I'd done a U-turn on the M25 motorway, crossing the central reservation at a crossover point to reach a serious RTA on the opposing carriageway. Yes, it was risky, but I had seen the accident as we passed it and knew that a driver was trapped and probably seriously injured; I'd carefully evaluated the traffic flows in both directions; and I'd given very clear signals of my intentions to following traffic so there was no confusion over what I was going to do. Had I not done the U-turn I would have had to run to the next junction, turn, and then run back - an aggregate distance of some 10 - 12 miles. And I knew that we were still the closest vehicle, so it wasn't as if we could afford to run the extra distance because another vehicle would get there first. Making critical decisions goes with the job, and you can't cover every situation with a set of written protocols. As a senior officer once remarked to me: "Rules are made for the guidance of wise men, and the blind obedience of fools".

I have to say I also commend Farrall's posting at #4 and his quote: "Rules are made for the guidance of wise men, and the blind obedience of fools" is so very, very, very true!!!! I am going to make this quote into a banner and stick it at the top of my H&S notice board. Rich (Impressed)

Look at it from the other side, the paramedic rushes into the burning car and gets caught in the fire and dies. The finger gets pointed, blame is put upon the person in charge, the grieving family of the paramedic sues for allowing this to happen and to vent their anger. This is the world we live in, this is reality and why we have rules and do what we do. To protect people from themselves. 'Being a hero is about the shortest-lived profession on earth'

Isn't that the core point...safety really is only about 2 things..common sense and communication... get those 2 right and you are on a winner... I agree in part there is a certain mind set in first responders that works well in most cases...if it doesn't they find themselves. But in the cold light of the office/training room/ground it is difficult to get others to understand that everything is going to be done 'at risk' it is just about making the least wrong safety decision balancing the needs of the PT.. It is very hard to get the public to understand that the committing of people to risk is only done when there are saveable lives.... The question was really about behavioural safety in the first responders environment. Discipline - is there is buckets in the fire service (excuse the pun)...little different here as there would never be a lone responder Police - well hard to get them involved at the best of times...but again discipline.. Ambulance - Difficult as the PT will always come first..so moral/discipline...and lots of instances of lone responders...straw pol of paramedics..most had not seen a risk assessment for their activity since being employed..plenty of patiuent safety and clinical risks but not workplace...arguably clinical is workplace...so the only risk assessment is dynamic (DRcABC - D Danger)

"Dynamic " risk assessments? Where have they come from. Fertile ground for the enforcers and legal folk. Jon

Dynamic Risk Assessment is a fairly well known/used technique by emergency services, primarily the Fire & Rescue Services:- http://www.fire.org.uk/m...vice-guide-pamphlet.html The HSE Guidance, "Striking the balance between operational and health and safety duties in the Police Service: An explanatory note" provides a background for some of the issues discussed. http://www.hse.gov.uk/se...ice/explanatory-note.pdf

Care to qualify this Jon? The Home office guideline for operational risk assessment are widely used and are essentially dynamic in nature.. This was about safe behaviours and getting across that by the very nature of what a first responder does they are operating at a higher risk a risk that is acceptable in the circumstances...to save a life..

Roydalby raises an interesting, and contentious, point which is probably best dealt with in a separate thread. However, to summarise, ambulance staff are classed as "skilled workers" but not as emergency service personnel - which has long had a dramatic (and negative) effect on pay scales. In practice the person at a traffic accident who is directly managing the care of the casualty is probably the person who is on the lowest salary. Certainly that was the situation when I was in the job some years ago, and I don't think things have changed that much :0(

Fascinating discussion. This is not an area I have experience, so I admit I'm having some difficulty, with the concept "rules are made to be broken" if you think it is ok in the heat of the moment philosophy. Unless I have misunderstood. One thought as some of you seem to have been at the sharp end of this thorny situation - Is it really personal choice or is there pressure to take risks because others do / is it sort of expected? I really don't envy those in this situation. Chris

Can anyone point me to any H&S or Fire legislation where the word "dynamic" is used to create or qualify a risk assessment? Jon

Not sure there is any direct 'legislation', as DRA in the fire service is a tool to comply with the HASAW Act A simple Google Search will give you much more on the subject (as will a search through the HSE site) https://www.google.co.uk...+assessment+fire+service

To begin I have a quick, probably totally illogical, comment about what has become known as dynamic risk assessment. Isn’t the point that in making the initial assessment of the risks of such activity there is recognition that employees will inevitably be faced with making dynamic decisions that cannot be ‘proceduralised’? Thus the primary risk assessment identifies suitable and sufficient controls for minimising the risks arising. That may be formal ‘dynamic’ (task based) reviews at the point of work; it may not. The OP asked ‘How do you get a paramedic/Doctor to err on the side of a safety rule when their professional conduct rules require them to use their skills to save a life?’ You don’t want to and probably can’t anyway! If there is a conflict then your ‘safety rule’ could be inappropriate. Is it any different from the unworkable safety rule in a factory? I recognise the direct conflict that the stronger, ethical imperative raises. However, the proper control of that risk should be reflected in the management controls. For the employee the go/nogo conflict is an ever present, clearly foreseeable, possibility for which their study and training should have prepared them as best as can be done. Then they should receive support, if they require it, post event. Aren’t these all controls that should be in any primary risk assessment? The post event situation given by the OP is distressing on first read. But, does the employer have reasonable, risk based, clearly defined red lines? Were these reached? Did the employee do what was expected of any employee in the situation they faced? Did that result in the terrible conflict of go/nogo? Ergo, do the red lines need to be redrawn as a result of lessons learnt? For the bereaved relatives the answers to those questions would help explain why. From the outside it often seems to me that there has been a 'willingness' to side step the forward planning and assessment of controls for such situations because they are 'dynamic'. Maybe that is the 'human factor' that needs attention? p48

This is the crux of the matter, there isn't always that willingness...as I described earlier the Fire Service are very disciplined at following the process whether you call it dynamic or not..there is responsibility taken and risks assessed..ambulance staff in the majority of cases can seem to have a higher moral duty to the PT (unless they are dead - Lockerby was not a major incident for the ambulance service) and therefore could be accused of going one way or the other.. to do their best for the PT.. I guess what I am trying to get at is that there are some here who would say there are breaches of regulations, I personally disagree, yes emergency service personnel take risks in 'operations' that most sat in cosy safety departments would not accept..but in reality unless you have been on the ground and faced with the dilemma yourself it is pretty difficult to understand it. This is not advocating bending or breaching the rules but there is only a choice between a bad decision and a really bad decision you have to take the bad one...example...CPR - to give chest compressions properly you will in most cases break a rib..do you not do it for fear of breaking the rib? or is the compressions more important to save the persons life... Human Factors is complicated at the best of times for a chemical or offshore site..