# Scene Safety Scenario #2



## DT4EMS (Jan 9, 2009)

Scene Safety Scenario
01-09-2008


*Note* Although the preface of this story is not “Exact” the type of attack is from a recent case. I will attach a link to the news story after we discuss it.



On a warm and sunny spring afternoon you are dispatched to a report of a child that has fallen off of a bike.

Upon your arrival in a residential neighborhood you see several adults standing around what appears to be a young boy in the roadway. A bicycle is only a few feet away.

The crowd does not appear to be agitated. You hear the child crying, saying his leg hurts. Since the kid looks small enough, your partner tells you he will grab the “Papoose” and Peds bag.

You make your way to the child and can see he is CAOX3 and only appears to have abrasions to his knees and palms.

You ask if family is present and begin your assessment. A person in the crowd states “It took you long enough to get here”. You smell a strong odor of intoxicants in the guy’s breath. You begin to apologize for any delay and begin your assessment and treatment when without warning , the man, later found out to be the boy’s father, grabs you by the throat and shoves you backward into a nearby car. He strikes you several times in the face…………………………………..

Now what?


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## KEVD18 (Jan 9, 2009)

double tap, redirect and excape?!?

heres another one where the provider failed to recognize a scene safety hazard until it was too late.


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## Explorer127 (Jan 9, 2009)

Again, run and push the panic button on the radio :unsure:


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## Explorer127 (Jan 9, 2009)

But, seriously. I think I might call for PD once I realized there was ETOH and the agitation. If it's too late for that it's possible that I might work with my partners and hold him down until there's a cop?


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## DT4EMS (Jan 9, 2009)

No officers were dispatched. Even here in Branson for a simple trauma, like a kid who fell from a bike, there is not usually a automatic officer dispatch.

The only time you had any idea there was ETOH involved was when he spoke.

I have a point to make with these posts. I promise I will reveal. I just want to see how people are processing the information and how they handle it.

Again, one of the most important training tools is pre-planning. One of the ways we do this is through mental rehearsal. With mental preparation you are less likely to "Freeze". You will have options at your disposal. 



Read my RACE 2 REACT article that was published in JEMS online:
http://www.jems.com/news_and_articles/tips/R_A_C_E_2_R_E_A_C_T.html


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## artman17847 (Jan 9, 2009)

These are very touchy situations.....

In this situation I may have chosen to ingnore the off hand remark and not have engaged this person. However, he may have still attacked.

I do have the right to defend myself and if I have no choice and no way to disengage I will defend myself.

If I strike this person and cause him injuries I and my employer may find ourselves on the wrong end of a lawsuit. Thus I might lose my job.

I don't think you can preplan for this type of situation. Especially if you are ambushed.


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## Mongoose (Jan 9, 2009)

Deflect blows, distance yourself from the perp in a defensive stance, retreat. Call for help the easiest way possible at your disposal.


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## bowulf (Jan 9, 2009)

Count me glad that in my small suburb town, PD shows up at all calls, and that my department typically rolls two vehicles to most calls.  I realize that my department is probably not the typical EMT service being a volunteer FD / paramedic service.


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## Laur68EMT (Jan 10, 2009)

Get yourself and your crew back to the ambulance, call dispatch for PD.  Scene is no longer safe.


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## EMTinNEPA (Jan 10, 2009)

Kick him in the balls and run.

Or hope your partner has a D cylinder handy.


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## EMTinNEPA (Jan 10, 2009)

artman17847 said:


> If I strike this person and cause him injuries I and my employer may find ourselves on the wrong end of a lawsuit. Thus I might lose my job.



Screw that.  He hit you several times.  Do what you have to do to distance yourself from him.  If he has you backed up against a car, then like I said... kick him in the balls and run.


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## DT4EMS (Jan 10, 2009)

Three great points come from here now................

1) Striking someone with an O2 bottle is considered Deadly Force in most places. That level of force would NOT be considered justifiable. This is why EMS providers must be shown the different levels of force and understand their relationship.

2) Yes, you can preplan for this type of situation. While there is very little that could be done to prevent the initial grab (you were caught by surprise) once you were touched, regardless of a "technique" you chose to use you can still escape with minimal injury without taking several strikes to the face. It is the mental conditioning along with skills practice that will allow you to MOVE and not just stand there and get your face punched in.

3)  Originally Posted by artman17847 
"If I strike this person and cause him injuries I and my employer may find ourselves on the wrong end of a lawsuit. Thus I might lose my job."

Even better............ I get to sue my employer here and get a big fat check!!!!! Here's why........ According to the NAEMT .......... Assault is the number one reason EMS providers are injured in the field. Now, your employer FAILED TO TRAIN you for the environment in which you work. 

This is why you PRESS CHARGES! Winning a criminal conviction makes it very difficult for a dirtbag to win in civil court!


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## BossyCow (Jan 10, 2009)

Couple of points not made clear in the initial scenario... 

You stated that you asked if there was family present and then began your assessment. Did the father at that point identify himself as the parent? Did anyone in the crowd identify him as the parent? Did you wait to see if a parent was present before beginning your exam? With a hurt kid, being one of those MamaBear type mom's myself, I always want to talk to the parent before going anywhere near the hurt kid, especially one I can see is alert and conscious. 

I learned the art of dodging the unexpected attacks from the beligerent drunk in my idyllic Norman Rockwell type childhood. I have a hyper-alertness to the smell of alcohol and an almost visceral reaction to it. Anytime I smell that I immediately start to put distance between myself and that person. I start looking for that narrowing of the eyes that shows the drunk has started believing I'm the jerk in the scenario. 

We can't prepare for all events. But I like what you said about pressing charges. The only way to get any progress out of an event like this is to assure that first the drunk is given legal consequences for his actions, that means assault charges, interfering with the performance of an emergency worker if those charges exist in your area and pretty much anything else the PA can add onto the list. And yes, making your department pay for the event, because that presses home in the only way that an agency understands that they have a need to protect their workers in what can be a fatal environment.


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## Lin57EMT (Jan 10, 2009)

BossyCow said:


> You stated that you asked if there was family present and then began your assessment. Did the father at that point identify himself as the parent? Did anyone in the crowd identify him as the parent? Did you wait to see if a parent was present before beginning your exam?



Bossy is correct here.  Since the "look test" didn't indicate any life-threatening injuries, permission to treat should have been sought.  This would include questioning bystanders or the patient for the whereabouts of a parent - a phone call would have been in order if a parent weren't present.   This wouldn't resort to Implied Consent until a good attempt was made to get Express Consent first.

Since the parent WAS there and not indentifying himself, and the scenario became unsafe due to the presence of ETOH and violence, retreat was in order.  I'd have bugged out as fast as possible to the safety of the ambulance and my radio.  Hopefully without sustaining too much injury.

REALLY glad that was not my call.  I'm sure it was a bad one.

And like Bossy, I like the idea of making a case to the employer.


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## DT4EMS (Jan 10, 2009)

It is good that you are both thinking. That is what we want to do. We want to think about these things before they ever happen. 

In this particular scenario........ there were the words stated..... then no one answered....... you begin to assess...... remember an assessment doesn't always have to do with "touching" first. 

The principle was the person spoke, then aggressed upon you.

Here is a link to the way this scenario really played out. Again....... I modified it for the sake of EMS.
http://www.dt4ems.net/forums/index.php?PHPSESSID=7ci12iv8amj4vt1osan37hdo00&topic=664.0


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## june125 (Jan 19, 2009)

warning signs should have gone off when he first got verbally agressive, and police should have called, the medic at that point should have positioned him/herself so that they could see him coming. Being aware of your surroundings is the most important part of keeping yourself safe.


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## LAS46 (Apr 22, 2009)

I dont care if PD was originally dispatched to the call or not, if you show up to a scene with multiple people crowding around I would have PD enroute before I ever stepped out of the unit. 

Use your head... thank about what you are doing... it will go along way.... Remember your safety then your partner, then the patient and everyone else follows after that.

Dustin
MFR, NREMT-B Student
Emergency Scene Safety Officer


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## curt (Apr 25, 2009)

Assuming that the appropriate scene precautions failed and prevention is not a possibility in the given scenario:

Palm strike or backhand to the center of the face to create a stun reaction, deflect any attacks, retreat, hit panic button en route, lock self and partner inside ambulance.

 Should the stunning attack not work, proceed to body manipulation/control techniques (wristlock, armbar, etc.) only long enough to deflect and/or re-direct the attacker and fall back. Should that fail, proceed directly to restraining the attacker until PD arrival. Direct and continued counter-attacking should be a rare measure of last resort, with the ultimate goal still being escape.


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## VFFforpeople (Apr 25, 2009)

artman17847 said:


> These are very touchy situations.....
> 
> In this situation I may have chosen to ingnore the off hand remark and not have engaged this person. However, he may have still attacked.
> 
> ...



No disrespect to you, but reading it and seeing "large crowd" made me think, well regardless they may be hostile, I would have loaded the child into the ambulance where I would have started my assesment. That way if they did get hostile I could just roll. That is my thoughts along with calling PD.


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## CAOX3 (Apr 26, 2009)

I have the right to defend myself at all times and I have a few times.  Whether its a simple restraint or an all out brawl whatever it takes.  You dont end up on the wrong side of lawsuits with drunks and fifty witness's.  Every scene has the potential to go bad.  I dont care who you are or who you think you are at times in your career you will be put in situation where physical confrontation occurs.  Diffuse it, or them. 

My partner and I are going home, that is something I can guarantee.  If that means if I have to turn you away from a scene with hurt feelings or leave you laying in the middle of it unconscious and bleeding.  Whatever thats you choice.  

My first, second and third attempt are always to try to diffuse the situation verbally.  If that fails I have no problem diffusing it physically if I or my partner are in danger. I have and will always hold the safety of us as the utmost priority, if we dont feel its safe we dont go in.  However scenes evolve and there is no way to determine which one will go south on you.  I much rather be judged by 12 then carried by six.  As far as the fear of litigation, Its not a deterrent when my safety is in jeopardy.

If you like to sue, you have that right.  I have a responsibility to myself my partner and our families, to go home at night. 

We are not punching bags and targets for twisted society members, these recent issues of assault on public safety personnel needs to be dealt with immediately.  In a perfect world it would begin with an *** whipping while your handcuffed to my stretcher.  My more professional, educated and rational side would fight for lengthy prison sentences to start.


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