# Elbow Control



## DT4EMS (Aug 2, 2005)

This is one of the articles I did. When you click on the link, it has pictures and all to help it make sense.


*“He who controls the elbow controls the Warrior.” *
_A concept to protect EMS providers against violent encounters. _

There is a widely recognized but little acknowledged problem threatening emergency medical service personnel: injury through assault. The frequency of assault on our EMS providers is alarming. Many EMS providers have anecdotal stories of how they were attacked by a violent patient, an angry bystander or upset family member. While most attacks are not life threatening, the risk of serious injury is evident and unpredictable. EMS providers need an effective and reasonable plan on how to avoid an attack, and also know how to defend themselves once attacked. Emergency medical services staff require a reasonable, liability-conscious, effective means of preventing and avoiding assault by patients, their family or bystanders. 

Defensive Tactics for EMS (DT4EMS) is a course created for EMS providers that teach EMS providers how to protect themselves against a violent encounter. DT4EMS is for EMS providers created by EMS providers. This is not an article on how to fight. This article is not intended to make anyone into a martial artist. The reason behind the article and the DT4EMS course was to protect people (patient AND provider) from becoming the victim of an assault.. 

There are several courses and books on the market on how to recognize a potentially violent encounter. They all agree the best defense against an assault is not to be there in the first place. DT4EMS is a different type of course “For when the scene is not as safe as you thought it was.” EMS providers are trained well on how to check for scene safety. The truth is the least likely call puts a provider at risk for injury or even death at the hands of an attacker. 


*Assault Response Guidelines (Levels of Force) *

Before a provider can make a decision about the level of force to use against an attacker, that provider must have an understanding of force levels. It is important to know that any time you use force, the relationship of that force (provider v. attacker) is what will come to question. 

Here is a basic overview of some views on the Assault Response levels . The names of the levels may change depending on any given geographical area, but their overall meanings are the same. Most police departments recognize a similar chart for which their officers respond to levels of resistance. 


Verbal Skills (Low-level) 

The main objective when using verbal skills to diffuse a potentially violent encounter is to reduce the tension, so that a normal level of discussion becomes possible. Hopefully you are able to use verbal skills to diffuse a potentially violent encounter, but remember that if you are being physically assaulted, you will have to yell, loud verbal commands as you attempt escape. 

LOUD VERBAL COMMANDS must be given if you ever have to use force. “Stop!”, “Get Back!” That will turn any bystanders into witnesses. It will also alert others that you need help! 


Empty Hand (Mid-Level) 

Next on the DT4EMS force response guideline is Empty Hand. Empty Hand is divided into two sections, Soft Empty Hand and Hard Empty Hand. Soft Empty Hand refers to light contact (i.e. joint locks pressure points), where Hard Empty Hand refers to any type of strikes (Check, Slap, Push Kick). 


Intermediate (High Level) 

Intermediate Force generally encompasses intermediate weapon use. (Straight stick, Improvised Weapons) It is important to note that any strikes to the head, neck or spine with a weapon can be considered DEADLY FORCE. Train to strike limbs or center mass of the attackers’ body unless you are in a deadly force scenario. 


Deadly Force (Highest Level) 

Deadly Force is generally defined as any force that is likely to cause death or serious disfigurement. Deadly Force is Deadly Force. If you shoot someone, stab someone, strike them in the head with an O2 Bottle, it is still deadly force. Just because you are being punched at does not give you the legal or moral right to step up to deadly force. In order for you to use deadly force to defend yourself you must have a reasonable belief that someone was using or about to use deadly force on you. 

One of the most important concepts in the DT4EMS course is Elbow Control. With practice an EMS provider can learn to control the elbow of an attacker in many types of self-defense situations. An old saying in the martial arts still holds true today. “He who controls the elbow controls the warrior”. By controlling a person’s elbow, you can provide yourself with a means to escape, prevent an attack on your person or assist someone with restraint. Law Enforcement personnel have known for years that a straight arm-bar was a safe and effective means of controlling a much larger and stronger opponent. In the early 1990’s the viewing public watched “No Holds Barred “ fighters win against much larger opponents with arm bars. Practitioners of Philippino and Indonesian blade arts understand the importance if elbow control against a person attacking them with a stick or knife. For EMS providers we can use a simple concept of Elbow Control to prevent an assault. Elbow control for EMS providers is not intended to be used to gain a “submission” but rather to “buy you a chance” to escape a potentially violent encounter. 

First, you must understand that you cannot use force against another person unless you are acting under the reasonable belief you are acting in self-defense or under a physicians order to restrain someone. The law requires your belief to be reasonable at the time you used it. The situations that are discussed here assume that you have done everything in your power to not use physical force to defend yourself and you are left with no other option (i.e. verbal skills, walk away etc.). 

Any time that a person uses force against another the relationship of that force is what will be judged. For instance, if a person was attempting to push you and you strike them with an O2 bottle you will lose in civil and criminal court. The same would be true if an intoxicated elderly man was trying to scratch you and you punched him in the face. 
For the context of this article we will discuss: 

Elbow Control has some concepts within it. 
*1) Body part to body mass.* This means to press the trapped body part tight into your body or the attackers’ body depending on the situation. 
*2) Move in angles and circles.* This means to not move in a straight line against an attack. For instance, if your attacker is trying to reach out and grab you, simply parry or guide his arm (softly), from the outside with your hand on the elbow and guide it toward his/her body. You would use some sort of verbal direction at the same time (i.e. “please don’t or please stop.” This soft style of Elbow Control can help diffuse a potentially violent encounter by combining soft empty hand control and verbal skills. 



Because of the location of the bench seat and the stretcher, we employ another concept of “Closest weapon to closest reasonable open target.” In the first picture it is the EMS provider’s right hand that is closest to the patient’s reaching arm. Therefore the parry begins from the outside to the inside from the EMS provider’s right to left. 






The provider can then begin to use the “body part to body mass” principle by guiding the aggressor’s arm as shown above. Remember this is a soft guiding movement for low-levels of aggression. 





The provider could now replace the right hand with the left and slide their (provider) body toward the front of the bench seat out of the reach of the aggressive patient. This type of movement could buy the provider a few moments to make a decision on how to react to the aggressive patient. The provider would ask himself/herself the question “Is this person trying to hurt me”?







If the answer is “Yes” then the provider would have to make a choice of how to end the assault. One option that is rarely discussed is stopping the truck and either the provider get out, or the attacker getting out. If a person is an active aggressor and really trying to cause you bodily harm, you need to create space. You cannot do that moving down the road. There are too many objects that can become weapons of opportunity in the back of an ambulance. 

The same concept of Elbow Control can be employed while standing. If you perceive a threat and you were caught in a situation where you were about to be punched or pushed, get your hand up and open. Try to create some space by stepping back, showing that you are not trying to be aggressive yourself. 





If the aggressor still wants to punch or push, then you can parry or guide the arm away. This again is used to “buy you a chance” to escape without taking a full power punch to the face. 






Switching hands can help show you the direction in which to escape. The importance of placing a hand over the elbow gives the provider greater control over the movement of the attacker. 






It would be difficult for the for the aggressor to strike the provider with his( aggressor) elbow controlled. Even if the attacker attempted to strike with his right hand, the provider simply pushes the aggressor away using the “Body parts to body mass” principle. 

There are many variations to the Elbow Control. These are just two of them. Just as with any type of self-defense technique practice is needed to become proficient. Just remember to find a way to get behind the elbow of the aggressor and you can “buy you a chance” to escape or prevent the assault from occurring. Remember your best defense was to not be there in the first place. 

_________________


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## Summit (Aug 2, 2005)

Very cool article.


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## DT4EMS (Aug 2, 2005)

Thank you very much for your help Summit!!

I hope that when people view it they understand that human conflict is dynamic. That is why we give a "concept" rather than a solid technique. A concept can cross boundaries, where a technique is often "specific". Remember the attacker didnt' come to class to "Know HOW he/she is SUPPOSED to attack."


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## DT4EMS (Aug 2, 2005)

On the homepage there is a video clip showing the "Elbow Control" in action. It is called "The Double Tap".

You cas see it here Homepage with clips


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## Wingnut (Aug 2, 2005)

Pretty cool stuff, my husbnad taught me pretty much the same thin. (He's paranoid about me). I helped him study for his cert and part of it was the levels of force/response. It's pretty basic stuff but I was suprised because while it's all so simple, I never really thought about it before.

Great Article. Thanks for sharing


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## Jon (Aug 3, 2005)

Great Stuff.

If you ever put a class on in this side of PA or Sothern New Jersey, let me know.

Jon


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## TTLWHKR (Aug 3, 2005)

Telling stories about us behind enemy lines?


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## DT4EMS (Aug 3, 2005)

> _Originally posted by TTLWHKR_@Aug 3 2005, 01:27 AM
> *
> 
> 
> ...


 Nope and you have mail.


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## TTLWHKR (Aug 3, 2005)

Enemy Lines. New Jersey.


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## DT4EMS (Aug 3, 2005)

Gotcha!!


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## ExEMTNor (Jan 23, 2021)

How manny years, full time, does the EMT education take ower there ? ( 4 Years full time here )
How manny years, full time, does the PMT education take ower there ? ( 9 Years full time here )
?


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## ffemt8978 (Jan 23, 2021)

Thread closed for useless 16 year bump


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