# Using force to defend yourself.



## Fox800 (May 21, 2010)

I'll bring this up because I recently ran on a diabetic who is well-known by responders and his family as becoming combative when hypoglycemic. He's a pretty strong dude and could definitely give most EMS providers a good fight.

The patient was initially unconscious/unresponsive, with a BGL of 10 mg/dL. After administering some D50%, he became very combative.

What's the most extreme example of EMS providers using force to defend themselves that you know of? Has anyone you know/heard of ever been prosecuted for using force to legitimately defend themselves from a patient with altered mental status (lets leave out examples of providers using force in an obviously malicious manner)? Does anyone know of any case law regarding this matter? 

I came closer to getting bitten that I ever have, and while we were able to control this patient, it would have been dicey if there weren't six of us on scene. If it were just my partner and I, we would have had a heck of a time.


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## medic417 (May 21, 2010)

I have used the minimum required force to defend myself and as a result subdue a dangerous patient on more than one occasion.


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## Fox800 (May 21, 2010)

medic417 said:


> I have used the minimum required force to defend myself and as a result subdue a dangerous patient on more than one occasion.



Thanks. Really. Very informative. <_<


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## TransportJockey (May 21, 2010)

Fox800 said:


> Thanks. Really. Very informative. <_<



That's pretty much the way the laws about it are written. Use the minimum necessary force.


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## medic417 (May 21, 2010)

Fox800 said:


> Thanks. Really. Very informative. <_<



Any one that suggests beat the hell out of a patient will get you sued.  What is minimum required force?  It is what is required to stop the threat and nothing extra.  At times that could even be deadly force.  But to use force make sure there was no other option such as backing away.


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## fma08 (May 21, 2010)

Make sure it is documented well. Perhaps take preventative measures and have LEO, FD, or First Responders restraining his arms and legs before he becomes conscious if he has a strong history of being combative?


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## medic417 (May 21, 2010)

fma08 said:


> Make sure it is documented well. Perhaps take preventative measures and have LEO, FD, or First Responders restraining his arms and legs before he becomes conscious if he has a strong history of being combative?



Actually entering a known patient with violent tendencies w/o proper precautions is not a smart ideal.  In fact if you end up hurting the patient by using even minimum force you could get in legal trouble.  Why?  Because had you taken proper precautions there would have been no need to use the force that caused patient harm.


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## DT4EMS (May 21, 2010)

This is the subject I have focused on for 14 years........... 

First there must be a clearly defined difference between a "pateint" and an "attacker".

I teach the "Diabetic" is one of our "6 D's", the calls with the potentiall for violence. There are tactics that are considered "reasonable" when it comes to using any force with a pateint and those tactics that are considered "reasonable" when dealing with an attacker.

Be very careful about what you read......and then put into action. I have spoken with many folks in the medical field who have been terminated becasue they used force while on the job. Some were completely justified in the force they used, but failed to report and document it properly.

You need to understand force levels and their relationship to the force being used against you. You MUST have a clear understanding of what is considered "reasonable".

And as an interesting note........... the major use of force case that is the basis for "reasonable" in law enforcment cases was over a DIABETIC!


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## MonkeySquasher (May 21, 2010)

Learn verbal judo.  It'll save your bacon for some who ISNT altered mental.

For this guy, I agree, have Fire/partner restrain him while the line and D50 are prepped.  Then push and let him come around.  You certainly can't knowingly risk yourself by doing a IV/D50 and waiting for him to attack you, but you also can't stand there and wait for his BGL to hit 0 and for him to seize and die, either.


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## Shishkabob (May 21, 2010)

Fox800 said:


> Has anyone you know/heard of ever been prosecuted for using force to legitimately defend themselves from a patient with altered mental status




That's the thing... if it's legitimate, you wont be prosecuted.     If you're attacked, you have the right to defend yourself up to the point of controlling the situation.  


Back in February, I ran on a postictal patient who was combative.  He took a swing at me, and was consequently Tased by the LEO there with us.  Spent the next few minutes with 1 cop, 4 firefighters and me wrestling him to get him under control.  



If all else fails, 5 of Valium or 5 of Haldol does wonders


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## 8jimi8 (May 21, 2010)

Linuss said:


> If all else fails, 5 of Valium or 5 of Haldol does wonders



sometimes.

sometimes haldol doesn't touch them.


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## Shishkabob (May 21, 2010)

8jimi8 said:


> sometimes.
> 
> sometimes haldol doesn't touch them.



That's when you offer them a lollipop.


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## exodus (May 21, 2010)

I would get some people to help lay him on your gurney, then restrain. And once he's good and all there, un-restrain him. It's perfectly acceptable to restrain pt's you know will be violent because in their right mind, would they still beat you? Or would they want the treatment to keep them and their rescuers safe? Implied consent, you can restrain aloc patients if you want.


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## johnrsemt (May 21, 2010)

Versed IM or IN   to control violent patients

Glucagon to pull liver stores


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## tazman7 (May 21, 2010)

We are allowed to "use as much force on them, as they are using on us..."  My question is so if a guy spits at me I can hit him with an oxygen tank?? haha (kidding)

I usually try not to get into those situations but I have had a couple people come at me while doing the transfer. The soft wrist restraints suck. I tend to go for pillow cases and sheets. They work great. Just wrap the sheet around their chest, and tie it around the part of the cot that sits up. Tie their hands to the rails, lay them flat so they get worn out quick. Then put a nrb on them to prevent spitting.

Done this a few times not and the medical director was ok with it.


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## Akulahawk (May 21, 2010)

I've had to deal with combative patients too, like the post-ictal or the low blood sugar... If you know they're going to have violent tendencies, restrain the patient while setting up for proper treatment. Once they get going, it's MUCH harder to control them without risking injury to them or yourself.


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## DT4EMS (May 24, 2010)

tazman7 said:


> We are allowed to "use as much force on them, as they are using on us..."  My question is so if a guy spits at me I can hit him with an oxygen tank?? haha (kidding)
> 
> I usually try not to get into those situations but I have had a couple people come at me while doing the transfer. The soft wrist restraints suck. I tend to go for pillow cases and sheets. They work great. Just wrap the sheet around their chest, and tie it around the part of the cot that sits up. Tie their hands to the rails, lay them flat so they get worn out quick. Then put a nrb on them to prevent spitting.
> 
> Done this a few times not and the medical director was ok with it.



Not too bad except...... if you are dealing with someone who may be having issues with excited delirium, don't place anything across the chest that would interfere with breathing........period.

A  NRB mask on a patient can place liability on the provider........for instance....... if something goes wrong....placing an NRB on a person not requiring high flow O2 ..... "is the NRB mask an approved spittle protection device?" Would not turning on oxygen while using an NRB cause an increase in CO2 the person would be rebreathing? If they were fighting prior to or during your restraint is there an increase in lactic acid and a need for blowing off of the lactic acid?

Now the kicker.........

How many people are you using to "medically restrain"? Do you know where the NAEMSP stands on this? I can assure you lawyers know the number the NAEMSP has take the "position" of.


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## tazman7 (May 24, 2010)

DT4EMS said:


> Not too bad except...... if you are dealing with someone who may be having issues with excited delirium, don't place anything across the chest that would interfere with breathing........period.
> 
> A  NRB mask on a patient can place liability on the provider........for instance....... if something goes wrong....placing an NRB on a person not requiring high flow O2 ..... "is the NRB mask an approved spittle protection device?" Would not turning on oxygen while using an NRB cause an increase in CO2 the person would be rebreathing? If they were fighting prior to or during your restraint is there an increase in lactic acid and a need for blowing off of the lactic acid?
> 
> ...



Using a nrb mask to prevent spitting is actually in our protocols. Obviously you have to hook it up to oxygen 15 lpm to do this or if you didnt it would be the equivalent of putting a plastic bag over someones head..

I have only had to do this two times. And it was for a person that 5 cops could hardly keep down because he was the size of Paul Bunyan.. Plus the guy had hepititis a,b,c,d,e,f,g, aids, and every other disease..and was spitting blood all over the place.  I have actually had ppatients handcuffed and put the pt face down, but a leo has rode with in the back.

What is the lawyer going to be more mad about, me restraining a person with the best thing I can use in the ambulance or seeing a medic getting his a$$ kicked in the back of the ambulance..  If they dont like creative ways of restraining people that is still safe (checking breathing, pms) then they need to give us handcuffs and tasers. Because a junky little soft restraint doesnt always do the trick...we arent always tying down a 90 pound 90 year old woman who is postictal.


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## lightsandsirens5 (May 24, 2010)

Linuss said:


> Back in February, I ran on a postictal patient who was combative. He took a swing at me, and was consequently Tased by the LEO there with us. Spent the next few minutes with 1 cop, 4 firefighters and me wrestling him to get him under control.


 
Aint it fun? Had a narc OD last winter that we used Narcan on. I was just out of ILS class and my Intermediate partner was doing pt care. So while I am bagging the guy she draws up 6mg of Narcan and attaches to the dripset. I assumed she was going to push 2, maybe 2.5 and the check resps. Well, she starts, I watch her push about 1 or 1.5, I look over at the monitor to check SPO2 and rhythm and by the time I look back she is just finishing pusing all 6 mg! AHHHH!!! The last thing I thought before he woke up was "This is about to get really bad........" In 10 seconds he went from dead to fighting like a maniac. He picked my partner up (And she is not a featherweight) and threw her about 3 feet onto a couch. We had two cops on scene with us, one county deputy, us two Intermediates and one firefighter Basic. It took the two cops, the firefighter and I to hold this guy while the deputy cuffed him. One cop had him in a headlock, the basic was holding one arm in a winglock I had his other arm and the other cop had his legs. If he had come at me though he would have got a fist to the jaw and a knee to the groin.


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## Veneficus (May 24, 2010)

These threads are always so much fun to read.


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## medic417 (May 24, 2010)

Veneficus said:


> These threads are always so much fun to read.



LOL you got that right.  My first reply should have been the end of this discussion.


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## DT4EMS (May 24, 2010)

tazman7 said:


> Using a nrb mask to prevent spitting is actually in our protocols. Obviously you have to hook it up to oxygen 15 lpm to do this or if you didnt it would be the equivalent of putting a plastic bag over someones head..
> 
> I have only had to do this two times. And it was for a person that 5 cops could hardly keep down because he was the size of Paul Bunyan.. Plus the guy had hepititis a,b,c,d,e,f,g, aids, and every other disease..and was spitting blood all over the place.  I have actually had ppatients handcuffed and put the pt face down, but a leo has rode with in the back.
> 
> What is the lawyer going to be more mad about, me restraining a person with the best thing I can use in the ambulance or seeing a medic getting his a$$ kicked in the back of the ambulance..  If they dont like creative ways of restraining people that is still safe (checking breathing, pms) then they need to give us handcuffs and tasers. Because a junky little soft restraint doesnt always do the trick...we arent always tying down a 90 pound 90 year old woman who is postictal.



Please don't think I am not on your side.........because I am. The issues I have are with administrations failing to provide training for the people who actually do the job.


I am glad you clarified turning on the O2......... sometimes people new in the field of EMS read something posted in a forum and take it as gospel.......without realizing the OP meant well but left a line out.

Simple........... A PPE face mask makes a perfect spittle protector........ then there is no need for the NRB or the O2. Plus that mask is DESIGNED to prevent the transmission of diseases. I will gladly debate it with your medical director to help your agency out.

LEO agencies across the country are training to get people off of their stomachs as soon as possible. Leaving a restrained person in the prone position is really bad ju-ju........they die....

Again the issue is simple.......our street level EMS providers across the country face daily split-second decisions that must be made. Most of the training is on-the-job for the assault  and restraint type topics.

Talk to a few people that have lost a job or faced criminal prosecution for using force that was not considered reasonable.

I am here to help........not hack you off. I truly hope you take the same stance with your safety at the workplace.

Kip


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## tazman7 (May 24, 2010)

lightsandsirens5 said:


> Aint it fun? Had a narc OD last winter that we used Narcan on. I was just out of ILS class and my Intermediate partner was doing pt care. So while I am bagging the guy she draws up 6mg of Narcan and attaches to the dripset. I assumed she was going to push 2, maybe 2.5 and the check resps. Well, she starts, I watch her push about 1 or 1.5, I look over at the monitor to check SPO2 and rhythm and by the time I look back she is just finishing pusing all 6 mg! AHHHH!!! The last thing I thought before he woke up was "This is about to get really bad........" In 10 seconds he went from dead to fighting like a maniac. He picked my partner up (And she is not a featherweight) and threw her about 3 feet onto a couch. We had two cops on scene with us, one county deputy, us two Intermediates and one firefighter Basic. It took the two cops, the firefighter and I to hold this guy while the deputy cuffed him. One cop had him in a headlock, the basic was holding one arm in a winglock I had his other arm and the other cop had his legs. If he had come at me though he would have got a fist to the jaw and a knee to the groin.



In my experience I have found that if you use the MAD device instead of an iv, not only does it limit your exposure to "goo" it seems that they dont come out of their high as mad...

I work in a town where I have given more Narcan than Normal Saline....(not kidding either)

Here is how my partner and I typically run an overdose, so take it for whats its worth. considering the pt is unconscious with slow respirations. We will bag the pt if needed or a nrb mask. Put pt on a backboard with spider straps if they are known for getting violent. If not just use the backboard straps. Give pt 2mg narcan through the MAD device up the nose. Put pt on cot and into ambulance. Take some vitals and by that time the pt is usually starting to regain consciousness..  then obviously cardiac monitor, iv- if needed and they wont tear it out...

Doing it this was in my experience seems to result in them not being as mad as a hornet when they realize you ruined their high..

Before the MAD device was put in service they seemed to get a lot more angry giving it to them through the iv, plus they would rip the iv out and blood would fling everywhere... As far as im concerned its my safety before the patient. So doing it this way eliminates blood exposure to myself and my partner.


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## tazman7 (May 24, 2010)

DT4EMS said:


> Please don't think I am not on your side.........because I am. The issues I have are with administrations failing to provide training for the people who actually do the job.
> 
> 
> I am glad you clarified turning on the O2......... sometimes people new in the field of EMS read something posted in a forum and take it as gospel.......without realizing the OP meant well but left a line out.
> ...


Yeah I sometimes have to control my anger with some of these idiots and so far so good. But I refuse to let a pt hit/spit/kick/push me. 

Ill see if I can dig up one of those masks to try the next time...I think I seen one at the back of our airway cabinet with a bunch of dust on it.


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## DT4EMS (May 24, 2010)

tazman7 said:


> Yeah I sometimes have to control my anger with some of these idiots and so far so good. But I refuse to let a pt hit/spit/kick/push me.
> 
> Ill see if I can dig up one of those masks to try the next time...I think I seen one at the back of our airway cabinet with a bunch of dust on it.



I am 100% all for EMS providers being able to defend themselves...........heck it is what I have been teaching for 14 years...... but there is more to it than just the physical skills.

EMS self-defense is unique......first of all.......the general public has no idea the rates of EMS assault (30x that of other private sector jobs)

Then hospitals want to have the perception of being like a "hotel"
 so unless a person is shot or stabbed inside the ER......it rarely makes the news.

Now........ in training for EMS self-defense....or better put Defensive Tactics for EMS (because tactics are way more important than any technique) the provider needs to train four specific areas"

1) Mind- by learning what is OK and what is not acceptable the provider can make better decisions about force. Plus they can get past the "it's part of the job" mentality that has plagued EMS

2) Street- the actual physical self defense skills must work "more often than not" and be easy to learn and retain.

3) Media- Must be trained so that all skills; including verbal, body language and actual physical skills appear to be in self-defense.....not a fight..........because EVERYONE loves to post stuff on YouTube. 

4) Courtroom- Force is judged by relationship. Was it reasonable? So every tactic/technique has it's place on the reasonable scale.

Any anecdotal stories in the station of how a provider did this or that to protect themselves may not always be the best course of action. If the provider isn't covered in all "4" areas.....they could be without a job or worse.

This is what I do......... I get calls from EMS agencies around the country telling me their nightmare stories of providers allegedly defending themselves. It's funny how when liability sets in.........how quickly agencies wish to "separate" themselves from the employee.


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## tazman7 (May 24, 2010)

DT4EMS said:


> I am 100% all for EMS providers being able to defend themselves...........heck it is what I have been teaching for 14 years...... but there is more to it than just the physical skills.
> 
> EMS self-defense is unique......first of all.......the general public has no idea the rates of EMS assault (30x that of other private sector jobs)
> 
> ...



This is very true. Restraining people is a very touchy topic. That is why you should only doing when possible.....  almost all of the time I just call LE- but sometimes I have to handle it myself.


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## medic417 (May 24, 2010)

DT4EMS said:


> It's funny how when liability sets in.........how quickly agencies wish to "separate" themselves from the employee.



LOL.  You are correct on that.  Another reason to carry your own liability and malpractice insurance that covers your own attorney.  The employers attorney does not always have your best interests at heart.


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## FLEMTP (May 24, 2010)

easy way to answer this for those of us who work and/or live in the state of Florida... and this applies to ALL people in Florida.. including EMS... on duty or off duty. Also battery of a EMS worker is a felony in the state of Florida... just in case you were wondering.



> 776.012  Use of force in defense of person.--A person is justified in using force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other's imminent use of unlawful force. However, a person is justified in the use of deadly force and does not have a duty to retreat if:
> 
> (1)  He or she reasonably believes that such force is necessary to prevent imminent death or great bodily harm to himself or herself or another or to prevent the imminent commission of a forcible felony; or
> 
> ...


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## usafmedic45 (May 25, 2010)

> I teach the "Diabetic" is one of our "6 D's", the calls with the potentiall for violence.


So....
1. Diabetic
2. Drunk
3. Drugs
4. Delirious/demented
5. DTs 
6.  Uh.....dumbass? Dog tattoo? 
I would think "damaged" might be a good fit for the mnemonic to indicate the prevelance of combative behavior after head trauma.



> Restraining people is a very touchy topic.



Yeah, healthcare became a much less pleasant job when it became a bad thing to chemically or physically restrain uncooperative/unpleasant/combative/demented patients.


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## CAOX3 (May 25, 2010)

Hows that old saying go.  "Its better to be judged by twelve then carried by six"

Ill deal with a courtroom later if it comes up, but I will do anything whithin my power to assure we go home at night.

I always tend to lean more towards waiting or calling for the police if something doesnt feel right.  Yeah sometimes they get pissed off but hey they get over it.

I agree I think EMS as a whole is completely unprepared for violent confrontations that may occur.


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## DrParasite (May 25, 2010)

CAOX3 said:


> Hows that old saying go.  "Its better to be judged by twelve then carried by six"
> 
> Ill deal with a courtroom later if it comes up, but I will do anything whithin my power to assure we go home at night.
> 
> ...


I was wondering when someone was going to say this.

You should only use as much force as is necessary to mitigate the threat.  that being said, if I find myself where I am faced with a threat to my life or health, I am going to use whatever force is necessary to make sure I go home at the end of the night. 

That doesn't mean I beat the crap out of a EDP or drunk until he stops breathing just because he is pissing me off.  but if i need to use force until he stops moving, or until additional help arrives, or until I can get myself to safety, then I am going to do what I need to in order to stay alive, and I will deal with the consequences later.

As the old saying goes:  "Its better to be judged by twelve then carried by six"


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## Melclin (May 25, 2010)

*The agitated patient*

Pt does not respond to verbal de-escalation techniques.
Clinical causes have been excluded (hypoxia, hypoglyc etc)

Basic: 0.1mg/kg IM Midazolam, ten minutely, max 4 doses, half doses for systolic BP<100 or age >60.

Intensive Care: 0.1mg/kg IV, 5 minutely, as needed.


I'm of the opinion that with the hypo patient, without any Water Fairies or? Jacks present, if you can get close enough to safely administer Midaz/Diaz/Haloperidol, then you should probably be giving them Glucagon and standing back, if they're seriously off their tree, its one for the Jacks.


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## DT4EMS (May 25, 2010)

DrParasite said:


> I was wondering when someone was going to say this.
> 
> You should only use as much force as is necessary to mitigate the threat.  that being said, if I find myself where I am faced with a threat to my life or health, I am going to use whatever force is necessary to make sure I go home at the end of the night.
> 
> ...



Like the medic in Denver?


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## DT4EMS (May 25, 2010)

CAOX3 said:


> Hows that old saying go.  "Its better to be judged by twelve then carried by six"
> 
> Ill deal with a courtroom later if it comes up, but I will do anything whithin my power to assure we go home at night.
> 
> ...



Unprepared because many believe that preparing for defending oneself in EMS means smashing them with the O2 bottle or "doing whatever it takes" and "I'll worry about the court later type of mentality" without training.

The former medic in Denver.............who is now serving 12 years in prison..........for having that same mentality. Smashing a guys face..........when REASONABLE is a good deal. Those that sit and talk about how they will handle the court later must realize you can PREPARE for the court before you ever go.

Why is it you think that personal protection must not be liability conscious? You think you either have to cream the attacker OR be legally defensible............ 

It is this failure to prepare mentality that is keeping EMS in more of harms way. You don't have to agree with me........ just look at the facts. 

If it is not an issue, why have the NAEMT, CDC, OSHA and others completed studies on the assaults facing EMS and healthcare?

If Dr. Brian Maguire (UMBC) found EMS is assaulted at a reate 30X that of other private sector jobs......... why is it wrong for people to train? 

Recognition, Prevention and ESCAPE training is different than training to be a combatant.


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## ZVNEMT (May 25, 2010)

I've been pretty lucky so far and not had to defend myself. though i realize now that I've left myself pretty open to assault on at least one occasion where a drunk (not a pt, didn't flag us down or even speak to us) jumped into the back of my ambulance while we were posted. I jumped out, grabbed the collar of his jacket and dragged him out, yelled "what the hell are you doing?!"... after a couple seconds i relaxed a bit and asked him what he needed, he wanted a ride home, we called a cab for him. Now i realize things could have gone catastrophically wrong, putting myself and my partner in danger. really the whole situation could have been avoided had we locked the ambulance... but I never thought about locking it while in it...


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## DT4EMS (May 25, 2010)

ZVNEMT said:


> I've been pretty lucky so far and not had to defend myself. though i realize now that I've left myself pretty open to assault on at least one occasion where a drunk (not a pt, didn't flag us down or even speak to us) jumped into the back of my ambulance while we were posted. I jumped out, grabbed the collar of his jacket and dragged him out, yelled "what the hell are you doing?!"... after a couple seconds i relaxed a bit and asked him what he needed, he wanted a ride home, we called a cab for him. Now i realize things could have gone catastrophically wrong, putting myself and my partner in danger. really the whole situation could have been avoided had we locked the ambulance... but I never thought about locking it while in it...




We ask agencies make it a policy doors be locked at all times just for the very reason you mentioned. The interesting point you made with your post is "perception". At the time of your incident, you did not preceive a threat of bodily harm to you or your partner. The force you used would be considered reasonable even though the guy never touched you.

It is interesting how a situation that made you think has probably changed your behavior. It essentially trained your brain. Good job!


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## DT4EMS (May 25, 2010)

I have had more than one administrator make comments just like some of those previous ones posted………until they attended one of my courses. Now they have made our training mandatory for all staff. 

I have presented at many local, state and even national conferences and have had people with 20 years plus experiences in EMS have a paradigm shift about this subject. Not every assault is a battle of life and death….. Safety tactics can help a provider prevent an assault from taking place.

For instance…….. Where do you stand when you knock on a door?
Did you know your normal patient assessment positioning can be used as a self-defense tactic? We call it the “Assessment L”.

If everyone stages for an unsafe scene……. Why are assaults the number one cause for lost work hours in EMS?

How do you define “uncooperative patient” vs. “attacker”? Do you respond differently to them?

Do you know how to properly document an incident if attacked? What if you used force to defend yourself? 

If a police report is filed after an EMS provider is assaulted, does it make it more difficult for the attacker to win a civil suit? Can that same paperwork remove the “machismo” appearance of the EMS provider?

My credentials have made me subject matter expert in the field of self-defense for EMS and why EMS should be training for it. What makes you an expert on why EMS should not train?


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## MonkeySquasher (May 25, 2010)

tazman7 said:


> Using a nrb mask to prevent spitting is actually in our protocols. Obviously you have to hook it up to oxygen 15 lpm to do this or if you didnt it would be the equivalent of putting a plastic bag over someones head..
> 
> I have actually had patients handcuffed and put the pt face down, but a leo has rode with in the back.




A.)  Surgical mask.  NRB are made for O2 administration.  N95 is made to not allow droplets -IN-, and can kind of hamper breathing.  Surgical mask is paper-thin for a reason - When you just need a little, breathable barrier and stop spitting.  And no one will fault you for having it.  Also good for ill coughing patients..  

B.)  Nooo, no no no.  There is no reason to ever transport someone face-down and restrained.  I have flat out refused to do it, and made LEO cuff their hands to the stretcher frame on either side.  This forces one officer to ride, and another to follow, and my patient survives, and I follow my protocols.  Everyone's happy.

You can be polite about it, and most cops will be okay with it.  "Hey, my rules/protocols say they have to be face-up and cuffed in front.", and most cops will oblige.  The only time the guy ever questioned me, I called my supervisor, who basically told him if he didn't feel like doing it, he can hand his collar over to someone else or transport the bleeding guy himself.  haha




DT4EMS said:


> For instance…….. Where do you stand when you knock on a door?
> Did you know your normal patient assessment positioning can be used as a self-defense tactic? We call it the “Assessment L”.
> 
> If everyone stages for an unsafe scene……. Why are assaults the number one cause for lost work hours in EMS?
> ...




I know the first parts, but that's also because I've had training outside of EMS for personal protection.  But you're right, that kind of stuff should be taught more.  Our BLS/ALS classes spend about 1 hour/1 night (respectively) covering it.

Unfortunately, people DONT stage when they should.  Just because "the assailant is gone" doesn't mean they didn't go to grab a bigger gun and come back.  Just because a police car has pulled up doesn't mean the scene is safe.  And just because he's "just a crazy old man" or "just a drunk" doesn't mean he won't turn violent.

Also, are you sure on those figures?  I'd think that back injuries lead to more lost work hours than assaults...  Just my thought.

As for the definition...  An "uncooperative patient" usually has an altered mental status.  Your diabetics, ETOHs, semi-responsive patients, electrolye imbalances, even in some cases your psychiatrics..  Suicidal people, agitated people, etc.  They don't MEAN to hurt you, they aren't in their right state of mind.  In my definition, an "attacker" is someone who WILLFULLY seeks to cause harm to an EMS worker, while in a proper frame of mind.  That's not to excuse someone who has schizophrenia or something who walks into a McDonalds and stabs an 18-year old girl in the chest..  That's an attacker.  But the semi-conscious drunk kid who hit me last year because the nurse attempted an IV when I let go to do something, that's just an unfortunate incident.  For the AMS, I just talk to them and attempt to gently restrain them or keep them from causing harm to themselves or others.  Also includes putting "gloves" on them...  A towel wrapped around their hands with immobilization tape around it.  For the actual attacker, they are no longer a patient, they're an aggressor, which means using any and all means to defend myself to the extent possible to escape the situation.

Unfortunately, in the law, the "attacker" would be anyone who causes the harm, no matter the cause.  Then they'd have to prove a medical condition as the proximate cause as a defense.


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## DT4EMS (May 25, 2010)

MonkeySquasher said:


> A.)  Surgical mask.  NRB are made for O2 administration.  N95 is made to not allow droplets -IN-, and can kind of hamper breathing.  Surgical mask is paper-thin for a reason - When you just need a little, breathable barrier and stop spitting.  And no one will fault you for having it.  Also good for ill coughing patients..
> 
> B.)  Nooo, no no no.  There is no reason to ever transport someone face-down and restrained.  I have flat out refused to do it, and made LEO cuff their hands to the stretcher frame on either side.  This forces one officer to ride, and another to follow, and my patient survives, and I follow my protocols.  Everyone's happy.
> 
> ...



OUTSTANDING! Finally an educated non "machismo" response!

An attacker is no longer a patient! It is their intent that makes the difference!

Just becasue a person is on drugs or alcohol does not negate their criminal activity and force them into being a "patient". Example....... If a person drives drunk and runs over someone.......does the court say.... "Awe..... they were just drunk.....they didn't mean to kill that child. So we should just let them go".  Of course not...... being drunk makes the crime worse does it not?


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## thatJeffguy (May 25, 2010)

Guns FTW.


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## MonkeySquasher (May 25, 2010)

DT4EMS said:


> An attacker is no longer a patient! It is their intent that makes the difference!



Exactly.  I've been hit by only 3 patients.  I've never pressed charges because 2 of them were too intoxicated/AMS/frantic to realize their actions, and didn't mean to cause any harm.  (The one actually apologized and shook my hand later when he came around.  haha)  The third was already in police custody, my charges would have just been a drop in the bucket.  haha

And I attribute those numbers to my ability to just stay calm and talk to people rationally.  I know a few people at my work that seem to always be fighting with the patients..  Lo and behold, they're also some of the most hot-headed, chip-on-the-shoulder EMTs around who "hate disrespect from our patients".  Coincidence?


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## DT4EMS (May 25, 2010)

MonkeySquasher said:


> Exactly.  I've been hit by only 3 patients.  I've never pressed charges because 2 of them were too intoxicated/AMS/frantic to realize their actions, and didint mean to cause any harm.  (The one actually apologized and shook my hand later when he came around.  haha)  The third was already in police custody, my charges would have just been a drop in the bucket.  haha
> 
> And I attribute those numbers to my ability to just stay calm and talk to people rationally.  I know a few people at my work that seem to always be fighting with the patients..  Lo and behold, they're also some of the most hot-headed, chip-on-the-shoulder EMTs around who "hate disrespect from our patients".  Coincidence?



So, are you suggesting the point of "Good Customer Service" being at the root of an EMS protection program could be used as a scene safety tactic? Heck....... and to think I was crazy for preaching such a thing..........

and NO........it's not coincidence........ I'll bet money on that.


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## MonkeySquasher (May 25, 2010)

DT4EMS said:


> So, are you suggesting the point of "Good Customer Service" being at the root of an EMS protection program could be used as a scene safety tactic? Heck....... and to think I was crazy for preaching such a thing..........



Heh.  Well of course EMS is customer-service-oriented.  But I think it comes down to you just putting yourself in the patient's shoes and showing some mutual respect.  I get a much better response out of an uncooperative person by saying "Look, I understand you're upset.  You didn't wake up this morning planning to end your day like this.  Please don't be angry at me, I was told to come here, I didn't come on my own.  I'm here to help you, and there's a certain procedure that must be followed.  So we're going to do (A), (B.), (C).  The outcome is (D).  I promise the sooner you relax, we can all work together, and everything will run smoothly"  than saying  "Look, I'm trying to do my job, sit down and shut up."

Also, offering them a pillow seems to help.  

I remember I had one guy who was so angry, he just said he wanted to punch things.  "I'll punch him", "I'll punch this", "Im so pissed", "Im going to explode", etc..   Police were about to taze and/or arrest him.  They were trying to 9.41 (mental health transport for threat to self/others).  I talked to him, turns out he's a boxer and that's how he keeps his emotions in check, by punching a bag.  He told me, he doesn't want to punch anyone, just something inanimate.  So I put a pillow on the bench seat, and he punched it a bunch, and said he felt better.  I told him LEO still wanted him to go talk to someone, but that I'll tell them what happened, and hopefully he'll be out shortly after.  He agreed, and we had a nice calm transport talking about college and women.   haha


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## medichopeful (May 25, 2010)

thatJeffguy said:


> Guns FTW.



Are you being serious or just saying this as a joke? h34r:


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## thatJeffguy (May 25, 2010)

medichopeful said:


> Are you being serious or just saying this as a joke? h34r:







Just a joke.


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## medichopeful (May 25, 2010)

thatJeffguy said:


> Just a joke.



Ok good.  The thread will survive


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## medic417 (May 25, 2010)

medichopeful said:


> Ok good.  The thread will survive



Guns now that does bring us to another important fork in this discussion.


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## Trayos (May 25, 2010)

medic417 said:


> Guns now that does bring us to another important fork in this discussion.


If guns are actively involved, you shouldn't be*

*Unless specialized subset, e.g. TAC-EMS or military medic (where you still don't want to touch weaponry, and lose UN designated status unless forced too)


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## usafmedic45 (May 25, 2010)

> military medic (where you still don't want to touch weaponry, and lose UN designated status unless forced too)



It's a little more complicated than that and you're showing your ignorance of modern combat.  We carried weapons all the time as medics while I was in the military whenever we went outside of a secured base.  No one but the US and our allies abide by the Geneva Convention (not UN) regulations so it is not like it is going to matter if you're a medic or a grunt and are caught with a weapon.  Also, very few people who wind up as medics are conscientious objectors ("Ooooh! Guns are bad!  I can't kill anyone!") since there is no conscription so people who don't want to deal with guns usually don't enlist.

In modern warfare,  would be exceptionally stupid to go into combat without being armed.  We are allowed to carry but are "restricted" to use them only in the setting of protecting ourselves and our patients.  Of course, my definition of that is a little loser than yours.  If I can see them and they are carrying a weapon and are not on my side, they are a threat to me and my patient and I can and will shoot them.  I've never lost sleep over those sorts of decisions.  The moment someone starts shooting at you, your concern for their well-being and any flimsy preconceptions about how you don't want to use a gun goes straight out the window, whether you're a medic or not.


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## Shishkabob (May 25, 2010)

Trayos said:


> *Unless specialized subset, e.g. TAC-EMS or military medic (where you still don't want to touch weaponry, and lose UN designated status unless forced too)



Wrong.  Medical personnel (doctors, nurses, medics) are allowed to carry weapons for defensive purposes to protect not only themselves, but their patients, and still be under the full protection of the First Geneva Convention (what little crap that actually means). 

Quote direcrtly from the Geneva Convention 


> The following conditions shall not be considered as depriving a medical unit or establishment of the protection guaranteed by Article 19
> 
> (1) That the personnel of the unit or establishment are armed, and that they use the arms in their own defence, or in that of the wounded and sick in their charge.





And considering how NONE of our current enemies even care about the Geneva rules, why would a medic make himself unprotected since it is known that they are one of the first ones targeted in a firefight if they are able to be distinguished (which is why they try to look as much like the average infantryman as possible)


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## usafmedic45 (May 25, 2010)

> And considering how NONE of our current enemies even care about the Geneva rules



Neither did the Japanese during WWII.  The medics in the Pacific theatre of operations (PTO) often carried weapons even though it was "technically" a violation of the regulations.


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## Shishkabob (May 25, 2010)

The Geneva Conventions are outdated, underthought, and a danger to the modern day 1st world country soldier.


They, and the UN, have outlived their Post-WW2 life, and need to be scratched and rewritten.


Alas, no one will go for that...


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## usafmedic45 (May 25, 2010)

I agree about the Geneva Conventions needing to be reworked, but I disagree with you on the UN.  People simply forget what it's role is supposed to be (to avoid getting into the situation where war is the response).  Sadly, a lot of Americans forget that there are ways to deal with other countries that do not involve military force.  Sometimes it is necessary, others it is not.  But let's not go there since it will simply lead to a thread lock.


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## Shishkabob (May 25, 2010)

I was just getting at that the UN takes long enough to get crap done, and when something is finally agreed upon, it has little to any real affect / power to get the desired outcome outside of military action.  (Iran anyone?)


The UN would suffer greatly if the US pulls out its funds (25% of their budget last I saw) and military forces... but a reason why we won't let it fail is because we still have that Veto power...


*sigh*


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## LucidResq (May 25, 2010)

I love how one day I read a thread and we're talking about self-defense in EMS, and the next we're talking about international relations and the UN. 

I love this forum.


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## usafmedic45 (May 25, 2010)

> (Iran anyone?)



We've kept them in check so far haven't we? We attack them and we do the equivalent of kicking a nest of hornets.  You might kill the one or two hornets that you want dead, but all their neighbors are going to get pissed and suddenly you're overwhelmed.  Believe it or not, the dumbest move in the history of war is opening a second front.  Two words for you:  Operation Barbarosa.  Three more words:  Operation Iraqi Freedom.  

There was a great quote from Otto von Bismarck:  "Anyone who has looked into the glazed eyes of a soldier as he lies dying on a battlefield will stop and think long and hard before going to war".  I've done that and I believe that is the most valuable lesson one can learn about the use of force at a broad level like war.  

Like I said, let's not keep this up or we're going to get yelled at by the mods.


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## ExpatMedic0 (May 25, 2010)

I read a booked "Paramedic buff to burnt" ( i think it was called) a couple years ago. It was about an NYC medic. He was attacked once by a guy with a knife who tried to kill him. If I remember correctly him or his partner used backboards and whatever they could grab to beat this guy. The Author ended up remembering a move he learned in the marine corp and breaking the attackers arm.

But this video is one of my favs.

http://www.wkrg.com/caught_on_camera/article/man_punches_paramedic/20089/Oct-17-2008_5-17-pm/


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## DT4EMS (May 25, 2010)

schulz said:


> I read a booked "Paramedic buff to burnt" ( i think it was called) a couple years ago. It was about an NYC medic. He was attacked once by a guy with a knife who tried to kill him. If I remember correctly him or his partner used backboards and whatever they could grab to beat this guy. The Author ended up remembering a move he learned in the marine corp and breaking the attackers arm.
> 
> But this video is one of my favs.
> 
> http://www.wkrg.com/caught_on_camera/article/man_punches_paramedic/20089/Oct-17-2008_5-17-pm/



That video must be a fake......... because that type of stuff NEVER happens....... (sarcasm)

I actually like that clip for a teaching tool. Many issues here......

The guy was amped..........why was it EMS' responsibility to deal with him? The guy was a bystander.......

With all of the body language presented, why did the provider stay so close? (More often than not it is the willingness to help everyone)

The audio showed the medic was "angry" after the fact when he comments "I'm fine" or something along those lines........ and it was obvious he was deriving pleasure from using force in retaliation for the attack.

Also...... with the removal of the shirt and the loud verbal language, waving of the arms etc this guy is prime for being an excited delirium candidate.

These happed almost every day................ just so happens a video camera caught this one.


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## got_shoes (May 25, 2010)

I have to say that the gentleman in that video doesn't seem to be presenting with excited delirium, I do believe that the issue for that man more due to  “exhaustive mania” per Dr Bell 1849, or there is a potential that this man is suffering from neuroleptic malignant syndrome (NMS) both of these medical issues have similar S/S to excited delirium,and can have the same ending eg:death. But a major difference is that those two conditions have more to so with the person taking antipsychotic drugs as opposed to those who use psychostimulants (cocaine, methamphetamine, MDMA) and have mental health issues. 

The EMS provider that was hit in the video, well he may have some of his own mental health issues to work out. He took a little to much pleasure from being in a fight. 

just my .02 cents


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## DrParasite (May 25, 2010)

DT4EMS said:


> Unprepared because many believe that preparing for defending oneself in EMS means smashing them with the O2 bottle or "doing whatever it takes" and "I'll worry about the court later type of mentality" without training.
> 
> The former medic in Denver.............who is now serving 12 years in prison..........for having that same mentality. Smashing a guys face..........when REASONABLE is a good deal. Those that sit and talk about how they will handle the court later must realize you can PREPARE for the court before you ever go.


the former medic in denver? who gave a seizing patient a skull fracture and broke his orbit? and then tried to cover it up and blame the cops?  not exactly the shining example of self defense, don't you agree?

now, if you have a guy on PCP or who you just woke up using narcan who now has his hands wrapped around your thought, and the only way you can get free is by hitting him in the face with something hard causing damage, then yes, that's justifiable force.  and if not, then I would rather be tried by 12 instead of carried by 6.

here is an example from my past.  I was dispatching one night, and sent my EMS crew to an EDP.  No report of violence, no reports of weapons present, so PD doesn't get sent before EMS.  The crew gets there, and 3 minutes later, I hear a panic call stating "send me PD, he has a knife!!!!!"  So now my 2 person EMS crew is in a room, with an EDP armed with a knife, and I am betting they can't get out easily.  even after sending all available PD and additional EMS units to assist (yes, we look after our own here), they advised the situation was under control before help arrived.  So if they were forced to break the guys elbow to get him to break the knife, or him in the face with an object to remove the threat  (the knife in his hand), I would back the crew 100%.

unfortunately, EMS has to go into places we don't know, often with just a two person crew.  not every area has PD securing the scene.  I have heard stories from coworkers that EMS used to pick up shooting victims and be enroute to the trauma center before PD even arrived at the scene.  We don't have guns, we don't have vests, we don't carry weapons.  and we deal with "nice people" who often don't mean us harm, and others who don't intend to harm us, we just end up being collateral damage.  This happens more in the urban cities more than the suburbs, due to having fewer cops available for all the calls.

I'd rather be serving time in jail than be serving time in a pine box 6 feet under.  but that's just me.


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## DT4EMS (May 25, 2010)

DrParasite said:


> the former medic in denver? who gave a seizing patient a skull fracture and broke his orbit? and then tried to cover it up and blame the cops?  not exactly the shining example of self defense, don't you agree?
> 
> now, if you have a guy on PCP or who you just woke up using narcan who now has his hands wrapped around your thought, and the only way you can get free is by hitting him in the face with something hard causing damage, then yes, that's justifiable force.  and if not, then I would rather be tried by 12 instead of carried by 6.
> 
> ...



You did a great job of making my point...... without an understanding of what "reasonable" is .... it is a proven fact people respond primally......like a caveman. I use that example because it made the news. There are several where administrators have  told me stories and asked my opinion............ Here's and example...

Transporting a psych on a transfer........ supposedly routine..........

En route the tech in the back gets attacked........ driver stops......grabs a mag light........enters the back of the ambulance and begins to strike the "patient" several times in the back of the head.

I asked "Did you discipline the employee"? there was a pause.......... I asked......... "If you did, on what basis?"

If the agency failed to provide training for the number one cause of lost work hours in EMS (assaults) how could you discipline the employee for doing what he "thought" was right?

Now another issue......striking to the head with an object can be considered deadly force. Simply getting your butt kicked does not constitute the need for deadly force...... striking the body or limbs would be "reasonable" in a situation where deadly force was not justified.

Regardless of views on the subject (pro or con) it is the reality we face in EMS. We can't act like a kid hiding under the blanket pretending the monster doesn't exist. The more we bring awareness in the form of recognition, prevention and escape training the safer before, during and after the incident our people will be.

BTW........ I was one of those guys that picked up shooting victims prior to LEO getting there. I also had LEO tell us the scene was secure.....only to use our ambulance for cover one time.


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## usafmedic45 (May 25, 2010)

> who you just woke up using narcan



Pardon the stupid question but why the hell are you not restraining someone _before_ giving them naloxone? 



> so PD doesn't get sent before EMS



Then you don't make the scene.  Force the cops' hands. 



> I have heard stories from coworkers that EMS used to pick up shooting victims and be enroute to the trauma center before PD even arrived at the scene.



That was pretty much the practice in one urban area when I was there.  The cops were less trustworthy than the wounded guy's homies, if they ever showed up at all.



> I am betting they can't get out easily



That's poor decision making on their part.  I would never make a scene with a known EDP with LEOs on scene.  Also, you never let ANYONE get between you and the door. 



> we don't have vests



Even in a rural area, I always wore a vest. 



> and we deal with "nice people" who often don't mean us harm



As soon as they become violent, they are no longer- by definition- nice people.  Don't let hindsight bias cloud your judgment.   If they are trying to hurt you, they mean you harm at that moment.   The reason for it is secondary.  

Not that it has any applicability in our setting, but the basic premise I was taught to operate under while deployed was be polite, be professional and have a plan to kill every person you meet.  Just for clarification: *I AM NOT ENCOURAGING THIS ATTITUDE IN EMS AT ALL*.  I am simply making the point that the "nice guy" you meet one minute could very well be trying to kill you the next.  Trust no one.


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## Trayos (May 25, 2010)

usafmedic45 said:


> Not that it has any applicability in our setting, but the basic premise I was taught to operate under while deployed was be polite, be professional and have a plan to kill every person you meet.  Just for clarification: *I AM NOT ENCOURAGING THIS ATTITUDE IN EMS AT ALL*.  I am simply making the point that the "nice guy" you meet one minute could very well be trying to kill you the next.  Trust no one.


That would tend to complicate matters, now wouldn't it?
I do feel that the polite/professional actions would be very applicable to EMS- people are less likely to provoke an incident with someone they (even grudgingly) respect.


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## usafmedic45 (May 25, 2010)

> That would tend to complicate matters, now wouldn't it?



How so?


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## Trayos (May 25, 2010)

usafmedic45 said:


> How so?


The whole anticipating a violent conflict in a proactive way might just give some hotheads the little extra push, and blow up to a serious incident instead of a rapid extraction from the situation.


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## usafmedic45 (May 25, 2010)

> The whole anticipating a violent conflict in a proactive way might just give some hotheads the little extra push, and blow up to a serious incident instead of a rapid extraction from the situation.



In a combat situation, the rules are different.  You either expect the worst or you get caught off guard.


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## medic417 (May 25, 2010)

Trayos said:


> The whole anticipating a violent conflict in a proactive way might just give some hotheads the little extra push, and blow up to a serious incident instead of a rapid extraction from the situation.



Holy crap batman that's like the claims that if you have a gun you are more likely to get tough guy attitude.  Again being prepared to defend yourself does not equal intending to hurt someone.  Honestly by being prepared mentally and physically you actually stay out of dangerous situations or at least get away from them before they escalate.


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## usafmedic45 (May 25, 2010)

medic417 said:


> Holy crap batman that's like the claims that if you have a gun you are more likely to get tough guy attitude.  Again being prepared to defend yourself does not equal intending to hurt someone.  Honestly by being prepared mentally and physically you actually stay out of dangerous situations or at least get away from them before they escalate.


What he said....I was about to edit my post when you posted that.


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## Trayos (May 25, 2010)

usafmedic45 said:


> In a combat situation, the rules are different.  You either expect the worst or you get caught off guard.


I know, its fully applicable for a combat situation. However, I think that the combat mentality _while undeniably effective in some of its tenets_ should not be incorporated wholesale into a non-military setting. Being proactive is not a crime, but if people who are not trained for such a situation are exposed to that mentality, they could react in a negative manner by drawing bits and pieces from what they have heard.


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## usafmedic45 (May 25, 2010)

> However, I think that the combat mentality while undeniably effective in some of its tenets should not be incorporated wholesale into a non-military setting.



Which is why I bolded the statement that I did. 



> Being proactive is not a crime, but if people who are not trained for such a situation are exposed to that mentality, they could react in a negative manner by drawing bits and pieces from what they have heard.



There are nutcases in any group.  I see your point but I think you're letting your biases get in the way of rationalization.


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## mycrofft (May 25, 2010)

*Amazing how this subject keeps resurfacing like Elvis.*

The site's demographic supports it, though. 
"Five is four".

Addition: "Amateurs talk tactics, officers talk strategies, generals talk logistics".


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## Trayos (May 25, 2010)

usafmedic45 said:


> There are nutcases in any group.  I see your point but I think you're letting your biases get in the way of rationalization.


I dont mean to say this as a clear and shut rule, I apologize if that is how it was conveyed.
I think that this proactive mindset could be very beneficial to EMS personnel, but would understandably require additional instruction (e.g. an additional class on evaluating scene safety or whatnot). I do not have as much knowledge of the combat mentality as you do, but I am not sure that taking the bits and pieces that apply to EMS without connecting them would not be confusing. Otherwise the learner would, instead of having a specific mindset to fall back on, rely on connecting the dots in every situation they encountered. 
I dont mean to say that scene safety should be an absolute, clear and dry matter, but I'm worried that this comment will seem as such.


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## DrParasite (May 26, 2010)

DT4EMS said:


> I use that example because it made the news. There are several where administrators have  told me stories and asked my


it's a bad example, because it would seem like the patient wasn't trying to hurt the paramedic, but was experiencing a seizure and this medic beat the crap out of him. again, wasn't there, not sure what exactly what happening, but that's what I gather.


DT4EMS said:


> Transporting a psych on a transfer........ supposedly routine..........
> 
> En route the tech in the back gets attacked........ driver stops......grabs a mag light........enters the back of the ambulance and begins to strike the "patient" several times in the back of the head.


that's a better example.  here are my questions:  how was the tech attacked?  was he being punched?  bitten?  did the patient grab the clipboard and swing it at the tech's head?  did he grab a needle and jab it into your partner's head?  was he completely free and he was had the tech on ground and was stomping him into unconsciousness?  you can't make a general statement like that, without additional details.


DT4EMS said:


> I asked "Did you discipline the employee"? there was a pause.......... I asked......... "If you did, on what basis?"
> 
> If the agency failed to provide training for the number one cause of lost work hours in EMS (assaults) how could you discipline the employee for doing what he "thought" was right?


those were your questions?  maybe you should have asked my questions, before you assumed the driver used excessive force.  


DT4EMS said:


> Now another issue......striking to the head with an object can be considered deadly force. Simply getting your butt kicked does not constitute the need for deadly force...... striking the body or limbs would be "reasonable" in a situation where deadly force was not justified.


Agreed.  However, before I would call someone's actions excessive (especially when they were attempting to defend himself or defend his/her partner), I need to know all the details.  And then, after the investigation is completed, I would determine if it was excessive. but also remember, its easy to make a decision after you have all the facts, vs when you have to make a decision in a second where your inaction could cost you or your partner his life or health.


usafmedic45 said:


> Pardon the stupid question but why the hell are you not restraining someone _before_ giving them naloxone?


off the top of my head, I can recall giving narcan twice to wake up an overdose.  the first time the guy wakes up and was non violent. the second time it was a former college football linebacker/former special police officer, and it was given while he was unconscious and being ventilated with a BVM in his bed.  he accidentally overdosed on his pain meds, and he woke up swinging, and once he realized what was going on, he calmed down significantly.  if he hadn't woken up, we would have moved him to the cot, and been bagging him all the way to the hospital.  and then no need for restraints.


usafmedic45 said:


> Then you don't make the scene.  Force the cops' hands.


nice theory, doesn't happen.  they don't have enough cops to do it. they are too busy with the shootings, stabbings, drug deals, car jackings, and other criminal events that occur in our city.  esp when many of our EDPs are just depressed people or others with diagnosed disorders who just need to go to the hospital to get their meds adjusted so they can return to baseline status.  however, those who are KNOWN to be violent or KNOWN to possess weapons we always wait until PD is on scene before EMS is sent.  but if it's an unknown situation (which happens quite often) it is not dispatched as an unsafe scene.


usafmedic45 said:


> That's poor decision making on their part.  I would never make a scene with a known EDP with LEOs on scene.  Also, you never let ANYONE get between you and the door.


happens all the time around here.  LEO rarely beats EMS to the scene of an EDP call, except as noted above, or if EMS is really backed up with higher priority calls.


usafmedic45 said:


> Even in a rural area, I always wore a vest.


I don't, and most of my coworkers don't either.  You would think if it was that important, we would be issued vests.  But alas, we are not.


usafmedic45 said:


> As soon as they become violent, they are no longer- by definition- nice people.  Don't let hindsight bias cloud your judgment.   If they are trying to hurt you, they mean you harm at that moment.   The reason for it is secondary.


damn, sarcasm doesn't travel well.  by nice people, I was referring to the gang banger, skell, drug dealer, and honor student who is walking at 3am through the bad part of the city and gets shot.  you know the high quality individuals.


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## Melclin (May 26, 2010)

DT4EMS said:


> the number one cause of lost work hours in EMS (assaults)



Seriously?

I would have though it would be stress of back injury. What the hell kind of environment do you people work in?


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## mycrofft (May 26, 2010)

*What does Labor Department say?*

What is the official cause of lost time among EMS workers?

I've never known a worker to ever actually be seriously hurt by a pt other than lifting. (My closest call was while working as a staffer (RN) in a convalescent facility).

Let me hazard a guess, though. Most total hours lost across the category will be to acute illness. The highest number to acute and recurrent injury will be lifting-related back/neck/knees. The potentially most hrs lost to single acute episodes _per individual case_ might be trauma (mental and physical) secondary to assault and battery because it can be very serious and it definitely makes you scared to come back.


ADDIT: I have sent an inquiry to US OSHA.

ADDIT: Reasonable fear of suffering signifcant bodily harm constitutes cause for force if flight is not possible. If you think you are going to get your butt kicked you can do whatever needs to be done defend yourself with the minimal necessary force, but you also have to allow the attacker the means to give up or leave. And the old "He said he'll be back to burn down my house, so I back-shot him" defense is very hard to prove.


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## mycrofft (May 26, 2010)

*I also started a poll on EMTLIFE.*

I'm outta this thread, have a good day. (Me, I'm cleaning the garage).


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## FLEMTP (May 26, 2010)

I think one of the most remembered quotes I have heard and use daily... i learned during my law enforcement training:

"Have a plan to kill everyone you meet. Pray you never need it." 

I know some of you more touchy feely liberal "lets hug them til they love us" people are :censored::censored::censored::censored:ting a brick right now... but if you consider the statement and the context of the quote.. it simply promotes SITUATIONAL AWARENESS... so that should there be a "situation" developing, you have time to analyze it, and decide if you should leave, move to verbally diffuse the situation, move to physically defend yourself or someone else, or do nothing and just continue to be aware. 

True, we are not law enforcement, and people will argue that EMS should never need to know defensive tactics or ever have to use force against an attacker (note: attacker, not a patient, the difference has been stated above) However, this is not a perfect world, and EMS & Fire are just as prone to attacks & assaults as law enforcement is.  It would be sheer ignorance of the world around you, as well as a complete lack of personal responsibility, to not be prepared to defend yourself or someone else ( your patient, your partner) in a use of force type encounter, or rely solely on law enforcement to defend you. 

This includes knowing the legal liabilities of defense, and use of force in the state or locality you live in, as well as where when and how to retreat, AND how to verbally and physically defend yourself the CORRECT and PROPER way. Just like there is a generally accepted method of how, when and why to intubate, or start an IV, there is a generally accepted method of defending ones self. 

Looking at the website DT4EMS is affiliated with, I'd say they have a pretty good grasp on offering that training for EMS and Fire.

Personally, I think it is irresponsible of EMS educators to not provide defensive tactics training and situational awareness training to their students taught by a QUALIFIED instructor, as well as the laws and legal liabilities that go with that training and use of training, as well as the BEST way to document your use of force. Just like treating a patient, documentation in a hands on (or even a verbal) encounter is EVERYTHING... and will mean the difference between jail, discipline from your employer, and being patted on the back and offered any other assistance you may need as a result of your encounter.

And my final words of advice: As much as I love my law enforcement brothers and sisters, when seconds count, the police are only minutes away!


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## DT4EMS (May 31, 2010)

mycrofft said:


> What is the official cause of lost time among EMS workers?
> 
> I've never known a worker to ever actually be seriously hurt by a pt other than lifting. (My closest call was while working as a staffer (RN) in a convalescent facility).
> 
> ...



•	According to the study released by the NAEMT in 2005, the number one injury to EMS providers is assault (52%). 

•	In 1999 Bureau of Labor Statistics estimated that 2,637 nonfatal assaults occurred to hospital workers—that is a rate of 8.3 assaults per 10,000 workers. This rate is significantly higher than the rate of nonfatal assaults for all other private-sector industries, which are 2 per 10,000 workers.  

•	According to the Bureau of Labor Statistics, a healthcare provider is more likely to be assaulted, while on the job, than a police officer or a prison guard.

•	OSHA has identified a Potential Hazard in relation to the increased risk of violence in the medical setting, and the ineffective training of staff to deal with or identify potential violent problems. There are specific OSHA recommendations for the health care setting.

•	The ENA (Emergency Nurses Association) has taken the following position “Health care organizations have a responsibility to provide a safe and secure environment for their employees and the public.”  And “emergency nurses have a right to take appropriate measures to protect themselves and their patients from injury due to violent individual.”



•	According to Brian J. Maguire, Dr.PH, MSA, Clinical Associate Professor, University of Maryland, Baltimore County:

“The risk of non-fatal assault resulting in lost work time among EMS workers is 0.6 cases per 100 workers per year; the national average is about 1.8 cases per 10,000 workers per year. So the relative risk for EMS workers is about 30 times higher than the national average. The relative risk of fatal assaults for EMS workers is about three times higher than the national average.”


Dr. Brian Maguire has done the most extensive research.........to my knowledge on the subject.

Source:
http://durangoherald.com/sections/F.../05/31/In_the_ER_violence_befits_a_TV_series/

In 1994, The Wall Street Journal reported on a study of 1,209 ER nurses that found one-third were assaulted each year and two-thirds suffered at least one physical assault in their careers. Nurses, of course, are the front line of the ER, usually first to see violent or agitated patients.

A 2010 Australian study found nurses "out-ranking police and prison officers in exposure to workplace violence." A 2009 survey of 3,465 ER nurses in the United States found that 25 percent had experienced physical violence over 20 times and verbal abuse over 200 times in the last three years.

A survey of 171 randomly selected ER doctors in Michigan found 75 percent had at least one verbal threat in the previous year while 28 percent were physically assaulted. Twelve percent were confronted outside, and 3.5 percent were stalked.

Nurse respondents in one of these studies reported "fear of retaliation and lack of support from hospital administration and ER management (how did you offend the patient?) as barriers to reporting workplace violence."


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