# 6 Steps to better Scene Safety



## DT4EMS (Jan 21, 2007)

This is an article that I was able to get printed in the Missouri Code 3 Magazine.

Six  steps to better  scene safety


With increases to EMS Provider attacks in recent years, DT4EMS seeks to arm emergency workers with court defensible yet easy to learn defensive tactics instruction. The firm, based in West Plains, Missouri, will provide its courses to EMS Providers across the country.

Several studies have concluded that threats to Emergency Medical System professionals from their patients, the patient's family members, or bystanders have increased to an alarming rate. EMS workers are now issued body armor, in some jurisdictions, to protect them while working in "gang areas."

However, it is a common conception in EMS that there is no "safe scene," and there is no "safe time of day," to do their job. From the moment that they begin to respond to a call for emergency medical services, they risk injury – rushing to the scene with lights and sirens blazing, violating traffic laws in order to gain needed seconds while someone may be dying.

Most regional and national EMS courses address ways to mitigate or lessen the danger to EMS staff. They are taught how to administer lifesaving medical procedures. They are taught how to drive with lights and siren through traffic, in most cases. They are taught how to minimize contamination or infection in both patient and provider. Some areas attempt to teach the providers "verbal de-escalation skills," or "non-confrontational conflict resolution." The average person would call these skills "all talk." And they'd be right.

The liability conscious EMS administrator or business owner dreads the liability from three events. Their EMS workers being injured or killed, requiring worker's compensation and insurance increases. The company or city being sued by a victim of excessive force from the EMS provider, and the negligence of not providing effective self defense courses for their employees.

With a lack of real defensive tactics training geared for EMS providers, most providers will rely on knowledge gained "in the back of the rig" or resorting to "cave man" style tactics such as clobbering the bad guy with an oxygen cylinder or a "LifePak Defibrilator", which is a rather heavy piece of equipment.

Enter DT4EMS with plans to change the current standard for defensive tactics instruction for EMS professionals on a regional and national level. The company, founded by Paramedic (former Police Officer) Kip Teitsort and Dr. Aaron Newton M.D, works to provide a system for EMS providers which is easy to understand and retain, court defensible, grounded in the real world, and able to be used under stress by less than athletic persons.

The course, DT4EMS-1 (Initial), consists of 16 hours of instruction in identification of threats, avoidance, de-escalation, disengagement, and escape. While other "feel good" courses teach avoidance and de-escalation and then stop at the moment of physical attack, DT4EMS continues through defending the attack, escaping the situation, and articulating the attack for liability and prosecution reasons.

Since DT4EMS is not a karate class, a ground and pound class or law enforcement defensive tactics people may confuse the tactics taught with other courses. DT4EMS is for EMS by EMS. It was created from a medic's perspective, holding the EMS provider to the same high standards a police officer is held to when using force. An EMS provider should not train in martial arts learning how to "win a fight" or law enforcement defensive tactics (which is actually a play on words) that must take acts of aggression to place a person in custody. Instead the EMS Provider must have an approach to avoid, recognize and escape a violent encounter.

DT4EMS gives the EMS provider a systematic approach on how to respond when an assault, not a fight, unfolds. The following six steps are the basis for how DT4EMS trains the provider. The goal is to get back to step number one.

1) Don't be on an unsafe scene. Now we wish this could happen all the time, but is not always possible. More and more reports are surfacing of EMS Providers being assaulted on "Safe scenes". The provider must do what they can to stay away from the areas known to be prone to trouble. 

2) Awareness. The provider must to be aware of surroundings in order to prevent an assault. Being mindful of "who" is around and pay attention to the little things. (What is being said? What is the mood of people around? etc.) 

3) Maintain a safe distance. This is when a person started approaching.  The provider's hands go up in NVP (non-violent posture) and the provider would back away if possible.  The NVP makes it harder for people who are "witnesses " to say it looked like the provider was the attacker or wanted to fight. Safe distance would vary depending on the threat presented. If the provider noticed the problem here, the provider would go to #2 then #1.

4) DTP- (Double Tap Parry) If the provider failed with steps 1-3, the DTP can "buy a second" to correct the mistake, and try to get to #3, then #2 and so on. It is the constant idea of escape that is in mind. Not knocking a person out or submitting them. The essence of the Double Tap Parry is the parry.  The DTP is not a block. If the provider's hands were up (refer to #3) it is like swatting a bug away from their face as they flee.  (Trying to get to #3, to #2 and eventually to step #1.)


5) Basic Ground Defense: If the DTP failed and contact was made and the provider was knocked to the ground...The provider would tuck their chin, bring their knees up and yell on their way down. The BGD keeps a person from mounting you. 




6) Escape the Mount (Basic Ground Drill) for if you made a mistake and let them mount you. If mounted the idea is to escape it, create space and work to #5, then 4, 3, 2, 1. 

DT4EMS has nothing to do with training a person to "fight". Fighting is hard but self-defense can be very easy.  (When you think of the goal… to get off of the unsafe scene (getting back to #1))

When the steps are followed it is easy to see it is tactics not techniques. Techniques are taught, but it is the tactics the provider must follow. A clinch or a ground and pound (both very effective) could be seen as aggressive and the EMS provider who wins the street battle would ultimately lose the courtroom battle and the battle of the media. 


Most attacks on EMS are not life threatening, some are. The EMS Provider must have sound tactics, not just fancy techniques in order to respond to all levels of attacks. The level of response must be "reasonable" and court defensible.  

Some of the video clips on the www.dt4ems.net  website show the progression of how the DTP can be used in many situations. In a DT4EMS class the DTP moves into Elbow Control, a head takedown or the push off escape. The videos just show how regardless of "what" you trained in before you can blend the principles/tactics into your training. But the most important thing is to not get hit with the first attempt and LEAVE.

Most of the two days is built around preventing the first strike, punch, push, grab, slash etc from taking place. That is what makes us different. If you look on the internet for fight clips you will see almost every one of them has two things in common: 1) Two willing participants and 2) The fight started with an outstretched limb.

Attacks on EMS rarely have “ground and pound involved”. Most are a spontaneous attack that catches the victim by surprise. The stories of EMS providers attacked with a pipe, shot, stabbed, punched; kicked etc. can be read in several places. Not one story of an EMS provider being ground and pound has surfaced. Not that is hasn't happened, but statistically it has been strikes with empty hand or weapon attacks on EMS. So for EMS providers (not fighters) the goal has to be avoidance, if caught off guard go through the steps above to get away. (Steps #1- #6)


DT4EMS is a class for EMS, not to fight, beat a person up or compete in an MMA event. The goal is to prevent at least one person, patient or provider from being the victim of an assault. For the provider it's to get back to #1 above.

DT4EMS was created from an EMS perspective. It is liability conscious while maintaining the safety of the EMS provider as paramount.

The DT4EMS course is currently taught for continuing education credits, allowing those who take the course and pass to use the credit hours towards their continuing EMS education re-certificate.


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## Ridryder911 (Jan 21, 2007)

Congrat's upon a great written article. The system needs those with foresight and awareness like you. Instead of complaining, whining and continuation you actually took it upon yourself to develop a program that is beneficial to our profession. 

Keep up the great work as you fine tune your methodology and program(s). I am sure as soon as administration and working field medics understands the benefits, we will see more and more wanting and requiring your program. 

Again congratulations,

R/r 911


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## Jon (Jan 21, 2007)

Kip - Great job, and a VERY well-written article.


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## DT4EMS (Jan 21, 2007)

Thanks so much guys. I really appreciate it.

The article basically outlines what the 2 day class covers. Every move, technique or verbal skill is to get the provider off of the unsafe scene. 

We know we can't teach everyone, but at least we can set the standard.


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