# Uncooperative Patient vs. Aggressive Attacker



## DT4EMS (Dec 1, 2009)

Uncooperative Patient vs. Aggressive Attacker
                                    Defining the difference
                                   © 2009 Kip Teitsort


With the high numbers of EMS providers assaulted on the job by what so many refer to as “patients” I would like to help clarify the difference between a patient and an attacker. In order to better prepare for scene safety “tactics” and Good Customer Service the EMS Provider must have a clear separation between a combative/uncooperative patient who is confused due to a true medical emergency and an aggressive-attacker who may be under the influence of drugs or alcohol trying to assault them. 

There is a commonality between EMS and police officers. Many times the two different agencies deal with the same people. Sometimes it is because the police call EMS to a scene and sometimes EMS having called the police to a scene.  In law enforcement police officers are trained that there are usually three different types of people they will encounter on the job. These three are commonly referred to as the “Yes” person, the “Maybe” person and the “No” person.

The “Yes” person is usually cooperative throughout the entire contact. This is the most common person for police officers to deal with.  For EMS this is the majority of the type of “patient” we deal with. Regardless of the call it is not usually their intent to cause harm to the EMS provider. On all calls for service the EMS provider must use their Situational Awareness. For the “Yes” person the EMS provider should continue their Good Customer Service. 

The “Maybe” person is one the EMS provider is not sure of. The “Maybe” person is one of the most dangerous for the EMS provider to deal with. The initial dispatch information may not have alluded to a possible danger the EMS Provider may be on an unsafe scene unknowingly. This person may be under the influence of drugs or alcohol and exhibits behavior or language that makes you leery of their intentions. A “maybe” person may fall into one of the “5 D’s” (Drunk, Drugged, Diabetic, Domestic, and Deranged). There may be something about the scene the provider isn’t comfortable with. When a police officer encounters the “Maybe” person and needs to take them into custody the police officer is prepared to use force (physical, OC, Baton, Taser etc.). The police officer is trained to expect this type of person to resist or fight “upon first touch”. The officer is trained not to be paranoid, but rather prepared for the situation.

Since the EMS Provider is not taking a person into custody, when the EMS provider deals with a “Maybe” person, Situational Awareness and Good Customer Service become major priories. Having situational awareness aroused will help the EMS Provider pay more attention to speech and movements of the “patient” during contact. Any indication of aggressive activity should cause the provider to back away and create a safe distance. Good Customer Service can keep the provider from allowing a situation to become personal. It may also keep the “maybe” person from becoming aggressive toward EMS.   


The “No” person resists or fights any and all forms of control. This person is usually under the influence of ETOH or drugs. Their verbal and non-verbal language is aggressive in nature.  Police officers train in keeping a safe distance and using tools to deal with this type of person. When dealing with the “No” person officers are trained to overcome the level of resistance or aggression with superior numbers, skill and tools. In EMS, the provider finding there is active aggression directed at the EMS provider should retreat. If the intent by the “No” person is to cause harm to the provider, escape, not control, becomes the priority. The EMS provider should not attempt restraining a “No” person. The “No” person in the EMS setting can change from being a “patient” to being an aggressor or “attacker”.

Answering some simple questions will help the EMS provider determine the difference.
In every situation where the EMS provider is presented with a potentially violent encounter must ask themselves several questions.
1)   “Is this person trying to hurt me?”  Seems like a simple question but all too often EMS providers stay too close, too long with an aggressive attacker. Paying attention to the “gut feeling” will help keep a provider safe.
2)   Is it the person’s intent to due you harm? If you think they are confused due to a medical emergency, they are a patient.
3)   What is your perception of the movements directed at you? Are you in fear for your safety? If you are, they may be an attacker.
4)   Why are they trying to hurt you? If they are confused because of a medical emergency they are a patient.
5)   What are their spoken words in the process of their physical actions? When physical aggression is combined with verbal threats it is easier to perceive the intentions of an “attacker” vs. a “patient”.

When responding to a patient or an attacker, your techniques or tactics will be judged on their reasonableness. Reasonable can be defined as actions that would be considered just, rationale and usual under the circumstances.


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