Using force to defend yourself.

[DT4EMS]

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.

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.

 

[usafmedic45]

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.

 

[Trayos]

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.

 

[usafmedic45]

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

How so?

 

[Trayos]

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.

 

[usafmedic45]

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.

 

[medic417]

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.

 

[usafmedic45]

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.

 

[Trayos]

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.

 

[usafmedic45]

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.

 

[mycrofft]

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".

 

[Trayos]

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.

 

[DrParasite]

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.

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.

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.

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.

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.

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.

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.

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.

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.

 

[Melclin]

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?

 

[mycrofft]

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.

 

[mycrofft]

I also started a poll on EMTLIFE.

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

 

[FLEMTP]

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!

 

[DT4EMS]

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.

• 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."