EMS Provider Safety – Escaping Violence and Changing Culture
By Sean Hulsman
“He bit my hand. It’s my own fault. I got too close to his mouth.” I spoke those exasperated words over ten years ago. I said them to a somewhat amused police officer who had just watched the intoxicated male on our stretcher attempt to eat my thumb. All he offered in response was “Break the skin?” When I said no, he just went about his business at the station.
We’d been called to the cellblock to pick up a violent, intoxicated prisoner. The police had decided to put him on mental health commitment papers and summoned us to transport the individual to the hospital. When we arrived the prisoner was screaming profanities and smashing his head against the bars of his cell. We rolled our stretcher in, opened our packages of soft restraints, and watched as four officers opened the man’s cell and wrestled him out and onto our stretcher. He was flailing wildly, yelling, and spitting, and as the police worked to secure him to our stretcher, I began to perceive that my partner and I should be doing more to help control the violent subject. I mean, we couldn’t just stand there, right? So I put my knee on his shoulder and grabbed a near-by non-rebreather. I went to put the mask on his face to prevent us from being spit on, he curled forward, got his teeth on my thumb, and locked in a nasty bite.
I struck out at the man in blind rage and was able to free my hand and assess the damage. There were teeth marks, a tear in my glove, and some decent bruising, but the skin had not been broken. When we finally got the man restrained, we transported him to the hospital. That was it. There was no assault report and no treatment at the hospital for my injury. I just went back to work. I was tough, and it was my own fault for not being more careful.
We’ve seen the news reports lately and we know the score. People are ambushing Law Enforcement Officers. A man ambushed and killed volunteer Firefighters in West Webster, NY. A disturbed individual attempted to copy the West Webster attack right here in the area where I and my colleagues work shortly thereafter. Emergency services, it seems, is becoming a more dangerous occupation.
The media has begun to more frequently report on violence toward EMS providers. Paramedics slashed and stabbed in Detroit, a paramedic assaulted in Massachusetts, and an EMT attacked by a family member of a patient on Christmas morning are just a few of the headlines since December, 2015. Yet this is not really news. EMS has been getting assaulted for years.
“Why would anyone want to assault an EMT?” It’s a good question. The answer, unfortunately is not an easy one to find. In fact, it is extraordinarily difficult to explain violent human behavior, especially when that violence is directed at people whose sole purpose is to help others. Such explanations are the purview of learned mental health professionals, and certainly not within the skill set of an EMS educator like myself. However, explaining such behavior is not my job and, as it turns out, neither is being subjected to it. This was a major take-home for me when I finished an incredibly insightful week of training with Brett Peine, an instructor with DT4EMS.
DT4EMS is a company created by one Kip Tietsort, veteran paramedic, former Law Enforcement officer, and experienced martial arts enthusiast. Kip started DT4EMS and its catalog of “EVE” classes with his passion to bring both safety and awareness to EMS providers, Firefighters, and even Clinical Medical staff. EVE, or “Escaping Violent Encounters” classes are in essence self-defense classes. During our instructor training three of my fellow administrators learned how to escape from wrist grabs and chokes, deflect and block punches, and use open-hand techniques to escape from assailants. But by far the most important things we learned were concepts that did not include putting our hands on someone.
Building on the sage advice “The easiest fight to win is the fight you never have,” EVE training hammers home tactics for avoiding assaults altogether. We reviewed deceptively simple concepts like: don’t be on an unsafe scene, use your awareness to detect potentially unsafe scenes, and maintain a safe distance from questionable patients or bystanders. De-escalation and verbal skills were taught. Believe it or not people (even potentially violent people) react much less aggressively when you speak to them with respect and attempt to explain that your goal is to help them. Yet, the most useful thing that I learned during EVE was this: It is NOT part of our work as EMS providers to be assaulted. Embarrassingly, I’ve been a paramedic for 22 years but had never considered that I really shouldn’t be assaulted at work. It’s funny – people behind the counters at coffee shops don’t take it in stride when a customer shoves them. Mail carriers would not be accepting of a punch to the face as they placed a package in a mailbox. Why, then, should anyone who is summoned to deliver medical care receive and accept physical violence? That is a question that I can answer thanks to Kip and Brett: EMS culture.
EMS is slowly recovering from a chronic identity crisis, but in the past we’ve come to see ourselves more like police and less like physicians and nurses. We’re on the streets in rough neighborhoods dealing with unstable people. We’re supposed to be tough mentally and physically. When that “patient” storms over and shoves us against the wall or surprises us with a punch from the stretcher, EMS culture says “Suck it up! It’s just part of the job.” Personal bravado makes things worse. I am nearly seven feet tall and weigh around 290 pounds. How in the world is a guy my size supposed to respond when a drunken jerk bites my hand while on duty? File an assault report with the police? Seek medical care? The answer is a resounding “Yes!”
Many people know who and what they are. True wisdom is knowing who and what we are not. Paramedics and EMTs are not police. We are not MMA fighters or professional wrestlers. We are not trained to apprehend criminals or tackle and restrain violent subjects. We’re there for medical care. While on duty, being knocked down, pushed, kicked, slapped, bitten, or punched is no different than if the same thing happened to us while playing with our children at a park or while enjoying a drink with our significant other. It’s unacceptable, it’s assault, and it’s a criminal offense.
EVE teaches how to use our hands as a last resort, how to escape from an assailant, and most importantly how to avoid all of that to begin with. But on a more universal level it teaches that we need to change our culture and not accept violence as part of our jobs. We spent five days with Brett and EVE concepts. It’s now our job to ignite the fires of cultural change within our organization, in our region, and perhaps even in our state.
All in all, DT4EMS is providing the EMS world with a tremendous product and an opportunity to teach personnel how to both steer clear of violence whenever possible, and to escape and survive when violence is unavoidable. It even touches on what force is “reasonable” in various circumstances and how to, in the wake of an assault on our people, win the battles in the Courts of Law and of Public Opinion.
Our agency is excited to pass this knowledge along to anybody who wants it, and we applaud Kip, Brett, and DT4EMS for bringing that knowledge to us. We need to be safe and look out for each other in EMS. The best way I can recommend doing that is to investigate the benefits of DT4EMS EVE training. There is no more pressing time than right now to begin expanding on the foundations of provider safety. You can be part of the change, too! As for me, I’m a believer. Perhaps the next time I pen an article about provider safety it will begin “He didn’t bite my hand because I stood back and allowed four trained Law Enforcement officers to do their jobs so that I could do mine.”
(For information about Kip’s programs, visit www.DT4EMS.com)
Sean was able to get this published in EMS1. You can see it here
Sean P. Hulsman
Director of Education
Twin City Ambulance Corporation
555 Commerce Drive
Amherst, New York 14228