By Kip Teitsort, Founder, DT4EMS
1) Your safety comes first. Nothing takes precedence over your safety. Be it a hazmat scene, blood borne pathogens, downed power lines and driving with due regard. Each receive regular safety talks and
training. However when it comes to the subjects of violence and the use-of-force on the job… they receive little or no attention. Your safety comes first in any use of force situation (self-defense or restraint attempts) just as it does on any other call for service or “patient contact”.
2) Understand there are people and situations that you can’t control. In my law enforcement training to become a defensive tactics instructor, one of the most important statements that ended up proving true through years of arrest and control experience is- no single person can control another unless they want you to. That is why officers have multiple tools on their belt for when empty hand technique fails or is not an appropriate option. This is important for us to recognize in medicine especially when it comes to placing a person in restraints. Often times the criminal assaults that occur to providers happen during some sort of restraint situation. Research it yourself in our Assault On Staff Log.
3) Recognize the difference between a patient and an attacker. Probably the single most important factor in keeping staff safe from violence is getting them to understand the fundamental
difference between a patient and an attacker. All too often staff gets to close or end up remaining connected with a person they should actually be backing away from. This is why we work so hard at DT4EMS to get the words “Combative Patient” removed from medical lingo. This blog post about combative patient may help.
4) Fleeing a violent encounter is not patient abandonment. Since so much time is given to or provided for the training and continuing discussions around the water cooler regarding patient abandonment, staff sometimes has an erroneous belief that if they flee a violent encounter, they will be abandoning a “patient”. This is not true. If you are in fear for your safety, back away and call the police.
You cannot be compelled to place yourself in danger without proper training and equipment. This is why police have SWAT, fire departments have high angle rescue, swift water rescue etc. and the military has elite units, all have specialized skills, tactics and tools and training to deal with the danger/hazards they agreed to face.
5) Not all self-defense problems can be solved with the use of force. This is the entire reason DT4EMS was created. People would ask about techniques when the focus should be on tactics of prevention. It is not possible to be the toughest person on the planet. Remember the old saying there is always someone bigger, stronger or tougher than you. So in self-defense it is better to back away and not be in a position to get beat up. Besides, we did not get into the medical field to “fight” or beat people up. If a person did…they need to find a new career. Here is a post about my lifelong journey from physical skills to philosophical understanding.
6) You must train for more than just the physical battle you may face. Just because you may possess the skills in which to kick someone’s posterior does not automatically mean you should. What about what
happens if you do? Since most assaults on medical staff are less than lethal in nature and many of which can be mitigated, what will happen if someone captures your incident on film, shares it with the media and you find yourself in court?
7) Personal safety is just that, personal. You are ultimately responsible for your safety at all times, on or off-duty. End of discussion.
8) Employers have a duty to provide a safe work environment. While an employer has a duty to provide a safe work environment for known hazards, it is still the employee’s responsibility to have behavior that follows safe practices. This is why agencies provide training for things like PPE, driving (EVOC), Fire Prevention/Safety, Proper Lifting and Moving and provide the proper equipment for each. If an agency is not providing appropriate training for the use-of-force (restraints or self-defense) you should still educate yourself on the subject. OSHA
9) Wining in self-defense is different than winning a fight. Too often movies and TV shows influence perception of reality. No one really wins a fight. On the job we should never be in a fight. With that said, 
the common understanding of winning in a fight means you beat/submit/destroy your opponent. Winning in self-defense means you refuse to be beat.
10) Know the difference between custody and care. Police take custody or a person who is suspected of committing a crime. Medical staff provides care under consent. Two completely different
mindsets and approach to training. Have you thought about what to do if a person revokes their consent to treatment? Are you aware of situations where medical staff has actually taken custody of someone when they were supposed to be providing care? Read our post on Custody or Care.
11) Not everyone we are called to treat is in fact a patient. Many times we are called to people who have no real medical need, and yet people are trying to force them to go to the hospital. Many have heard the “you can go to the hospital with them or jail with me” statement. Read about how to properly address that here.
12) Most people, including patients are not trying to kill you. Although statistically a lot of assaults occur to medical staff, we must be careful to keep it in perspective. Not fully researching or understanding the subject has led many to become jaded. Since the media for so long only covered the
fatal assaults on healthcare providers (EMS/Fire/Nurses) many believe that fatal encounters are all that exist. With that being the case many providers have asked or do carry a firearm on the job. Here is our stance on firearms, we liken it to a surgical cric.
13) Penalty does not equal protection. While most states now have laws particular to providing penalty for those who assaults EMS/Fire or nurses (some states have enhanced penalties) a law does not always mean you will be protected from the violent encounter. The law is supposed to act as a deterrent to criminal activity. Our research shows most assaults are committed by a person under the influence of alcohol or drugs. Do you think they are thinking about a law while punching you in the face? If you are assaulted- press charges!
14) Beware of what you say or hear regarding the use of force on the job. Peers train others, sometimes without even knowing it. What is said around a station or a break room about how to handle a situation is actually a form of training. Those new to the field will look to others for advice on how to handle the use-of-force situation when there is no formal training on the subject. We call this unofficial training.
15) Violence directed at us is very real. For the first ten years I spoke about this epidemic, people would laugh at me. They would tell me there was not an issue with violence directed at medical staff. No media outlet would cover assaults on medical staff. It just wasn’t news unless a provider was killed on duty. Now there are several news reports both VIDEO and in our Assault On Staff Log
16) Failing to train appropriately for use of force incidents on the job has had dire consequences. Human conflict is dynamic. Know this: An attacker doesn’t come to a class learning “how” they are supposed to attack, so they attack by surprise and when they want to, not when you expect it. Couple that with; when there is no formal training on a subject, people rely on what they have learned based upon their own past training and experience. Think about it… what if you or your staff member was a former military member, an amateur or professional MMA fighter, a former bouncer in a bar? The previous training or experience obtained was great for what it was designed for. But what if some of their skills were used inappropriately while on the job in medicine- with no recognition of the difference between a patient and an attacker? Watch what happens in these videos and read some of the news reports here.
17) Staging is only effective for KNOWN violent scenes. Many agencies fall back to “staging” when it comes to keeping their staff safe from violence. This is a fantastic practice for known violent scenes. However, riddle me this: If 52% of EMS providers have been a victim of violence at a rate 22X
that of other private sector professions, and they are staging for scenes known to be violent…where are they being assaulted at? Right, supposed safe scenes.
18) Train for what you fear. If you are worried about pedi-codes, surgical cric’s or OB emergencies research and train for them. Immediately your stress will be reduced regarding those types of calls. We experience increased stress and/or “freeze” because we are in a situation we have never been before. The same is true for the violent encounter. The more you train, the more you recognize the difference between a patient and an attacker, know what you can do under the law in both restraint and self-defense situations. Training reduces stress because it allows the provider to have options.
19) Mental Preparation is as important as any physical skill you may possess. Mental preparation is the thinking through an imagined event, step by step, and processing everything you can about how you would reasonably handle the event.
Below is an example of Mental Prep
20) Drunk is not sick. Being intoxicated with no other medical/traumatic complaint does not in itself
constitute a medical emergency. Yet how many times in medicine have you been called to transport a person who you have assessed to be merely intoxicated? Here is a post we did just about this subject where we ask… why is there no pub in a hospital? Drunk is not sick.
Please let others in EMS/Fire and ED nursing know we exist. Ask them to visit www.dt4ems.com.
