We Expect Critical Thinking in Medicine…for Everything BUT Violence

Critical Thinking

The De-Training of Emergency Medicine regarding Use-of-Force on the Job. 


EMS/Fire and emergency nursing staff are expected to have critical thinking skills with regards to patient care. We need them to perform under stress and make split second decisions. We have this expectation because they are trained to handle these High Stress Events. However when it comes to the staff member being assaulted, there is a blanket expectation they respond “appropriately”. How can a staff member respond appropriately if they have never received training ? Here is the deal…  Violence against staff is a real problem and many ignore the fact it exists.

You can read many more by visiting our Assault On Staff Log. (You will have to register, it’s free.)



Current standards regarding  training for the violent encounter (on-the-job) or the lack of it is why our DT4EMS instructors have to spend so much time de-training experienced medical staff across the country.

One of the biggest de-training hurdles is custody versus care. Some agencies have hired local law enforcement police defensive tactics instructors to teach staff. While we applaud the agency for recognizing the need for training, police style techniques really have no place in the medical field. The problem is intended goal. A police officer’s intended goal is custody/control. Many times this involves techniques that require an officer to remain engaged in the conflict and the use of “pain-compliance”. Then the officer has tools (Taser, OC/Pepper Spray/Stick/Baton/Firearm) for if empty hand pain compliance fails.

In medicine we got into this job to care for the sick and injured. We are not focusing on custody/control.  We work on “consent” of a “patient”. What patient is going to consent to “pain” to be treated? So we are supposed to beat people into our ambulances or fight them to stay in our ER bed? Before you laugh too hard, or take too much offense…. Watch what this quick clip and see if you pick up on what some staff do….


Did you see the medic punching the guy while he was still in the car? What about the firefighters kicking the guy on the ground? You can see more here: Look at what these providers do in these videos.


The next part we have to de-train medical staff is when an agency has brought in a martial arts expert to train staff. Again, kudos to the agency for recognizing the “need” but if not trained properly, the intended goal/outcome is not what medicine needs. For instance, most martial arts train to win via submission or knockout.  Bringing a warrior “kill or be killed” mentality to medical staff clouds the staff’s judgment.

Since there is already confusion in the medical community about “patient vs attacker” if staff is not trained to recognize the difference between them, will they be “choking out” or attempting to “knock- out” patients?

How do we at DT4EMS know there is a difference in how we train medical staff? Well, many of our certified instructors across the country hold black belts in various arts. Some teach at their own schools but are also in EMS/Fire or hospitals ED’s. Then we have several who are currently certified or former law-enforcement. Again, we study and recognize the difference.

A lot of administrators believe that simply telling their staff to not be on an unsafe scene is sufficient training for keeping staff safe. If simply telling people to “stage” for unsafe scenes was working….. Where are our staff being assaulted? That is correct….. on supposed “safe scenes”.

Since meeting Skip Kirkwood and sharing our DT4EMS message, he has taken the subject to the national level addressing it with administrators. Here are three articles he wrote addressing the need for training staff.

EMS Providers Need Scene Safety Training  “One guy who’s doing something about this issue is a gentleman named Kip Teitsort, a paramedic-turned-police-officer-turned-educator out of Norwood, Mo. Tietsort runs an organization called DT4EMS (Defensive Tactics for EMS). He’s developed a variety of training programs, the most recent of which is EVE (escaping violent encounters) for fire and EMS personnel.

Since starting his training effort in 1997, in partnership with an EMS medical director, Teitsort has trained hundreds of EMSers in personal defense and has trained instructors who are now embedded indozens of EMS educational institutions and EMS agencies. The course includes not only physical skills but also the whole continuum, from mental preparation and situational awareness, through the violent encounter, to proper documentation of the event and managing the possible aftermath (the media and the courtroom). The course is oriented toward the “average EMSer” who doesn’t want to become a martial artist but who does wants to be safer on the street, at the scene and in the ambulance.” EMS Providers Need Scene Safety Training

Scene Safe Mantra Provides EMS Danger “It’s become a mantra: “Is the scene safe? BSI in place?” Once the answer is determined, a course of action follows—either we go about our business with an assumption that we can not be hurt, or we vacate the scene. This is easy to test, and unfortunately, has become embedded in the culture of EMS. It’s also dead wrong—and presents the possibility of paramedics (of any level) getting hurt because they are not sufficiently aware, or sufficiently trained, to deal with the hazards they may encounter.” Scene Safe Mantra Provides EMS Danger

It’s Time to Stop the Violence “Many agencies have cultures that accept, and teach new members, that paramedics are punching bags. This is wrong. It happens through a combination of peer interaction, policy and practice that teaches paramedics that it is better for them to “absorb the hit” and carry on, regardless of injury or indignity, than it is to report the violence and encourage prosecution.” It’s Time to Stop the Violence

Here are list of problems that all have a common thread, EMS/Fire and healthcare professionals attempting to handle issues as “patient care” that may not be an actual medical condition.

1) Officers turning over people that should be placed into “custody” to EMS/ED staff  without police escort.-  The ole’ “You can go to the hospital with them or to jail with me” statement.

2) EMS restraining (or attempting to restrain) people they should not- Simply because a person is “high” or “drunk” does not automatically make them a patient. Drunk is Not Sick.

3) Patient or attacker– A lack of fundamental understanding of the difference can have dire consequences on both real “patients” and/or staff.

4) Policy conflict (either written or simply an unwritten “Unofficial Training“)- There is a ton of information and policies regarding “patient safety” but little if any on provider safety, particularly with regards to violence directed at staff.

5) Front line staff are wanting to carry guns, yet administration does not see a need for self-defense training for on-the-job.

6) Without formal training, staff are jaded.



The solution to these problems is training. Get your people the critical thinking skills they need so they don’t make mistakes like the ones pictured below. Lord knows in medicine, when we are the vitcim….. it is not considered news….. but let someone in medicine make a mistake or commit a crimes and it is headlines! Look at what these providers do in these videos.

Training the emergency medical community in the use-of-force for self-defense is unique. It is unlike any other profession. No one else has to make a split-second decision about using force regarding a patient or attacker. They must be trained in four equally important areas; Mind-Street-Media-Courtroom.


The caveat is the training must be multi-disciplinary involving law enforcement, EMS/ Fire, hospital staff and local prosecutors. Only with this approach will the supervisors of each agency show a cooperative stance to safety of all involved.