Hurt, Hacked-Off….and Fiercely Motivated!

The stories of providers injured due to violence on the job have broke my heart, hacked me off, but most importantly have motivated me.
I have personally spoken with hundreds of providers from EMS bases, fire stations and emergency departments across the country. All who have a story that has either happened to them or someone they know.
Let me share one I got in a hallway while teaching DT4EMS’ EVE recently.
For the sake of this story we will call this Paramedic “Jack”. Jack starts his story by telling me he was dispatched to report of a psychiatric problem. Upon his arrival he finds  it’s a young 18-year-old girl having some behavioral issues. He stated his mind first looked at the seated girl and thought “ wow she looks like my daughter”, so he casually goes over and using good customer service, put his hand on the girls shoulder. As he does this and starts to speak to her, without warning, she kicks in the testicles. Shocked and in pain, he bends over covering his testicles with his hands (like any man would) then he noticed in a split-second his mind said “she’s trying to cut my throat”.
Jack instinctively takes his hands from his groin area and covers his throat (as he demonstrated the universal sign for choking) just as he does this her hand bounces off one of his hands and then gashes him from his ear to his chin, opening him up into a bloody mess. In this hallway I can see written all over his body language and his face it’s painful for him to discuss the attack. It is like he believes it attacks his manliness. I hurt with him when he told me the story.
The part that angers me at first, then motivates me, is when he proceeds to tell me how he feels that we (DT4EMS) are the voice of the victims and that nobody listens to these types of stories that go on in medicine. You see, I hear these all the time, all across the country yet there is still no universal, across the board “change” in the way we train staff before they are ever released into the field. . Well, the truth is not every assault on EMS or fire is life-threatening but they all however are life-changing.

Every truth passes through three stages before it is recognized. In the first, it is ridiculed. In the second, it is opposed. In the third, it is regarded as self evident.” – Arthur Schopenhauer
For the first 10 years I taught our version of EMS Self-Defense, people made fun of me. I was laughed out of multiple EMS forums. I was even call a fear-monger for posting studies and news reports of assaults on staff. Now for about the last six years…….. We have turned many of them into believers, but we have still not seen real change in the implementation of real training.

Here is why I believe there is such a resistance to change the way we train:

1) Lack of mandated reporting– Staff are trained to report any injury (needle stick, back injury, cut finger on a call etc) so those injuries are “acceptable” to report…
But since assault reporting is frowned upon (especially in-hospital) assaults go way under-reported therefore injury data from places like Bureau of Labor Statistics is grossly low.
2) Part of the job mentality– Violence directed at staff viewed by most as “just part of the job”- this again causes most assaults to go unreported to police for prosecution.
3) Mocking by senior of fellow staff—Since it is widely considered as “part of the job”, any attempt at a person wishing to pursue criminal charges is ridiculed.
4) Learning via Osmosis- working so closely with law enforcement, “techniques” (usually of the pain compliance type” have been observed/learned. This learned behavior is a double edged sword. Cops begin to think providers have more training on “subject control” than they do. Then the other part……… medicine works under “consent” not “control” like law enforcement.
One of the things that I have found interesting in trying to share our escaping violent encounters courses since 1997 is the lack of recognition of the real dangers that the provider faces on the street as it pertains to violence. I used to wrestle with this trying to understand why it was so difficult to bring such an important subject to group of individuals that didn’t really understand that they needed some training.

So even though I understood a need for change from my own experience there needed to be some more type of data to back it up. In 2005 when the NAEMT and McNeil pharmaceuticals released the study of injuries on healthcare providers it started to stand out a little bit more. The leading cause of injury per NAEMT study was due to ASSAULT. With 52% of providers admitting to being injured due to assault. But back injuries were 47%.
The interesting thing is that the providers asked about personal safety as a concern and only 21% responded is the personal safety was it was an issue. So the question becomes why is it that the leading cause of injury per the NAEMT study was a 52% yet only 21% believe their personal safety was an issue. I believe the answer lies in initial training. When a EMT or paramedic or firefighter first enters into school they are trained that their safety is most important, however then a great deal of time is spent on patient abandonment. With little more than lip service paid to violence recognition/prevention/escape scenarios or training.

I find two things pretty common in our course evaluations……. One is a statement we have read hundreds of “Everyone should have this class” and the second is “Why didn’t they teach us this in school”.
We have broken the mold with our training. We refuse to teach how others have. The people that have taken our course have fun but gain real-world skills.
If you are nervous about training with us, ask people who have trained with us. Then you will see we are truly different. The attitude is about YOU not us. We want you to be empowered, not to look at us and think “wow, they are good”.
So, until there is a real change in training….. I will continue to cry with those who cry, then I will get hacked off……. And even MORE motivated…… but I’m not alone!

In any situation, the best thing you can do is the right thing; the next best thing you can do is the wrong thing; the worst thing you can do is nothing.” – Theodore Roosevelt
Until next time!!
Kip Teitsort
Saving Yours, While You Save Others