Neutrality Lost? Is that why violence is rampant in emergency medicine?


* I wish a blog post about the use of force on the job could be short, without hyperlinks. The truth of the matter is the subject is not only large in scope, but deep in the need for understanding it is more than just “technique” involved. –Kip

Have we have lost our “neutrality” in emergency medicine?

In 1864,”12 governments adopted the first Geneva Convention; a milestone in the history of humanity, offering care for the wounded, and defining medical services as “neutral” on the battlefield.” –Source

If emergency medical staff were seen as “neutral” since 1864, what happened to change this perception? Why are we so often faced with the threat of violence in emergency medicine? Everyoneinmedicalservices

There is no denying violence against medical staff is an epidemic. Period. Just look at the videos here The question is what have we done to fix it?

With so many studies proving workplace violence (The Elephant in the Room) directed at medical staff is an issue what happened? Why are we so victimized?

A big part of the reason, in my opinion, is we have lost the true perception of neutrality. Not only by the public at large, but by us, within our own culture.

The recent news of gang members targeting EMS in New Jersey, in my opinion, brings my point to light yet again. We must change the culture in emergency medicine when it comes to safety and the use of force on the job.

Look at how law enforcement agencies, using social media are trying to win back the hearts and minds of the public by showing videos and stories of police officers doing kind things for various citizens. All while in emergency medicine appears, in social and mainstream media, to be spiraling out of control. We are  all familiar that perception has little to do with right or wrong…it is something personal.

With no formal training on the use of force, medical staff had no choice but to learn by watching what police officers (those trained in the use of force) do in the emergency department and/or on the street to “control” someone they were taking into custody. This type of on-the-job learning has led to:

  • Disorganized, chaotic, caveman style techniques applied in an emergent situations
  • Medical staff using force without understanding force options
  • Staff standing/talking and physically acting like police officers
  • When physically acting like police officers during a use of force encounter, police officers gain a mistaken belief medical staff are trained in the use of force
  • Staff taking a form of “custody” mistakenly believing it is “care
  • Without support from administration, lack of overall training, staff become JADED

Each of these leading to a lost perception of neutrality by both medical staff and the public. For proof watch video clips and read news articles here.

When it comes to the use of force in medicine, we are unique. No other person has to decide patient or attacker in a split second before using force. Not a person walking in a park, not a police officer, not a bank teller, a big-box store employee or a convenience store clerk… no one but those in emergency medicine.

With the lack of training, there are no critical thinking skills afforded to staff. This has led to dire consequences like you observed in the videos above.

We may, with a little hard work on our part, gain back a perception of neutrality both by ourselves and the public by thinking of a swimming pool and how that pool is actually good customer service.

When I was a kid growing up in South Florida, we had a sign like this on our deck by our pool:

What I would like people to take away from this is: Every person we come in contact with, while on the job, is a potential member of the Jury Pool.

When we lose neutrality and are perceived as an extension of law enforcement (either by ourselves or the public) a very different standard of perception/judgement will be applied. Not necessarily just in a court of law, but in the court of public opinion as well. Both are equally important and it is imperative with win both.

If a person has only one contact ever with EMS/Fire or emergency department staff, they will base their personal opinion on how they were treated. If treated kind and with neutrality that is what they will perceive all healthcare providers as being. If treated like a criminal using custody/control/pain compliance, that is what they will recall. Imagine going to court (actual or that of public opinion) if you, as some form of healthcare provider were involved in a real self-defense case as the providers where treating you like the ones here:Prepared

Likewise if a person is seated on the jury pool and has viewed comments like the ones above ( from medical staff) what is their perception of ALL medical staff?

Because I have worked in urban and rural EMS combined with travelling the country and meeting the amazing people I have, I understand “why” medical staff respond the way they do both in real life and in social media. Having this understanding gives me a pretty good insight into what the problem really is and the actions we can take to solve the riddle and fix the problem.

By using Good Customer Service, we can start to win back the hearts and minds of the public. We can strive to get back to being perceived as neutral. Until then, staff must be trained in what is reasonable when using force on the job  ,  defining the difference between a patient and an attacker , getting real support from administration and getting back to why we started in medicine to begin with… being the perception of being there to help the sick and injured- not the perception of ” beat people into submitting to our care”. At no time am I asking healthcare providers to be victimized by criminal activity, which is why we teach reasonable tactics and techniques of self-defense.  I am however asking staff to not treat system abusers or those who have not committed a crime, well, like a criminal. Good customer service, is an amazing self-defense tactic for use on the job in emergency medicine. 

Essentially I am asking people to not pee in the pool, the jury pool that is. By being nice, but prepared to use force if/when needed “reasonably” and using good customer service, you know caring for the sick and injured- the stuff we got into emergency medicine to do in the first place, then we may be able to gain back the neutrality for those who follow us into the field.