Pressure Points, Paramedics, and Combative Patients

Pressure Points, Paramedics, and Combative Patients


Hook, line, and Sinker!

As a young cop, I was introduced to a formalized suspect custody/control program. It was widely taught in law enforcement academies, and touted as amazingly effective. Being the perpetual martial arts white-belt, I jumped at the opportunity to train. I later became an instructor in the system.

During the instructor training, I was amazed at the level of pain I would experience from each and every pressure point. With seemingly little effort on the part of my partner; a little pressure under my nose, a slight dig behind my ear, or under the jaw, had me squirming away from the pain. Better yet, I would “comply” with any command the other officers in training would give. So, started my fascination with pressure points… Heck, I wanted to be a Dim Mak Death-Touch Master. I mean, after how effective the pressure points were on me during the instructor training, there would be no need for other stuff, right? No need for punching, kicking, pepper spray or baton strikes, I thought. Yup, I bought in! Hook, line, and sinker. (This too was during the time I believed my Karate and Tae Kwon Do training would help me against a skilled grappler, knife-fighter, or the bad-guy with a gun.)

Streets vs Classroom

If only there were videos captured, with me providing the verbal play-by-play, my thoughts of disbelief each time attempts at pressure points failed on the street. Like a skipping record, I would repeatedly attempt the pressure point. Each physical attempt was accompanied with unspoken words of inquisition: Why…*Press*… Is….*Press*… This…*Press*… Not…*Press even harder*… Working?! I found myself in a cyclic disbelief. After all, they worked so well on me during class. **Only after researching OODA (our R.A.C.E.) process, did I understand why my actions and thoughts were like a marble on an antique washboard).

As with many of my police officer peers, it didn’t take long to recognize the harsh reality of pressure points: Their use for pain-compliance only works when a person feels…pain. Personally, on several occasions, I would employ a perfectly placed, well executed pressure point technique, only to find it fail. Matter of fact, sometimes the very attempt made the use-of-force situation worse. It became apparent, some of the things that worked in the classroom didn’t work on the street. Thus, began my search for the truth about pressure points. How effective were they really for arrest/subject control or compliance? What about for self-defense?

Guinea Pigs

In addition to my own street-level research, and martial arts training, I started using DT4EMS classes to test my theory. Over the years, each DT4EMS class I taught became the proverbial Guinea Pig, for the one that followed. The idea being, I always want the content to be relevant, and effective. In order to do so, content has changed over the years. Thus, pressure points that were an early part of our growth/learning process, have since been completely removed from our teachings. Why?

While I am certainly a person most pressure points work on, my brother feels literally, none. On average, during a DT4EMS class, we found 60% of any group, had one or more of the pressure points prove ineffective. The participants were sober. The environment, a comfortable classroom setting.  Not at all reality, where the aggressor one is pissed off, and/or intoxicated to a point where their pain threshold is increased, or worse, non-existent.

As the evidence mounted, pressure points went from being presented as a part of DT4EMS for use as a self-defense option, to one of allowing participants to witness the high probability of failure for themselves (with no mention of our findings until AFTER they practiced). Not long after that transition, pressure points were completely removed from our classes.


  • The overwhelming majority of assaults on EMS/ED staff are by persons under the influence of drugs or alcohol.
    • Intoxicated aggressor’s pain threshold may be increased or non-existent.
    • The attempt of pressure-points may actually worsen the situation
  • With the likelihood of success in question, what will the defender do, if/when a pressure point fails to achieve the desired result?
  • What is the reason an EMT, medic, or nurse would use a pressure point?
    • To gain compliance for medical treatment? Is the use of pain as a compliance tool a recognized form of medical treatment?
    • To escape a hold or grab?
  • Bite Defense:
    • Granny nibbling on one’s arm is significantly different than a dude high on bath salts in zombie-face-eating-mode.
    • Force-Feeding is a much more realistic, effective approach to mitigating the bite than an attempted pressure point.


I have learned a lot of personal truths over my lifetime. Truths revealed by being the constant student of martial arts and human conflict training. The most important truths obtained from having my ass handed to me by skilled individuals. They were more than willing to teach me the truth about what I thought I knew: The truth my striking arts were of little use against a semi-trained person armed with a blade; The truth my basic 10 submission moves would protect me against a BJJ white-belt with solid fundamentals; Having a concealed weapon would be the answer to all my problems…my list of truths go on and on.

Point is, I was blessed to bleed in a gym on a mat, and not the side of some damn dirty road. Each time I would be, and continue to be, schooled… it made me hungry. I took the lesson(s) in losing. Loosing caused that hunger for more knowledge and better skill. Truth fed my desire to get better. My truth, that very personal truth, came from losing during training, and realizing no matter what… Prevention is best. Prevent using force when possible, because the people who truly schooled me didn’t fit the “look”. Because everything changes upon first touch, and the bad guy didn’t come to class to learn “how to attack” so you could defend… 

Not a single other person faces use-of-force decisions, the healthcare provider must, while on the job. You have a choice to train with us or not. I completely respect that fact. However, always seek the truth in training, especially when your reputation, career, and possibly your life depends on it. It is my belief that pressure points should be reserved for use as nothing more than a distraction. Even then, they are risky to employ.