Jeff McMullen, Denver Health

As most of us are aware, violence directed towards EMS and in-house healthcare workers is on the rise. It has long been recognized as a risk among the line providers in both urban and rural systems. Sadly, we also are aware that most of us are woefully under trained in both awareness and how to respond when it comes to this problem. More frustrating is the fact that it is rarely recognized at all by those who hold sway over the decision to prepare for it. Even those who do recognize the problem often seem to be hesitant when it comes to the need to prepare for the eventuality of dealing with hostility or being assaulted while on thejob. As a medic in a high volume urban 911 system I have been afforded the privilege of being assaulted more than once during the last 17 years. Although I have always tried to exercise the greatest caution when dealing with potential violence or dangerous scenes, you can never have enough tools when it comes tokeeping your hide intact, and when someone comes along with superior tools to do so, you should give those tools (and that person) some serious consideration.

I have recently returned from the 40 DT4EMS Initial/Instructor course in West Virginia and think the experience merits some appreciation. The class was broken down into two parts. The first two days (16 hours) were the Escaping Violent Encounters (E.V.E) Initial, this amounts to what is basically your entry level “provider” course. The following three days were the 24 hour Instructor Candidate course. This allows those who have successfully completed the 24 hours to teach the program at their facility or agency under the close supervision of DT4EMS (more on this later). The class was scheduled for 40 straight hours, 0800-1700. We got out early a couple of days though, 1657 or so instead of the scheduled 1700. It was, without a doubt, a very busy and labor intensive week.

Days 1-2
E.V.E Initial
From the moment class begins you are left with no reservation whatsoever that Kip Teitsort (pronounced tea-sort) is passionate about keeping me, you andeveryone else on the job safe. The responses to attacks he teaches are simple, yet effective, and I feel they would be very helpful if you ever get on the wrong side of bad and find yourself in need of them. Some other “products” that are marketed for use by EMS are terrific in that if you are sued secondary to using them in good faith the international corporation behind them will gladly defend you in court (good luck even finding their website after years of use of said product though). One of the multitudes of great things about DT4EMS is this; the only way you can use the techniques is in good faith. There is no submission, joint lock, pressure point, blows to the lateral neck or anything of that nature that is used to control a patient or attacker. Nothing taught can be used punitively, even if youwanted to. All responses to attack are just that, responses to attack. There are no bastardized LEO applications that are watered down or abridged for use by EMS. Everything is geared specifically for EMS (although Kip is a cop, he also happens to be a paramedic) If someone tries to hit you, try not to be there, if you find that you are there, Kip will show you a thing or two about how not to continue being there. In my humble opinion, and I have some experience with this sort of thing, the techniques are just what we in EMS need, simple, effective methods of protecting ourselves if the wheels come off. Even after all the cool, effective and ridiculously simple responses to attack, that is not the best part of days 1-2.

If you were to break down acts of physical aggression into 2 parts, the 1st would be recognition or understanding that something is about to happen to you. The 2nd would be the attack itself. Kip would prefer you never get to step 2 and find yourself in need of a method to avoid a punch that’s already left the gate or someone wrapping their hands around your delicate throat. That’s what step 1 is all about, avoiding the conflict altogether. We all know that it is not always possible to avoid conflict, but given a few tools help recognize where conflict may lie or maybe something you personally can do to avoid sparking conflict goes a long way towards your safety. From pre-arrival things to consider to on scene indicators of potential violence to tips on speaking to people it is all covered. One point that I thought particularly valuable was Kip’s assertion that good customer service goes a long way to keeping yourself out of a drama. There is more to theinitial course that I have not touched on here such as loads of open source material proving there is a need for this training, behavior in the courtroom, mindset during violent encounters, but I am running out of typing steam and don’t wish anyone to be discouraged by the length of this post.

Overall and without a doubt I feel that this course is just about as good as it gets when it comes to preparing EMS personnel for violent encounters. Depending on the organization there are more than enough things we are required to train for that we will likely never encounter and yet those things are mandatory. After all, when was the last time someone was killed in a hospital fire? The last time I, or a co-worker, was assaulted on the street? That I can recall.

Days 3-5
E.V.E. I/C
After days 1-2 you have more than a solid idea what this is all about. You know that assault on EMS is very real. You know what you might keep an eye out for that might clue you in to a bad situation. You know that you need to be prepared for assault, you know how to speak, you know how to stand, where to stand, what is appropriate and what is not, and what to do if the above does not keep you out of the donnybrook. You also know how best to document assault, present yourself in court and loads of other useful stuff. What you may not have noticed during this time is Kip’s exceptional ability to teach you all of these things. I feel a bit red in the face that I did not notice how good he is until I had to put myself in his shoes. Now, don’t get me wrong, there was at no point any doubt about his ability to teach, it’s just that he really turns it up during the last 3 days. I have, or have had, an instructor cert for most things out there, not one of those classes holds a candle to the way Kip conducts his instructor candidate course. Although he was still a bit of a jokester, he was defiantly a different guy. If you were not getting something quite right he explained that to you, and he did it in a way that you felt really good about. On day 3 we got homework. You may have to teach chapter 3 for instance, the rub is you don’t know which part of chapter 3. The next day he finds a spot somewhere in the ppt, calls your name and you get up and teach it. The class is given 5 or 6 points on which to evaluate you and when Kip has had enough you’re done. First the class is given the chance to discuss what was done well and what could have used some work. Then Kip gives you his ideas on what were done well and what might be improved. It seems that no matter how bad your presentation was or how much you need to work on, the praise always outweighed the criticism. When that bit is said and done he does some more lecture of the same topic explaining all the while what it is he wants to achieve and how best to deliver it. After the lecture portion you get to teach the class 1 or 2 of the techniques you learned during thin initial course. Again, Kip lets you go until you are done or he thinks it’s time to show you how to do it just a little bit better. This goes on for 2 solid days, all the while you are learning more about the tactics/techniques and how better to deliver the course. At the end of the I/C course I, and the fellow I traveled with decided that not only is Kip a top shelf instructor, but that it was the best instructor course either of us has attended. It is the only one I have been to where you have to prove that you can teach the content while making you more solid in the material all around.

Going back to the bit I typed miles ago about being able to teach the course under the close supervision of DT4EMS upon successful completion; I want to clarify something. Kip seems to be very particular about how you deliver the course content. In my opinion this has nothing to do with Kip. It also has nothing to do with his ego or any other perceived reason. I think the reason he maintains such tight quality control is that we deserve quality tools to keep us safe. It seems that Kipcould care less about Kip; he just wants us all to return home the same way we left. What this all boils down to is that I have not been involved in something so relevant in a very long time and I wish everyone felt the way I do. Thank you for your patience.

JEFF McMullen (Denver Paramedic Division