Violence- Duty to Act?


When the NAEMT posted the results of a completed study/survey, I found myself bewildered. The results of the study revealed the number one reason for injury in the field (52%) was due to assault, but only 21% of EMS felt their personal safety was an issue. Yes, I realize more have DIED due to ambulance crashes but many, many more are injured due to assault. An assault may leave a lasting psychological injury to a provider that lasts significantly longer than the physical injury. I say that not all assaults are life threatening, but they are all however, life changing.

There has been study after study showing safety concerns for EMS providers yet only a small percentage of EMS Providers believe they will ever get hurt on the job. Why is it personal safety is put on the back burner? With this lack of personal safety concern, providers put themselves in places/situations they should not go into or remain upon. That I believe is the big question and I will attempt to share my perception on “why”.
I started trying to look into specific reasons “why” EMS Providers do not rank their personal safety as high as they should. I have heard many anecdotal stories and have some of my own but there is little media coverage of them. I believe that was a case of under-reporting the incidents. Then I looked at why EMS providers where staying on scene, or dealing with a person who was actively attempting to assault them. When I would ask providers “why”, I would be told they had a duty to act, that it was their responsibility to “protect the patient or others”.

Steve Whitehead does a great job with DUTY TO ACT. Notice at no time are you to place yourself in peril.

Let’s go back to EMS 101. You know the first few sections when you were in EMT and Medic school. You are told YOUR safety comes first. You are usually given some examples:
So, if a car was trapped in swift water with a man on top of it, holding his child and screaming for your help, and you were untrained and ill-equipped to make the rescue, do you have a duty to act there? The answer is universally accepted as “no”.

What if it is the hazmat incident where the semi is turned on its side with people down on the ground around it and you are not trained and have no hazmat experience, do you still have a duty to act? When I was in school, this was where the joke of the “Rule of Thumb” meaning if you could not cover the accident scene with your thumb, you were too close. So, again, no duty to act.

If the so called “patient” is 255 lbs of stacked muscle, and is high on bath salts, meth or just really drunk…….. and a family member called because he just wasn’t acting right, and needs stitches because he cut his hand on a beer bottle….. (and the “patient” screams “F- You Man” and tells you he doesn’t want treatment” …… Do you still have a duty to act? So you wouldn’t go over to the guy if he is still standing….. Because it is unsafe….. so why would you attempt to RESTRAIN him in the back of the truck if he wigged out during transport?

A friend of mine, a fellow use of force educator, Jerry MacCauley, sent me a book called “On Combat” by Lt. Col. Dave Grossman. While reading this book it became very clear. There is a chapter “On sheep, wolves and sheepdogs.” Lt. Col. Grossman writes how the average person is a sheep, unaware all of the day to day dangers. Then there are wolves, the criminal element, always looking for their prey and there are sheepdogs (protectors)……….. always seeking to protect the sheep. Ta-Da! That strong sense of duty! That’s it!!!
While reading “On Combat” it hit me like a freight train. The main reason the average EMS Provider does not rank their personal safety as high as they should is they are a Sheepdog! They are willing to put others before themselves just like our brave military, police and fire personnel.

This sheepdog mentality comes with a caveat for EMS. Unlike police, fire and military, EMS providers do not have the same level of personal safety training. Think of the bravery of a fireman at the scene of a structure fire, does he enter without all of his gear and a way out? What about the police officer going to the shots fired call; does he go without his tools? What training do soldiers receive and tools do they carry into battle? These other protectors have tools and training to help them in their quest to help the masses, what does the EMS provider (protector) get?

Since there has been a fundamental lack of training on this subject, EMS has learned “tactics” and “techniques” from brethren law enforcement  This has led to providers attempting to use mechanics of arrest and control for situations that are possibly legally compromising and more often than not….just plain dangerous.

Cops don’t like to roll in blood. Firefighters don’t rush toward bullets and cops don’t rush into burning buildings. Each puts their own safety secondary when reality strikes. EMS and healthcare are NO different in their strong sense of duty! That is why only 21% of EMS feels their personal safety is an issue.
So it all boils down to training. EMS really “get it” when it comes to patient abandonment, because that is drilled into them in school. I can’t recall the last media report I read of EMS sued for abandonment. However, there is no standardized training for how to deal with violence and the frequency of reports of staff assaulted are staggering. Ironic right?

Once we change the safety culture and the medical community understands when it comes to violence, and you are in perceived danger, you have no “duty to act”.