The second in a series on defensive tactics for EMS providers. To view an interview with the author, Kip Teitsort, on his DT4EMS training, click here.
In last month's introduction to DT4EMS, we outlined six steps that form the basis of its defensive approach:
- Don't be on an unsafe scene --This is of course not always possible. Providers are often assaulted on scenes they thought were safe. It is important to stage appropriately and have law enforcement dispatched with callers or addresses known or suspected to be prone to violence.
- Awareness --Providers must be aware of their surroundings. Be mindful of who's around and pay attention to the little things: What is being said? What are people's moods? Where are the exits, should the scene become unsafe?
- Maintain a safe distance --If a scene starts going south, a provider should keep his/her hands up and open (a posture of nonaggression) and back away to about 6--8 feet, if possible. This body language makes it clear the provider is not the attacker and not looking for a fight. Verbal skills are important at this stage, when words can still defuse a potentially violent situation.
- Double tap parry --The DTP is the primary physical skill taught to defend against the majority of frontal attacks. It has three overlapping parts: the parry, momentary elbow control, and distraction. The DTP can be used in a variety of situations toward the ultimate end of escape.
- Basic ground defense --If the DTP fails, contact (punch, grab, push, etc.) is made and the provider is knocked to the ground, BGD tactics can keep an attacker from mounting (straddling) the fallen provider.
- Escape the mount --If a provider is knocked down and mounted by an attacker, this teaches them how to escape and use BGD to create space.
In practice, the goal of each of these steps is to get the provider back to the step before, and ultimately return them to step No. 1, and get them away from an unsafe scene. There is no perfect system for self-defense, but these six steps represent a proven framework for improving your chances of deterring/repelling an attack and coming home safely. Now let's discuss each of these steps in greater depth. This article will address the first three. These steps work together in prevention of an assault taking place, so even though they're listed separately, they may happen within seconds--almost simultaneously.
1) Don't Be On an Unsafe Scene
When I started in EMS back in the early 1990s, I was told, "Don't be on an unsafe scene." My instructors would tell a few anecdotes and discuss some very basic awareness skills. They'd teach us to stage at a safe distance and have law enforcement dispatched. They said little, if anything, about tactics for recognizing, avoiding or actually escaping from violent encounters. Yet most injuries come to EMS by way of assault.
EMS providers are trained to not enter scenes they know to be unsafe. When there's a question, it's routine to have law enforcement dispatched to secure the scene and notify EMS when it is safe to enter. This process is usually handled by dispatchers who are trained to identify the nature of calls. They may automatically send officers for situations like deaths, assaults, domestic incidents, emotional/psychiatric disturbances, etc. With others they may not. If you have a concern about a scene and dispatch doesn't advise you that law enforcement is on scene or en route, ask for it.
Once on scene, identifying patients or bystanders who could pose a threat can be challenging. Many patients are rude or difficult without being potentially violent. The EMS provider must do his best to distinguish between patients who are merely combative, uncooperative or confused, possibly due to medical causes, and those who are aggressive and potentially dangerous, due to alcohol, drugs or other reasons. Being able to tell the difference means knowing when a scene is becoming unsafe and it's time to leave.
With every potentially violent subject, there are some simple questions to help you determine what you're dealing with:
- Is this person trying to hurt you? This seems simple, but all too often EMS providers, erring on the side of compassion, stay too close, too long to attackers. Paying attention to your gut feeling will help keep you safe.
- What is your perception of any movements directed at you? Are you afraid?
- Why would they try to hurt you? Could their actions be the result of injury or illness, such as head trauma, blood sugar problems or stroke?
- What words accompany their actions? Physical aggression supplemented by verbal threats or abuse makes it easier to distinguish likely attackers.
If you find yourself on a scene that begins to go south, your situational and personal awareness needs to kick in. Think of this as training the brain. Specifically you need to be aware of several things:
- Where is my exit? Is it clear of obstructions (bags, stretchers, people)?
- Did I check my attitude at the door? (Machismo is a problem!)
- How many people are in the room?
- What room are we in? (Bedrooms and kitchens are where most weapons are located.)
- What is the mood of people involved?
A useful tactic in controlling scenes is to ask for "help" from a family member. Having them involved in caring for their loved one, if and when possible, can help them feel needed and like part of the care team, rather than opposed. Assign them trivial tasks that seem important.
If you become uncomfortable with your surroundings on a scene and feel the need to exit quietly, without inciting more trouble, have a code word or phrase known by all members of the care team. You may have more than one, to indicate different levels of perceived danger and urgency in exiting. Calmly tell those present that you and your partner need to retrieve some equipment from your ambulance.
3) Maintain a Safe Distance
If mistakes are made and you end up on an unsafe scene that you're not aware of in time, training to work Step #3 (the safe distance) into your daily routine will help you get back to the previous steps and out of harm's way.
Maintaining a safe distance depends upon the threat involved. For a person who's unarmed, a common minimum safe distance is 6--8 feet. You obviously can't assess a patient from such a distance, so this relies on your ability to distinguish patients in need from potential attackers. This judgment should be part of your initial arriving overview of the patient and the scene. Really, you do it already: You size up scenes upon arrival and look for environmental threats to you or the patient. Extend that critical eye to the possibility of attack by the patient or bystanders. Assess for your own safety as much as for that of those you care for.
For a subject who's armed, the minimum safe distance increases. A general rule is at least 21 feet for someone with an edged weapon. Distances for firearms are much, much greater.
Remember that cover and concealment can increase safety as well. The difference is important: Cover will stop bullets, concealment will not. As you arrive at scenes, make looking for both part of your routine. Things like large trees, telephone poles, other buildings and the engine block and front wheels of a vehicle are good cover. Concealment could be bushes or a vehicle door.
Park your vehicle so you can make a fast getaway if needed. Again, this has to become habit. Don't block the front of your vehicle in so you cannot pull forward. Backing takes too much time.
Employing these strategies on every call, every time will help you act appropriately when trouble actually arises. These first three steps can help you prevent an assault from ever occurring. That's always the preferred outcome; DT4EMS has nothing to do with training EMS providers to fight. Fighting is hard, but self-defense doesn't have to be. It can be as easy as getting off an unsafe scene (that is to say, back to Step #1).
When the six steps of DT4EMS are followed, it is clear to see it they represent tactics, not techniques. Though most attacks on EMS are not life-threatening, some are. The EMS provider must have sound tactics, not just fancy techniques, in order to respond to all levels of attacks.
In our next installment, we'll cover the double tap parry--the primary physical skill taught to defend against most frontal attacks.
Kip Teitsort is the founder of DT4EMS. He is a veteran paramedic and police officer who is experienced as an EMS educator and a certified law enforcement defensive tactics instructor. Kip continues to train in several martial arts, including Kali/silat, submission grappling and kickboxing. Kip is a featured speaker at EMS EXPO, scheduled to be held October 26--30 at the Georgia World Congress Center, Atlanta, GA. For more information, visit www.emsexpoevents.com.