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.