Real World Skills for Scene Safety: Part 1

DT4EMS emphasizes recognition, avoidance and escape from violent situations.

The first in a series on defensive tactics for EMS providers. To view an interview with the author, Kip Teitsort, on his DT4EMS training, click here.

The EMS community started 2009 with the murders of two providers and a lot of press regarding scene safety. On January 17, EMT Melissa Greenhagen, 37, was shot in the chest by a stranger outside a hospital in Glasgow, MT. Then, 13 days later, EMT Mark Davis, 25, was fatally shot during a response to a private residence in Cape Vincent, NY.

It is a tragedy that the deaths of these comrades did not receive more national attention. But to many, it comes with the territory. Even when EMS providers aren't gunned down on duty, they face daily threats of abuse and assault from patients and others. Days before Greenhagen's murder, the Edmonton Journal reported a patient pulling a loaded gun on paramedics in the back of an ambulance. One medic, according to witnesses, had to run from the vehicle and hide behind a fire truck. The providers did not receive any physical injuries, but likely endured a large psychological impact.

According to a 2005 NAEMT study, the No. 1 injury to EMS providers is assault, with 52% of those surveyed saying they'd been attacked on the job. According to Brian Maguire, DrPH, MSA, a clinical associate professor at the University of Maryland, Baltimore County, who studied the issue, "The risk of nonfatal assault resulting in lost work time among EMS workers is 0.6 cases per 100 workers per year. The national average is about 1.8 cases per 10,000 workers per year. So the relative risk for EMS workers is about 30 times higher than the national average."

The problem is also bad for hospital workers. In 1999, the Bureau of Labor Statistics estimated that 2,637 nonfatal assaults occurred to this population--a rate of 8.3 assaults per 10,000 workers. This rate is significantly higher than the rate for other private-sector industries, which is around 2 per 10,000 workers. Healthcare providers are more likely to be assaulted on the job than police officers or prison guards.

The Occupational Safety and Health Administration (OSHA) has identified violence in the medical setting as a potential hazard, and found the training of medical staff to identify and deal with potential violence ineffective. The Emergency Nurses Association (ENA) notes that "Healthcare organizations have a responsibility to provide a safe and secure environment for their employees and the public," and that "emergency nurses have a right to take appropriate measures to protect themselves and their patients from injury due to violent individuals."

But no matter how many studies are conducted, there remains a reluctance on the part of EMS agencies and hospital administrators to provide training to effectively address workplace violence. Some may not recognize the extent of the problem, and thus don't perceive the need for training personnel in basic defensive measures. Some erroneously perceive using defensive tactics as fighting, or a form of aggression/offense. Whatever the reason, it poses a problem: If a person is not trained properly to respond to acts of aggression, they will respond to them, when they occur, with "caveman" style tactics that can be inappropriate, excessive and difficult for an employer to legally and morally defend.

Defend, Escape
Proper instruction in basic personal defensive measures makes sense for emergency medical providers and organizations that employ them. Our company, Defensive Tactics for EMS (DT4EMS,, was created by EMS providers to train prehospital and emergency department personnel to recognize, prevent, avoid and escape physical assaults. Our primary focus involves physical measures for self-defense and the repulsion of attacks, with additional focus on areas like verbal skills, the legal, moral and ethical aspects of self-defense, and good documentation for protection after the fact.

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