Safe Response to Incidents of Violence
Across the United States, acts of violence towards firefighters and medics continue to grab headlines. Regardless of where you work, you will likely face the challenge of responding to a critical incident that may include an act of violence towards responders at some point in your career. Violence can and does occur in urban, suburban and rural settings and these can include shootings, stabbings, domestic violence, and large crowds mixed with alcohol and assaults.
Increasingly Fire and EMS responders are finding themselves drawn into these types of events.
Please remember to follow local guidelines and procedures. This article is for informational and educational purposes only. For some responders this may already be a daily occurrence. For others, it may be a less frequent occurrence but nonetheless one you must be prepared for. Some recent events that have occurred:
- A paramedic with Madison County Emergency Medical Services in North Carolina was shot in the chest by a patient on Sunday night, July 30 2006.
- This past July, 22-year-old Maplewood Firefighter Ryan Hummert was fatally shot by a man holed up in a burning home.
- In September, D.C. Firefighter Hakim Carroll was shot in the arm as he and other firefighters forced entry into an apartment.
- Just last month, firefighters in Independence, Ky. were shot at when they arrived at a burning home where they found three family members dead.
- A sniper shot at firefighters and MAST (Metropolitan Ambulance Service Trust) EMS personnel in Kansas City, MO, while they were responding to a house fire. In that incident, a paramedic from MAST was shot and had to be rescued by firefighters in the midst of gunfire.
- In 2005, paramedics in Edmonton, Canada, were provided with bullet-proof vests to increase on-the-job safety.
- In Scotland, CCTV cameras have been installed on some fire engines in a bid to stop an epidemic of violence against firefighters and rescue crews.
- February 13, 2004, a female career Lieutenant was shot while attempting to provide emergency care to a civilian shooting casualty. The victim died from her wounds before rescue personnel could reach her.
It is always important to gain as much pre-arrival information as possible and to listen for key verbal indicators that may come across, such as the fact that this is a high violence area, you have been to a location before (bar or club), reports of shooting, alcohol involved, crowds, etc.
Upon arrival at any critical incident it is important to conduct a quick "windshield survey" even when a scene is said to be "secure." Typical procedures require that law enforcement is dispatched to any type of incident that has the potential for violence, but you may find yourself on the scene due to a wrong address, victims coming to you, or by discovering an incident suddenly.
Any type of violent incident (stabbings, civil unrest, shootings, etc.) should raise a RED FLAG for responders to be more aware of what is occurring prior to and during the response. When responding, get all the dispatch information you can. Look at the routes into the event. Survey the scene for a moment. Keep an escape route to get out of the scene quickly. Look at the area where you are parking and staging. Never hesitate to call for law enforcement assistance if you THINK you may need it.
This is a topic of increasing debate among the Fire & EMS community. Old "hand me downs" of body armor from military and law enforcement agencies may not always be the best choice, as the armor may be severely damaged/worn out and this practice could open your agency up to legal action in the event of a problem.
Some jurisdictions provide no armor, some provide all staff armor and others provide armor to only those Fire/EMS units that routinely respond to a large number of shootings, stabbings and other types of critical incidents. On the other hand, the cost of body armor is very restrictive with armor typically starting around $500-$800 per unit and higher. If your agency is looking into purchasing armor it is important to do careful research into the topic, as there are numerous types and levels of body armor.
Large crowds and Fire/EMS may not always be a good combination. When responding to acts of violence such as stabbings, shootings and assaults there may be a large crowd forming and at times the crowd can be hostile. When we are called and arrive on scene to be greeted to a large crowd it is usually not a good thing. Alcohol may be present in large groups and there is almost always an individual or individuals who believe that the responders are moving too slow or not doing enough for the victim or victims. In these types of situations the crowd may end up being a significant threat to you and your agency's safety.
Fire Fighter Fatality Investigation and Prevention Program
The National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program conducts investigations of fire fighter line-of-duty deaths to formulate recommendations for preventing future deaths and injuries. For additional information on the program see www.cdc.gov/niosh/fire. NIOSH released report FACE-F2004-11 which listed the following recommendations for Fire Departments involved in the responding to scenes of violence:
- Develop standard operating procedures (SOPs) for responding to potentially violent situations
- Develop integrated emergency communication systems that include the ability to directly relay real-time information between the caller, dispatch, and all responding emergency personnel
- Provide body armor or bullet-resistant personal protective equipment; train on, and consistently enforce its use when responding to potentially violent situations
- Ensure all emergency response personnel have the capability for continuous radio contact and consider providing portable communication equipment that has integrated hands-free capabilities
- Consider requiring emergency dispatch centers to incorporate the ability to archive location, or individual, historical data and provide pertinent information to responding fire and emergency medical services personnel
- Develop coordinated response guidelines for violent situations and hold joint training sessions with law enforcement, mutual aid and emergency response departments
Please remember to follow local guidelines and procedures. This article is for informational and educational purposes only. Some basic guidelines for Fire/EMS responders when responding to suspected or confirmed incidents of violence:
- Stay alert to your surroundings at all times, maintain "situational awareness."
- Conduct a complete scene size up during your "windshield survey."
- Maintain a good working relationship with law enforcement and utilize a "Unified Command" approach to these incidents when possible.
- Look for places to take concealment and cover if needed. Cover may protect you from bullets and thrown objects, while concealment hides you without offering any real protection.
- Work with the family/friends of patients (understanding where they come from, but still being capable of doing your duties).
- Always operate in two-man or "buddy teams" during these types of situations.
- Stop and take a look at suspicious vehicles, occupants/contents.
- Stop and look/listen before entering a suspicious situation, residence or structure.
- Do not rush through the door of a residence or structure to assist a shooting, stabbing or assault victim. Conduct a quick scene survey.
- Recognize when verbal abuse could possibly lead to violence.
- Learn how to avoid violence and how to react when and if it occurs.
- Remember that dispatching information is not always correct or may be very vague due to the information the communications center is receiving.
- Note that a person who is intoxicated may confuse firefighters/paramedics with police officers.
- Park past the location when responding, which allows you to see three sides of the structure.
- Consider that in some areas, leaving flashing lights on can draw a crowd.
- Constantly maintain a sense of caution when dealing with suspicious individuals or situations.
- Firefighters and paramedics should have access to body armor if responding to high-risk areas or situations.
- Know your department's guidelines for if you find a weapon on a patient or if a patient becomes combative in the back of your unit.
- Caution should be used when responding to clubs, barrooms and large crowds mixed with alcohol. Especially the local "stab and jabs."
- If you arrive on the scene of an incident and the people you make contact with are belligerent, intoxicated or violent you are not obligated to enter the scene until it is secured by law enforcement.
- Be aware of booby traps and improvised explosives devices (IED) in questionable surroundings such as clan labs and indoor marijuana sites.
Responders should always stay alert and be safe!
Resources for Additional Information
- First Responders Critical Incident Field Guide, August Vernon, Red Hat Publishing, 2008 www.redhatpub.com
- When Violence Erupts, Survival Guide for Emergency Responders, Dennis Krebs, Jones and Bartlett Publishers, 2003 www.medicsurvival.com/
SAFETY is paramount for all responders during these types of events!
Again, please remember to follow your local guidelines and procedures. This article is for informational and educational purposes only. It is impossible to cover all of the issues that will need to be addressed during a "scene of violence" event. Each agency should have some kind of planning and guidelines in place to address these types of events. Hopefully you will gain some information to take back to your agency to assist with your planning and training efforts. The more our public safety agencies prepare, the better they are prepared to safely respond to and effectively manage any type of situation that might arise. The community has entrusted us with their safety.... SO LET'S PREPARE NOW.
August Vernon is currently an Assistant Coordinator for a County Office of Emergency Management. Mr. Vernon returned to his position at Emergency Management after a year in Iraq as a security contractor conducting long-range convoy security operations involved in several IED and combative engagements. He has been employed in emergency management since 2000, a member of the fire service and a fire service instructor. He also served in the U.S. Army as a CBRN (Chemical, Biological, Radiological and Nuclear) Operations Specialist for 4 years. Mr. Vernon teaches courses in Incident Management, Emergency Management, HazMat Operations, Terrorism/WMD planning-response and OPSEC for Public Safety. He also conducts public safety training at the local, regional, state and federal levels. He is a member of the IFSTA WMD/Terrorism Committee. Since 2004 he has served as technical reviewer for the development of five different training films produced by the Emergency Film Group (EFG). He has also written over 20 nationally published articles and is also author of the new First Responders Critical Incident Field Guide published by Red Hat Publishing.