By Captain J. Scott Quirarte, Ventura County Fire Department, IPSA RTF Vice-Chair, IPSA TEMS Committee Member, IPSA Treasurer
A recent NAEMT study reported that 52 percent of the EMS workers polled have been assaulted by a patient. Further, the FBI reported there were 50,212 officers who were assaulted while performing their duties in 2015.
These results are astonishing. However, what’s even more shocking is that assaults against first responders are likely never reported because of a false belief that it’s part of the job. Ask your crews and officers you work with how many of them have been assaulted, and you will likely find the true number is well above 90 percent.
First responders and leadership must stop ignoring the issue. First responder assaults are inevitably going to continue occurring, and we must be prepared to protect ourselves. This preparation starts before an incident occurs. First responders need to adopt a when/then thinking philosophy. “When this happens, then I’ll do this.” The key to this thought process is not “if” it will happen, it’s “when” it happens.
Example: If I enter a house and there is a combative patient, then I’ll just leave and call law enforcement.
Let’s pick apart this example. First, you’re not mentally prepared to respond if you think this is a hypothetical or rare possibility (nothing bad ever happens to me, right?).
Second, your situational awareness will be poor or lacking when you enter the room, and you won’t be assessing your environment.
Third, when something bad does happen, you will not be mentally prepared to act quickly and decisively. You will freeze. Maybe you only freeze a second, but a second is enough time for the assaulter to hit you in the head with a pan or stab in the face with a pencil.
Your frame of mind by using “if’s” is that you’re not mentally preparing yourself when you arrive on scene.
Every call is unknown
Typically, when arriving on scene, first responders park their vehicles directly in front of a house. While this is the general practice, it doesn’t mean it’s always the smartest approach.
Parking up the street gives time for evaluating the scene. When you arrive take a few seconds to evaluate the environment. Look, listen, hear and smell it.
- Do you see broken windows, drug paraphernalia, blood or any indicators of violence?
- Do you hear a fight or yelling?
- Do you smell alcohol, drugs or vomit?
Guns and knives are generally what comes to mind as conventional weapons, and when you don’t see them in the room, does that mean you’re safe? The answer is no.
Whether you are stabbed in the head with a knife or a pencil, the results will be the same. Most, if not all, household items can be used to inflict harm on us.
Patient care should be conducted in an area free and clear of any hazards, including those brought by us. If your patient can reach it, then your patient can use it as a weapon.
The worst place for patient care are bedrooms, kitchens and garages. Often, people keep conventional weapons in their bedrooms. Kitchen and garages also have several items that can be used as weapons.
Very few objects stop bullets
It’s important to do some research on this. Fire and EMS must meet with their law enforcement department to discuss what truly stops bullets.
- Does a water tank stop bullets?
- Does an engine block stop bullets?
- Does the door stop bullets?
These are all questions you must know the answer to before you respond to the next call. I guarantee that you will be shocked at how few things provide true cover and will stop a bullet.
Set up a meeting with your law enforcement partners today to get a debriefing.
This is a concept that many law enforcement officers have adopted that can be applied on medical incidents. It’s very difficult to conduct patient care and still maintain overall situational awareness of the overall scene. By using cover and contact one member can focus on patient care while the other focuses on scene safety. Essentially, one individual provides direct patient care – the contact person- and the other takes the position of cover. The crew member acting as cover is keeping his or her eyes on the scene, watching for threats and maintaining situational awareness. Make sure anyone tasked with cover is paying attention to everyone present.
Actively assess the entire scene until you leave
Take in the entire picture and identify escape routes and safety zones. Fire crews and paramedic/EMTs are not law enforcement officers. We have two objectives for safe response:
- Avoid the need to escape.
- If objective one fails, escape.
However, law enforcement officers must also take extra precaution when responding to a call and actively assess the scene for danger. Below are some questions that all first responders must start addressing to improve situational awareness:
- How are you determining scene safety?
- Is it a quick look around when you arrive on scene? If so, what are you looking for?
- Are you using dispatch information? If so, what pre-arrival information would cause you concern?
- Or are you using standard safety procedures developed by your agency?
- What should a firefighter or paramedic/EMT do if they believe there is a threat when responding to a call for service?
- Do you have a way to communicate with first responders at the scene when something is off – like a code word or phrase?
In addition to the above questions, below are some situational awareness tips that will also help first responders from preventing the next assault.
- When you are clear to enter the building or residence, clearly identify yourself as “fire department,” “paramedics,” or “law enforcement.”
- Put something between you and the patient (or individual) during your approach. This will provide a block and may slow any attacker trying to get to you.
- When entering don’t bunch up. This will allow for a quick escape if needed. It also allows each member to see a different portion of the environment.
- Don’t get tunnel vison on the patient or individual you’re talking to – remember to look around. Understand where your nearest exit is and whether it’s clear of any obstructions.
- Asses the scene, the area around the patient and the patient before beginning care.
- If you don’t like the room or if the environment seems off, then move. Remember patient condition does not dictate where patient care is done, the environment does. You would not do patient care in a burning house, under a hanging power line or in the middle of the freeway. For your safety, you would move the patient. When the environment the patient is found in can’t be made safe, then move the patient prior to beginning care.
- For fire/EMS: Have a safe word that everyone on your crew knows that tells them that it’s time to exit and call law enforcement. Make sure everyone’s radios are off when you’re making that call for law enforcement support.
- Check your attitude and ego at the door.
First responders get assaulted. It’s often under reported. And, it’s not going to get better anytime soon.
Sure, first responders can continue to tell themselves that “if” something happens, “then” I will handle it and be unprepared, putting themselves at unnecessary risk.
Or first responders can step up and say “when” something happens, “then” I will be ready. I’m going with “when” and preparing myself and my crews.
IPSA InfoBrief: Assaults Against First Responders
Webinar: Is this scene safe?
4 officer safety tips to ensure you go home at the end of your shift