Not a gun thread

[Veneficus]

Thanks to the efforts of DT4EMS and one or two others I have seen spring up, coupled with some very big names in the business calling the issue of assaults and injuries to EMS providers to the front and center, the hot topic in EMS right now seems to be what to do about it.

On FB, one of the groups I belong to has a very pointed discussion on what exactly EMS providers should and shouldn't do to defend themselves.

Nobody in that discussion brought up a gun and I think it is safe to say everyone in that discussion is of the mind that a gun is not the answer.

I would like to open such a discussion here. (because you don't need 20+ years of experience to join this group)

I thought about making a poll, but decided against it, because it restricts the ability to be creative.

So, without further adue, without a firearm, what do you think you need or would like to have in order to prevent injury to yourself or coworkers while doing your job?

You don't have to restrict yourself to a single item, if you think your agency needs cops riding the rig with you or pay you to go to Japan and learn Kobudo, let's hear it.

 

[Hunter]

go to Japan and learn Kobudo, let's hear it.

I'd like to hire MR.Miyagi

 

[DesertMedic66]

Police responses with EMS calls in bad neighborhoods and houses that have been "red flagged". Also a DT4EMS class required for all field employees.

Those are the 2 that come into my head right now.

 

[Veneficus]

Police responses with EMS calls in bad neighborhoods and houses that have been "red flagged".

This brings up an interesting point.

Is there something you could do prior to calls in bad neighborhoods that would reduce the danger there?

Is it the whole neighborhood or can you actually narrow it down to a specific street, location, or address where the most danger is likely?

 

[Achilles]

Police responses with EMS calls in bad neighborhoods and houses that have been "red flagged". Also a DT4EMS class required for all field employees.

Those are the 2 that come into my head right now.

But what about those, like myself; who have already had a self defense class, or eight years of class three days a week, lol

 

[Veneficus]

But what about those, like myself; who have already had a self defense class, or eight years of class three days a week, lol

Do you think there is nothing you could learn in such a class?

 

[EpiEMS]

Could always have PD as first responders on every EMS call. Easy. PD would love to have the extra budget, and EMS would get the added safety (plus, possibly faster hands-on time for CPR, faster defib, or, even somebody controlling bleeding).

This is realistic in many suburban areas, as well as in suburban/urban interface areas.

 

[Achilles]

Do you think there is nothing you could learn in such a class?

Well I'm sure you I could learn a ton of things.
The martial arts that I did was Hapkido. In fact, I know it's hard to believe, but I used to be a trouble maker, they straightened me up in about a week.
We would techniques to disarm, kicking, punching, breaking the wrist.
The one thing that most Instructors will tell you or should tell you, is to never turn your back in a fight.

 

[DesertMedic66]

This brings up an interesting point.

Is there something you could do prior to calls in bad neighborhoods that would reduce the danger there?

Is it the whole neighborhood or can you actually narrow it down to a specific street, location, or address where the most danger is likely?

We have troubled neighborhood where the whole neighborhood is into guns and drugs.

We also have specific houses that are trouble as well.

 

[systemet]

I think most of the answers are fairly common sense, and already implemented by good EMS systems:

* A good radio net that fully covers the response area, with a panic button system on the portable radios.

* Dispatchers with a dedicated police line

* Mandatory crew checks after a specified time elapses

* Mandatory staging on certain high risk calls, assaults with assailant on scene, stabbings, shootings, etc.

* A culture where both dispatch and the crew can initiate a stage without fear of punitive measures if it turns out to be justified.

* A management that will defend the staging policy to the media, punish those who breach it, and encourage crews to be responsible for their own safety.

Beyond that, I'd happily swap the department issue ballistic vest for a stab vest. A yearly course in not-being-a-jack*** or "verbal judo", or whatever, would be great.

Places I've worked have often held 8 or 16 hour self-defence classes every couple of years. I wouldn't say these are useless - they serve as a reminder to be careful, and may cultivate a combat mentality in some people -- but they're almost useless. Delivered poorly they produce and overconfident provider with mission creep who seems to think they've become law enforcement. It's difficult to think that any sort of real motor skills can be developed in such a short time frame, concentrated over a day or two, or that those skills don't degrade very rapidly.

Impact weapons and OC spray are problematic, but I could understand some areas allowing them with specific training. Personally I wouldn't want it in my environment, but some people might feel differently.

I train, btw, but I know that what I do is a sport for one-on-one confrontations. It might help me in a "street" confrontation, but I've also got a lot of muscle memory that's great for sportive martial arts, but probably going to get me hurt in a real world situation.

 

[CritterNurse]

One thing I've heard from trainings and then later in my EMT class was to always be aware of your surroundings, always have something throw-able in your hand when approaching a scene, and if something doesn't 'feel' right, trust your instinct and wait for backup in a safe location.

 

[mycrofft]

Speaking of urban/suburban and most rural calls:

Overarching question: what is the role of the mobile prehospital caregiver to be?

The majority of attacks in the real world I have read about, seen or been party to seem to be related to mental illness or drug abuse or other alterations of mentation. Threat of counter-action to them is meaningless, the action is impulsive not premeditated, they either use their fists and feet or they "habitually go about armed", often in self-defense.

Therefore, if physical action is going to be planned, it has to be instantly applicable, safe in a confined area, nonlethal, legal, culturally acceptable, and capable of being learned and used by all employees and fiscally possible to be learned then refreshed at least between every six months to annually. Be good if it couldn't be taken in a scuffle and turned around; these all point to some sort of really dirty martial art coupled with changes in policy and the PEMS mentality/culture:

SO, here are the choices I see:

1. First, no females alone with male patients or violent or mentally altered females. I have known quite a few effective female law officers, but they always operated with threat of male oversight and forceful assist ranging up to lethal force behind them. Stupid, drugged or crazy men, especially the big ones, often view females as targets for physical intimidation or neutralization; they live depending upon violence or its threat for food, sex, laundry, a car, etc etc, and especially against females. It can become emotionally and mentally linked to physical sex as well as gender; a female in uniform and carrying say an ASP they think they can overcome is like a pinup calendar for them. This may also militate against PEMS workers slight of build or without the will to fight.

2. PEMS as a armed force. Since every call potentially can yield an altered bystander or patient, every call needs potential instant force.

3. Redline some addresses and refuse to approach or load potentially troublesome patients without LE on your hip. (By "redline" I mean predesignated addresses or neighborhoods require LE be there and will call in PEMS when the scene is ready).

4. Mode of force: some sort of martial art, augmented by devices possibly including armor, sap gloves, steel toed boots, helmets, long sleeved uniforms with cloth resistant to scratches, spit, and tearing. Maybe a shock device carried on the belt and requiring a magnetic ring or something to neutralize it if it is taken away by stealth or in a scuffle.*
==============================================
OR, act like other types of health care workers/professionals and demand a safe working environment and build a community image as helpers and not sparring partners. If someone becomes or is trouble, respond with appropriate force on hand or just don't help them (scene safety is #1).
===============
The reasons they invented LE were to enlist the muscle to the side of good, and to decouple force from personalities; this prevents vendettas/gang wars/feuds (payback) because force is from a disinterested party.

*If you think the measures I listed are extreme, an employer who fields you without proper protection from foreseeable harm is negligent. They aren't going to send you out like a kid in sneakers/t-shirt onto an NFL field in motion, although they might send you out half-ready and call it even. Or EMS becomes a LE function.


PS: Ever seen someone shake off a TASER, or pepper spray or MACE? I have. I've also seen people unaffected by most "martial arts moves", especially under the infence of drugs like PCP, ketamine, LSD, or long stretches of crank amphetamines; if it isn't lethal it usually depends upon pain or threat leading to surrender, and when you neutralize that, it's "off to the races" as we used to say.

 

[JPINFV]

So, without further adue, without a firearm, what do you think you need or would like to have in order to prevent injury to yourself or coworkers while doing your job?

Seat belts and a treadmill.

The problem with assaults is that they often don't amount to anything that a weapon can be used on. Unless you're prevented from getting away or the patient is chasing you then there really isn't much you can do. Just because you get punched by a patient doesn't mean you get to go to town on the patient with an asp baton (which makes the firearm debate particularly hilarious since only an extremely small percent of assaults against EMS providers rise to justify deadly force). The more common weapons like pepper spray aren't really useful in enclosed spaces like the back of an ambulance.

 

[rescue1]

Some self defense/street smarts course would be the most helpful, I think. The thing about assaults is you usually don't expect them. When you head down to the trailer park for a drunken aggressive man, everyone expects him to be rowdy, and therefore you will be prepared, whether that means police on scene, staging, or you chemically sedating him as you say hello (I kid. Maybe).

When you respond for an abdominal pain at 9pm at some residential house and you get someone who is feeling ready to rumble is when the trouble starts. Like people have said, weapons are basically useless, except maybe a Taser, since it's either overkill (gun) or impractical (OC spray). Therefore, EMS being able to rapidly detect danger and escape or overcome it it is paramount. Also, not being shy about restraints, chemical or physical. Don't tie up everyone you see, obviously, but where I've worked, there has been a certain "grin and bear it" mentality, which leads to us holding down writhing, kicking patients all the way to the hospital, only to have them be sedated as soon as they roll through the ED doors. Why didn't we just do that in the ambulance?

Police dispatch on anything is helpful, though my last system had that and we were still without LE about half the time. Sometimes the cops are busy doing cop stuff. Emergency buttons are good too, as long as pressing them won't get dispatch on the radio yelling "AMBULANCE 2, YOU HAVE PRESSED THE EMERGENCY BUTTON. DO YOU REQUIRE POLICE?"

 

[emtandrew]

i am so glad nobody is suggesting that ems should carry a firearm. that idea just seems outrageous to me. the idea of taking a self defense class is a grate one in my opinion. as far as having PD on every call that seems to be a little overkill. i think the best way to prevent injury is to be aware of your surroundings. i understand that sometimes you cant help it. but you should never put yourself in a situation where your going to get injured. if the scene does not look safe don't enter. use your resources whether it be police fire or what ever let them do what they have trained for so you can safely do your job.

 

[Veneficus]

Seat belts and a treadmill.

The problem with assaults is that they often don't amount to anything that a weapon can be used on. Unless you're prevented from getting away or the patient is chasing you then there really isn't much you can do. Just because you get punched by a patient doesn't mean you get to go to town on the patient with an asp baton (which makes the firearm debate particularly hilarious since only an extremely small percent of assaults against EMS providers rise to justify deadly force). The more common weapons like pepper spray aren't really useful in enclosed spaces like the back of an ambulance.

So what about non-weapon solutions?

 

[Imacho]

I have 17 yrs of Taewkowndo and 1 yr of MMA training. So I'm good. And I'd carry concealed if allowed.

 

[Handsome Robb]

I skimmed this thread pretty fast so I may have missed it but personally a police-style TASER would be a viable option in my mind for EMS personnel.

They're "less than lethal" so if a patient takes it from me and uses it on me I'm not really afraid of them killing me. Will it suck? Absolutely, but I'll be able to walk away from it. Also, unless there's something I'm missing, they require less training to be used effectively and safely.

People always say "if they get wild just dart them". That's not always an option. I have to get a syringe, open it, get my narcs out of my pocket (or go into my bag, get the drug bag out of it and grab the haldol which isn't really an option in this type of situation anyways), do some quick math, draw the med, dart the patient then wait for my IM injection to take effect. Not really a good way to defend yourself if it comes down to it and you've also just introduced a sharp object into a volatile situation along with medications with sedative properties which could render you completely unconscious and vulnerable if they end up in your arm rather than the patient's. Whereas with a TASER, if it really gets that bad all I have to do is draw it, announce, aim and pull the trigger.

I wish self defense classes were mandatory and offered but we're on our own to get those.

I'm not huge on having to wear a stab or ballistic vest all day long sitting in the box but I'd like to have them issued to us and to see a policy put in place requiring their use on certain calls. I'm thinking a "pull-over" style that you can pop on and off easily for whatever calls you deem necessary either at your own discretion or by policy.

systemet has a lot of good points, we actually already do quite a lot of that at my agency already. Unfortunately we have to enter unless told to stage by our dispatch unless we have a damn good reason not to. If we get there and decide it's not OK for us to be there it's not a problem to back out and we will never be reprimanded for it, even if it is a life threatening emergency.

To be specific about what we do that s/he mentioned we all have panic buttons on our portables that are tested daily when you sign into the system, stage for calls involving violent crimes or unruly callers or at the dispatcher's descretion, have a mandatory "code 4" check every 30 minutes while on scene (I'd personally like to see that shortened to 20 minutes but that's just my opinion), have relatively good radio coverage in all our areas (unfortunately that's been hit by the FCC requiring us to switch to narrow-banding of our radio net recently, maybe this will be the final straw and get them to switch to an 800MHz system) and a dedicated "emergency" line to PD dispatch (better if we had a unified comm center but that's not going to happen any time soon).

 

[ExpatMedic0]

Versed auto injector or succinylcholine blow gun for EMS

 

[RocketMedic]

I think that we should seriously consider three-man crews for dangerous areas, with one of those personnel charged with scene safety. Consider arming them, if appropriate.

Law enforcement on every call may not be effective, and if you've got an extrication challenge or a sick patient, two people may be sucked in. A third person watching their back can be quite valuable, and they can help with care once they're clear or in less-dangerous settings. 46Young's FD comes to mind....it's a lot easier to fight two people than 7.