HEATHER CASPI
Firehouse.com News
Fire and EMS officials gathered at the Firehouse Expo in Baltimore
last week to learn about the growing dangers for rescue workers in a
presentation called "Street Violence: Fire/EMS Operations in the New
Millennium."
Almost everybody in the room raised their hand to having seen or
dealt with violence on the job. The presenters gave examples of
rescue workers who had been slashed in the neck, shot in the chest,
and had people storm their ambulance.
The presenters, Capt. Ron Mondragon of the Seattle Fire Department
and John Holschen of InSights Training Center, Inc. touched on
numerous issues including patient control and restraint, and unarmed
defensive tactics.
"I thought fire and EMS officials could benefit from being taught
some of the things cops have been taught," Holschen said. He argued
that although rescue workers develop some common sense about assault
through experience, they don't formalize it or pass it on, leaving
everybody to reinvent the wheel.
According to NFPA standards, departments should have written
standards for dealing with civil disturbances and assaults, and
should have a written agreement with local law enforcement about how
they will coordinate for such an incident. But few do, as another
show of hands confirmed.
The presenters stressed that safety strategies must include
disengagement, and if someone becomes violent, police should be
involved promptly.
Holschen said many rescuers take pride in handling dangerous patients
but warned the audience to be more critical of these situations, and
not to wait until there has been an attack before involving law
enforcement. He said he regularly sees rescue workers dismiss
behavior that would have landed the offending person in jail if they
had done it to police officials.
"I don't think that's right," Holschen said. "In fact, I know it isn't
right."
Holschen defined assault as an attempt or threat to do harm and
warned of pre-assaultive behaviors such as fist clenching,
purposeless movement, the "thousand yard stare," shoulders back, or
chin down and shoulders forward, and emotions inconsistent with the
person's dialogue.
He said the goal is to diffuse a situation early by watching for
anxiety, which can lead to loss of verbal control, followed by loss
of physical control. He suggests calming the person before they get
that far by making some distance, allowing them to vent, listening,
and showing concern.
He also stressed the importance of remaining dispassionate, for the
sake of professionalism and liability. If a rescuer is assaulted, he
suggests that whenever possible the rescuer step away and let
coworkers handle the situation.
Mondragon also stressed the importance of documentation after any
incident in which a rescuer has to use force, in case a lawsuit comes
up a year later. Mondragon said he's in the middle of such a case
now, and it's a good thing he was so detailed in his documentation
because that's all he has to remember the incident by.
Holschen then demonstrated defense tactics including strong body
language, the "verbal stun" and the palm strike to the back of the
head, which he says has the effect of a punch but comes off to the
person and to people watching as less aggressive.
The presenters also championed body armor, especially for workers in
high risk areas, but warned that all too often rescuers leave it on
the rig instead of putting it on in advance of dangerous situations.
They argued that it's excellent for diffusing punches and kicks, as
well as protecting against knife and gun attacks.
They livened up the presentation at this point by showing an old film
of a body armor manufacturer testing his product on himself, by
shooting himself and then attacking a huge piece of meat dressed in
the vest.
One of the major lessons of the session was that it is alright to leave
a dangerous scene and return to render aid when the scene is secure.
Holschen suggests having a code word for tactical withdraw, or asking
for something nonsense from the rig, so that the crew has a discreet
excuse to leave.
Holschen warns that you have to give your crew permission to leave
their equipment or they won't do it. And he suggests that anyone on a
crew, even rookies, should be able to initiate withdrawl without
getting questioned about why until the crew has left the scene.
He also suggests having a code with the police, so a crew can radio
"Engine 40 Code Blue," for example, and get immediate police
assistance of a certain level.
The presenters' numerous other tips included keeping track of exit
routes, and having people lead you through their homes so that you
can't stumble onto anything they don't want you to see, or surprise
anyone.
In order to remain vigilant about potential dangers, Holschen said
rescuers need to do some mental conditioning and realize, "It can
happen to me."
