First, have a read of this story: http://ottawa.ctv.ca/servlet/an/local/CTVNews/20111229/para_abuse11...
OK - is this a problem that exists in the US, that we're not paying attention to? Or is there something wrong with the study that over-states the epidemiology? Personally, I think it may be a little over-stated, because personally I don't consider "lip" to be a form of violence. Even so....
If a majority (or even a significant minority) of EMSers in the US (and keep in mind that in Canada, their equivalent of EMT-B and EMT-I are also called "paramedic") are subject to physical or sexual abuse, I have some questions:
1. Why aren't we making any NOISE about it?
2. Why aren't we DOING anything about it?
If half of our members were getting cancer or Hepatitis B, we'd be making a fuss. Yet, just recently, a couple of women working aboard an ambulance I visited told me of being rountinely "grabbed, pinched, fondled) and that it was "just part of the job."
WHY (help me out 'cause I'm getting worked up) are we, as a profession, industry, or peer group willing to accept having crimes committed against our bodies as "just part of the job"? Why aren't we (individually, through our associations, unions, management) up in arms, and taking steps to address the problem?
Help me out here - I need some input!
C'mon now - nobody have anything to say on this issue?
I'll say something. I believe as a profession we do think of our selves as a second class citizen. Police, nurses, doctors, or any other workers would not be ok with this kind of treatment much less do nothing about it. We really do think of it as just part of the job to be abused in 20 different ways.
I'm trying to get a handle on the problem. I think that there are two kinds of violence - one is the "uncooperative patient" who may fight you but who is not purposeful - hypoglycemic, hypoxic, DTs, etc. Then there is the violent attacker. What kinds of problems do you have with either? And what happens. What is "...this treatment..." that we do nothing about? And why not?
Yes, but an N of 1, and not really violence directed against EMS - a broken down ambulance in the wrong place at the wrong time is too wierd. Is there something that has a pattern, or is of widespread concern?
We've discussed this before, in the UK Paramedic Beating is pretty much a national past time. Why because of this god given right that the public "tax payers" believe they have to access EMS.
It can be argued that it is such a prevelant issue in the UK because better reporting has been achieved and crews have a wealth of technology protecting them. IE violence of any nature is picked up earlier than it would have been in the past.
That said, there is a distinct lack of respect from young generations for Emergency Services, people of local responsibility. EMS has become the easy and immediate access to healthcare by all, regardless of whether it is appropriate or not.
The two categories that you mention are about the broadest approach I can think of to describe the assaults that EMS face.
Your patient who is not in control of their actions is an occupational hazzard of EMS in the same way that a Starbucks employee may get burned or an airline customer service advisor facing verbal anger because a flight has been cancelled.
EMS fails where other organisations do not, in their risk managment of these types of situations. Shop managers don't close up on their own incase of robery, yet certainly EMS here will quite happily send lone workers into the line of fire.
Where I guess the problem lies certainly in our laws is what constitues a "boni fide occupational requirement" A fireman has to deal with fire, he is going to stand a good chance of being burned and there are strategies in place to limit this.
In EMS we do not;
- Train our staff ENOUGH in the communication of Dementia Patients, local cultures of patients, physical defence, verbal defence
- Give our staff proper equipment to do the role until serious incidents are reported.
- Train our staff to look at the wider situation, in the hypoglyceamic patient, we train how to treat it, give this drug ect but not patient approach, because simply it cannot be simulated safely in training and then we do not have a robust preceptorship approach to ensure staff see and respond to the wider situation.
In a roundabout way, I guess I'm saying that the uncoporative patient is an occupational hazzard as opposed to assualt, where EMS staff fall foul is that they find themselves in the wrong place at the wrong time and get a belt in the face for there efforts. (The amount of times I've seen fingers go near the mouth to control the airway, if the hole doesn't belong to you don't be sticking your fingers in it!)
With the violence, our statistics show that all incidents of violence against EMS can be predicited in that an unpexpected unprovoked attack does not happen. There will be clear esculation factors that the crew either miss or ignore. This starts all the way back to the body language of the crew when they first arrive.
The majority of the time, those that assualt EMS staff are known to Law Enforcement either having a history of assualt or violence. Here we fail again in that our Address Marker system is not fit for purpose, there is no clear joined up working with our sister forces, or infact with other health disiplicines, if a patient assualts a surgeon in a hospital, EMS should know and there should be a database somewhere..
Call taking staff do not have sufficient training in scene assessment so either declare a scene unsafe when it is not or vice versa, this leads to a Boy that cried wolf situation with the police and when EMS really needs them, they are not around.
Things that should be mandated therefore if not already;
1) Clear EMS Worker protection within Statue, a crimminal offence with real punishments
2) State of the art technology to protect staff - CCTV in vehciles as we have recording only when the panic strips are pressed. Personal Panic Alarms trackable to nearest 10m
3) Lone Worker policies and sufficient training for lone workers, including welfare checks from disptach if they haven't been heard of in a while
4) Better training and education in the "uncooperative patient understanding dementia, hypoglycemia and practice situational awareness
5) better links with Law Enforcement and other health disciplines, identify those to assualt staff early and share information
6) Organisations taking their operational hazzards seriously so that staff do not have to accept it as part of the job
7) share best practice with other conflict professions - customer service, pubs, travel companies ect....
Just some thoughts on this cold winters day!
The violence happens here in San Antonio Texas also. I hear medics saying things like its part of the Job also. Some of you who know me know I was an Army Medic and for 13 years and a DOD Paramedic for 7 years. I left the federal government last year to work in the civilian market. With that said I was sheltered but now I have seen it and I think one of the issues is Medics do not know what to do if something happens and some agencies don't encourage reporting. I report all issues to the police since here the Police respond to all EMS calls. There are laws that protect us assault is assault and it is a crime. I encourage Medics to press charges if they are found innocent or guilty iI did my part. This year we are going to begin training Defensive Tactics 4 EMS( DT4EMS) so we are excited to be able to help prevention, evasion and defense if need be.
Wow. I'm shocked that there is so little discussion on this topic.
I was thinking that this was important and worthy of some effort. Now I'm not so sure. How about it guys and gals - help me out?
To be honest Skip, I personally have gotten to the point where I do not comment on topics like this in the JEMS forums because it becomes a turf war and all about who knows best. I get tired of the machismo. So... I focus my efforts on promoting these issues throughout my State. Thanks for posting the article.
If you've got some thoughts on this issue, please send me a PM. I'm really trying to get my hands around this one - too many people getting hurt, physically and psychologically.
I have experienced violence. Quite often, but usually from a psych (no excuse in my opinion) or other normal hazard. They always try to bite. I have no problem with using strikes if necessary. Biting me or spitting at me is assault with a deadly weapon. I want non of your diseases. We are well equiped to handle these though. We carry spit hoods, restraints and the always handy Haldol and Versed. Very effective. Most of the concern I have regarding our safety comes from when we have to restrain a family member and the family gets violent. Im almost ALWAYS well aware of their intentions before my partners because when in this situation Im listening to what is being said around us. NOt what the pt is rambling about. I take the time to patiently explain to them the reasons we must do these things and if they begin to escalate I have no problem leaving the scene, even if the pt is acute. If its them or me, its always going to be them if I have any choice in the matter.
Im pretty good at restraining people and defending myself but thats because of lots of practice with my brother growing up. :) Ems is way under trained in this and MANY other areas. This area is not my passion. Sorry for being slow to jump in.
Changing the attitude that assault is just an unfortunate part of the job must come from top down. It's an ignored topic in the EMs cirriculum so we ignore it in the field as well. EMS providers need to know when it is okay to walk away without committing abandonment. Management needs to commit to a no-violence approach which includes training on recognizing potentially violent situations, strategies for disengaging, a supportive policy and follow-up that does not ignore an assault with meaningless macho posturing. I think the recent focus on this issue is welcome.