Protecting yourself from patients or bystanders...

[WannaBEMT]

Hey you guys, thank you so much for the advice. I guess the term "beating the crap outta someone" was not the correct term to be iused here, I was asking what options do I have to get someone off you that is hurting you if there is no PD around and you have to handle it with yourself and your partner. You guys gave me alot of good ideas as usual and I will check out those links. This is really the only thing I am worried about happening to me at this point, I do not know the other issues until I get out there with some experience, you guys are great!

Thanks you!

Jenn

[emsbrian]

Hey Jen,

Sorry this head down a argument tangent, think a lot of advice came out of it thought. Glad to help what we could.

[NREMT-Basic]

Brian-

Im not sure what you mean by "issues with personal attacks" so perhaps you could delve further into that for me in a PM where I think that kind of stuff belongs. I appreciate your comments and if I disrespected anyone by statement or tone, I sincerely apologize. One of the things that I was trying to reinforce, is that in terms of assault, youre focusing on the word "threat." This can easily be tested by having an argument with your neighbor. If he hollars "Im going to shoot you" this is not assault. At worst it is disorderly conduct. If goes to the house and gets a gun, he has then escalated not only to assault, but aggravated assault with a deadly weapon. Perhaps more to the point, assigning assault to a verbal comment, regardless of what it may be, is useless. Are the police going to arrest a patient for saying he is going to hurt you. Nope. Are they if he says it and then goes for ya, You bet (if they are doing their job) because that element of furtherance exists there. A really good example of this is that you can stand toe to toe with a LEO and say Im goona whip your a** pal, blah blah blah and there really is nothing he can do under the law unless he wishes to site you for some breech of peace related offense. The moment you reach for him...assault...and aggravated assault because he is a LEO. It simply doesnt matter what the person says, if there is no follow up action of any kind. If so, we would have people getting arrested on freeways, etc everyday for assault. I followed this up with my LEO father and he confirmed (living as he does in Devine, TX) that an act in furtherance must follow up the threat in order to have a true and prosecutable charge of assault. After 36 years on the job, I trust his judgement and knowledge of the law. He now works in private security and trains LEOs in appropriate use of force to ward off an assault AS IT IS DEFINED BY LAW. I respect all opinions posted in this thread and defer to anyone with more experience than I have. My only "issues" with assault (and assault and attack are not the same thing) is that I have the legal experience to know what these definitions are and how they will be prosecuted and the personal experience of having been assaulted twice by two seperate patients. Again, I greatly respect those with more experience than I have. As for the "actually" comment...i think it can be hard to judge tones in these posts and I assure you that no offense was intended and if offense was taken I again humbly apologize. Thanks Brian, and I look forward to more discussions on the topic of EMS safety and self defense.

PS- I think in your most recent post, you have the definitions of assault and battery reversed. There is no such thing as verbal battery. I assume that was a typo. I dont remember anything in the medical-legal section of NREMT exam about self defense or assault/battery. Would be most interested to see what they have to say. Not saying its not there, just saying medical legal on the Basic exam was about 5 questions about neglect and abandonment. It might also put things in perspective to acknowledge that the term "assault" is often used generally to mean a physical attack. Technically, its definition is the action leading up to the attack. Assault-Step 1 "I am going to knock your head off" Step 2 - I produce the baseball bat. Step 3- I swing it at you. If I miss, we have an aggravated assault with a weapon. If I make contact we have aggravated assault AND battery with great bodily harm, scarring or disfigurement. Two seperate charges. In Illinois, the assault portion would be a Class A misdemeanor and the battery, since a weapon and bodily harm is involved, would most likely be a Class 2 or Class 1 Felony.

[emsbrian]

Sweet, I'm an idiot... Yep now I can't even get what I mean right lol.

PS- I think in your most recent post, you have the definitions of assault and battery reversed. There is no such thing as verbal battery

Oh well. Moving on the the other part, that previous statement was awesome, both polite and informative. I've learned a lot here which will help greatly in my classes, as at times perhaps the NREMT's definition, the practical definition and the legal definition are different.

While even on the paramedic exam (and lets be careful here, the NREMT is not kind on test discussion) ethical/legal is barely touched because it varies greatly, their definition is perhaps made so that a paramedic could understand it. (While I in no way advocate "dumbing down" things, it is common amongst many schools here, mainly because a majority of our paramedics care nothing about it and just want to fight fire.) If faced with a question involving assault vs. Battery in EMS on a test the answer is A=verbal B=physical. I would prefer to think think that the test reflected the correct answer, but this is apparently a misconception common in EMS. Perhaps another thread should be created with your very clear and precise (got it in the first post you did) definition of it, maybe we can fix this misunderstanding as I have heard it from many lectures and conferences.

[NREMT-Basic]

Though we have gotten far off the original thread, I appreciate the level of informed discussion here, especially since this is an area that is so overlooked in terms of EMS. Just out of interest, I drug out my Brady Pre-Hospital Emergency Care text (Basic Level) which was the most current edition available at the time I took my course. Oddly, it mentions assault, battery and self defense by the EMT or Medic not at all in the Medical Legal Section, and in the chapter in Behavioral Emergencies shys away from the idea of self-defense in favor of the more politically correct notion of "human restraint." According to this admittedly non-legally based text, self-defense, in so far, as the EMT or Medic is concerned is defined as "the minimum amount of force required to affect humane restraint of the patient" and cautions that only methods which have no possibility of causing harm or further harm to the patient should be applied. Ironically, the accompanying illustrations, show the EMS crew getting involved with and EDP with a baseball bat. There are about 5 EMS members in these photos with no LEOs in sight. The crew is however, using decidely LEO techniques to obtain "humane restraint." In particular, they are using the wrist twist elbow thrust technique which if used by untrained personnel is likely to either break or severly injure the patients wrists and elbows. Whats next? The stiff arm bar across the throat. They also advocate packaging a combative patient face down, so long as his breathing is carefully monitored. I know that in the military pre-cursors to our modern EMS, such technique was often called a "sandwich case" in which two stretchers were lashed together with the patient in the middle, tight enough to allow the crew to flip him either face up or down depending on injuries. I also saw a documentary the other night on the Discovery Channel about police and EMS dealing with EDPs and they showed a EDP patient being handcuffed (covered in gravel after an obvious struggle) and restrained face down with his arms behind his back. Hmmmm. No wonder none of us know what to do to protect ourselves.

[AnthonyM83]

Just the way I personally do it. If it's someone just geting aggressive and trying to get away, I'll wrestle with him to restrain him. It's a lot harder than an actual fight sometimes, because we're not actually fighting, just trying to restrain. If I'm technically assaulted/battered (like he grabs my arm and tries/fails to hurt it), I'll still make a judgement call based on what's causing him to be violent. Only if it's a full-on active attack will I use full force (and that hasn't happened yet) where I actively hit the patient.

I'm always thinking about how I can justify it in court in front of a judge/jury and on a PCR. Once he's actively attacking me, scene is unsafe, and I don't consider him my patient anymore. But while a patient grabbing my hand and trying to push me to the ground in a (failed) wrist lock is technically battery, I won't respond the same way I'd respond if a non-patient did that. I consider it part of the job putting up with that, because these patients aren't in their right mind.

PS I agree with Nremet's post on what assault it for the most part. Assault-verbal, Battery-Physical is a good way of remembering the two, but only a guideline. Assaults are often mainly verbal with maybe a threatening stance or moving toward someone...in some situations it can be only verbal, though...but not necessarily.

[DT4EMS]

Hi All,

I will chime in with a couple of points as well.

In Missouri "Assault" can be verbal and/or physical. Some states do separate battery from assault. A Third Degree Assault in Missouri would be charged the same if a person threatened to punch you in the mouth, or actually did it.

The kicker is the person claiming to be the "victim" would have to be in fear the threat could actually be carried out.

As to actions in the back of an ambulance........

First, you have to define the difference between a patient and an attacker.

If an 18 y/o with a head injury thinks you are an alien from another planet and says he wants to kill you that's a patient

If an 18 y/o high on meth (with no other real complaint) says he is coming off the stretcher to kill you..... that may be seen as an attacker.

I am (like someone posted earlier) an advocate for the EMS provider to GET OUT of the back of the truck if you are/ or perceive you are in real danger.

And the DTP will buy you a second to escape. But there is much more than just a "technique" to safety on any scene. It is very apparent with 52% of EMS providers falling victim to assaults in the field the current training standards are lacking. (NAEMT 08-05)

I am also all for every provider who is the victim of an assault reporting it to both their supervisor and make a police report. I even created a form to help those who attend our course document the incident.

Remember the absolute best "Defensive Tactic" is good customer service. (Even at 3 am)

Kip

[DT4EMS]

Ummmmm I think I stated removing the little old lady who pinches you or the assault caused by a pt with suspected injury or illness from the scenario, no other assault or attempt will be tolerated.

I will let slide you personal attack again, sighting your obvious flaws in reading comprehension.

Nremt basic wrote:

I have been punched once and grabbed by the throat once and there was no available PD intervention in the back of the rig. Simple tap and escape maneuvers, and pulling over to the side of the road were what was required to regain control of the situation.

Well you attempt your tap and escape maneuver on a 250lb mad man amped on meth. I will just wait for the the guys with the guns to arrive.

Yes I will call PD if I feel threatened before the situation escalates to the point where someones safety is in serious jeopardy. I don't take the wait and see attitude.

I can assure you the litte "tap" (aka the DTP)would be the FIRST thing I would use against a 250lb person high on meth.....while I screramed to my partner to hit the brakes to let me out. The DTP was designed to help not take the pounding or wrestle with the guy that feels no pain.

[Asysin2leads]

I just think we should clarify a few things, because we've got apples and oranges all mixed up. It looks like there are three distinct scenarios we are talking about here, and what is needed and what the law allows are distinct for everyone.

Situation 3: Violent or uncooperative patient needs to be restrained and taken to hospital involuntarily. The "continuum of force" should apply here, first should be professional or authorative appearance, etc. The more people, the better, a person will much more likely take a swing at two people than 6 people. Try to keep your emotions out of it, remember the person is (generally) sick, not a criminal, treat them accordingly, minimize injury to patient using soft restraints but remember safety of the crew is paramount.

Situation 2: Physically confronted but not really in danger. I.e. while operating at a scene a drunk guy gets in your face then grabs you by the shoulders. This is the whole reasonable and necessary force thing. You have the right to pull him off you. You probably could even get away with kneeing him in the groin or smacking him in the face, but then you need to extricate yourself and call for appropriate resources. You don't have the right to then hold him on the ground and pummel him. A few weekend courses in self defense or non-combat martial arts like Akido can be useful for this. Or you can just get off your ass and hit the gym so you have the upper body strength to get people off you when need be. Generally speaking, things like kubtaons, mace, or retractable batons will only get yourself in trouble in situations such as this.

Situation 1: Imminent danger of death or grievous bodily harm. This is a situation, in my own personal opinion, in which all bets are off. The law no longer applies, the only rules is to survive. Remember the mantra, eyes, throat, knees, genitals. Don't play fair. Do what it takes to survive, whatever consequences come later, you'll be alive.

[DT4EMS]

I just think we should clarify a few things, because we've got apples and oranges all mixed up. It looks like there are three distinct scenarios we are talking about here, and what is needed and what the law allows are distinct for everyone.

Situation 3: Violent or uncooperative patient needs to be restrained and taken to hospital involuntarily. The "continuum of force" should apply here, first should be professional or authorative appearance, etc. The more people, the better, a person will much more likely take a swing at two people than 6 people. Try to keep your emotions out of it, remember the person is (generally) sick, not a criminal, treat them accordingly, minimize injury to patient using soft restraints but remember safety of the crew is paramount.

Situation 2: Physically confronted but not really in danger. I.e. while operating at a scene a drunk guy gets in your face then grabs you by the shoulders. This is the whole reasonable and necessary force thing. You have the right to pull him off you. You probably could even get away with kneeing him in the groin or smacking him in the face, but then you need to extricate yourself and call for appropriate resources. You don't have the right to then hold him on the ground and pummel him. A few weekend courses in self defense or non-combat martial arts like Akido can be useful for this. Or you can just get off your ass and hit the gym so you have the upper body strength to get people off you when need be. Generally speaking, things like kubtaons, mace, or retractable batons will only get yourself in trouble in situations such as this.

Situation 1: Imminent danger of death or grievous bodily harm. This is a situation, in my own personal opinion, in which all bets are off. The law no longer applies, the only rules is to survive. Remember the mantra, eyes, throat, knees, genitals. Don't play fair. Do what it takes to survive, whatever consequences come later, you'll be alive.

All great points except "The law no longer applies".

The law will always apply. Particulary any time one person uses any force against another person. As long as a person can justify their actions as "reasonable" they will stand a better chance when the law does come into play.

See a lot of the problem is just what you mentioned..... people fail to train......... regardless.

Isn't that what the real issue is? Not physically or mentally training........... it is a problem all over Asys.

See when you don't train you will respond primal. Primal can land good people in bad places. Just blanketing a problem and using the old "When the only tool you have is a hammer every problem looks like a nail" is what got us here in the first place.

Problem #1- People think "Why would anyone want to hurt the people that come to help?" So no training

Problem #2- Under reporting of actual assaults in the field ( old dawgs say "It's just part of the job") So.... no training needed.

Problem #3- A medic gets spit on.....punches a guy in the face and loses his job.......... but come on now..... he is a seasoned medic...... that would never happen right? Yup..... Problem ---no training.

Asys pointed it out very well. There is a level of force expected/accepted for different situations but IF the EMS provider has never seen them , studied them and forced to make decisions based on them.......... how can he/she be expected to make the right decision under stress?

The answer......... learn what is "reasonable". Do your homework! Agencies will drop you like a hot stone and leave you high and dry when this issue arrises. It is hard to feed your family when you did something you thought was right based on bad information.