EMS personnel need to make personal safety a priority, or they face becoming a grim statistic, say experts concerned about violence against medical workers.
In recent months, there have been several states that have reported EMS workers being beaten or worse while doing their job of providing patient care. In many cases, the incidents expose a key area of unpreparedness in the field.
“We have this belief in our EMS culture that there are calls that are dangerous, and there are calls that aren’t very dangerous,” says Mike
Taigman, a security expert and general manager of American Medical Response. “The reality is, it is very difficult to predict safety.”
For example, a man attacked a Chicago paramedic who was treating him after a crash in late November. Reports from the incident indicate the attack was sudden and unprovoked. And this past May, a Long Island (N.Y.) EMT was shot by a heavily armed man who the provider was helping following a wreck.
Violence is potential on the job; that’s a given, but few are doing enough to prepare paramedics and EMTs to work in the field.
“From the time somebody walks in the door of a basic EMT school, we treat safety like it’s someplace between a non-issue and a joke,” says Skip Kirkwood, MS, JD, EMT-P, EFO, CMO, chief of the Wake County (N.C.) EMS Division and president of the National EMS Management Association.
“We now have a culture of denial. We pretend we’re not going to get hurt and we’re shocked when we do,” says Kirkwood.
“We train for the best and hope nothing happens,” Kirkwood says.
That kind of thinking leads to some taking safety for granted. For example, some EMS providers carry body armor but only put it on if the call is for a shooting victim, which leaves them unprotected if a routine call suddenly turns violent.
Kirkwood says personnel in the field need training now to be more aware of how quickly a simple scene can go bad.
“My personal effort is to raise awareness,” says Kirkwood. “If we all keep pushing it, somebody’s going to walk up and say we need more training for paramedics than running them through 1,000-hour puppy mills to get them past the National Registry.”
Kirkwood and Taigman suggest some immediate changes to what’s now considered routine with EMS workers. They suggest putting away the multi-colored handled scissors and pocket knives many carry because those tools can and have become weapons in incidents against EMS providers. They also say EMTs and paramedics should become proficient in communication skills necessary for defusing situations, rather than escalating them.
Further, they claim EMS officials should reach out to local law enforcement and set up some defense and awareness training.
“EMTs and paramedics should spend some time on a regular basis rehearsing in their minds, ‘if this happens, what am I going to do?’”
Taigman says. “What am I going to do if I’m caring for a patient and they reach for a knife? Or if I’m restraining a patient and they’re trying to bite me, what am I going to do? Or if I’ve got a partner who is using profanity, adding sarcasm and adding anger, and adding adrenaline to an adrenaline-filled situation, what am I going to do to stop my partner from doing stupid things?”
Taigman says, “Nobody is going to take care of your safety for you. You’ve got to take care of your safety yourself.”
—Richard Huff, NREMT-B
Responding in Personal Vehicles
One of the biggest contributors to EMS legal liability is vehicle operations. Crashes involving emergency vehicles are too common. However, the risks are even greater when EMS personnel respond to emergencies in their personally operated vehicles (POVs). This is common in volunteer agencies and in EMS systems that use on-call personnel.
Sometimes these responses are to the station; other times, they’re directly to the incident scene. Either way, the risks of a crash—and the risks of costly legal liability—are multiplied as the number of responding vehicles increases. This liability may fall on the individual vehicle operator as well as the EMS agency with which they’re affiliated. The individual’s personal auto insurance will likely also be affected, as this may be the primary source of coverage in POV response accidents.
Note that most states do not treat personal vehicles as “emergency vehicles” and do not grant them any special privileges under the law. This is usually true even if the personal vehicle is using emergency lights. Of states that even permit emergency lights on personal vehicles, many treat these merely as “courtesy lights” and don’t obligate other motorists to yield the right-of-way or permit the responder to illegally pass another vehicle. Be sure to check your own state law.
EMS agencies that allow personnel to respond in their POVs should consider taking several steps to minimize or reduce the agency’s liability. First, agencies can, of course, elect to prohibit the practice of personnel responding directly to the scene. Not only does the act of responding pose risks, but the presence of multiple personal vehicles on an incident scene can also be hazardous. Alternatively, agencies can limit direct responses to the scene in personal vehicles unless the incident location happens to be in a direct path to the station and/or unless extenuating circumstances exist based on the nature of the call.
If your agency permits direct scene responses in personal vehicles, consider adopting an operating policy regarding the parking, staging or placement of POVs on an incident scene. Of course, no personal vehicles should impede the response of emergency vehicles or be placed in a location that could delay patient access or transport.
Another step that EMS agencies should take is to adopt a clear and strict company policy requiring any personnel responding in POVs, whether to a scene or to the station, to fully and completely obey all motor vehicle laws, posted speed limits, stop signs, traffic signals and other traffic control devices. This should expressly include requirements that the responder come to a complete stop at all stop signs and red lights, observe the proper direction of travel on one-way streets and other specific requirements.
EMS agency policies can also require that individual responders complete emergency vehicle operator’s training to engage in POV responses. The policy can also require that responders carry personal automobile liability insurance, with appropriate liability limits (that the agency can—and probably should—set above state minimums) before being permitted to respond to any calls in a POV.
EMS agencies might incur liability from the acts of their personnel when responding in their personal vehicles, so having appropriate policies, training and insurance in place can help to better manage these risks.
Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s website at www.pwwemslaw.com for more EMS law information.
Physio-Control Leaving Medtronic
Physio-Control Inc., manufacturer of LIFEPAK monitors/defibrillators, the LUCAS chest compression system and AEDs, is leaving parent company Medtronic. A global, private investment firm, Bain Capital, has acquired Physio-Control for approximately $487 million. The deal should be finalized during the first quarter of 2012.
Current President and future Chief Executive Officer of Physio-Control, Brian Webster says Medtronic’s divestment of Physio-Control is understandable because Medtronic focuses on treatment in hospitals and through surgery, rather than first-response scenarios.
Always an EMS-centered company, Webster says Physio-Control now “can really put the emphasis on EMS and bring out great technology.” He predicts an acceleration of new products and markets with Bain’s investments in the company.
Webster says Bain saw a business plan, robust product plan and product strategy, which they were looking to invest in.
Bain Capital Managing Director Chris Gordon says, “Physio-Control is an impressive market leader. We are extremely enthusiastic about the company’s growth prospects, and we look forward to working alongside Brian Webster and the whole Physio-Control team to support their strategic plans.”
Physio-Control was founded in 1955 by cardiovascular surgeon Dr. K. William Edmark. His research led to the first commercial defibrillator. Physio-Control joined Medtronic in 1998. From 2004–2006, Physio-Control was known as Medtronic Emergency Response Systems. It regained its original name when Medtronic said it wanted to release Physio-Control as a separate company.
Take a look around the world, the country or maybe your city park: Civil unrest is no rarity these days. Law enforcement has traditionally been the agency dealing with crowds of people who are out of control.
However, EMS and fire personnel also need to know to prepare for and respond to unruly, if not violent, crowds. The Firefighters Support Foundation provides a free course, “Fire/EMS Response to Civil Unrest” that includes a downloadable video and PowerPoint presentation. FireEngineering.com hosts the program on their website at www.fireengineering.com/training/ffsupport.html.
Some of the topics covered are types of events, coordination with other agencies and law enforcement, approach strategies, the potential for violence, lessons learned from previous events and why no jurisdiction is too small.
The course was developed and is delivered by August Vernon, operations officer with the Forsyth County (N.C.) Office of Emergency Management. Vernon says the potential for trouble exists “any time you get large numbers of people together.” He adds, “All communities, large and small, need to be prepared as we enter the hotly contested political season.”
Vernon teaches courses in incident management, mass violence, emergency management and terrorism/weapons of mass destruction planning-response. He also spent a year conducting route clearance and long-range convoy security operations in Iraq.
In Brief: To read more about EMS safety, visit jems.com/training
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This article originally appeared in January 2012 JEMS as “On Target: Are EMS providers trained for dangerous patients?.”