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Training EMS for Violent Encounters


No matter how much we wish it weren't so, EMS providers can and do become targets of violence from various threats, including patients, family members and bystanders. EMS personnel must be mentally and physically trained to respond effectively to such incidents, especially if they work in rural areas with extended law enforcement response times.„

Changing Your Mentality

The first hurdle is admitting that there are evil people in the world who are willing to hurt or kill you despite the fact you are a caring individual who wants to help them. It doesn't matter how small your community is or how many violent crimes are reported in your areaƒit can happen to you.„

Mental imagery is an underutilized training tool that has long been taught to law enforcement and works just as well for EMS. Visualize common types of calls you respond to. Imagine those calls resulting in some type of attack. Imagine being hurt, and mentally rehearse your response to the attack and how you would treat your own injuries until help arrived. Practicing mental scenarios is invaluable. Plus, you can do them anywhere, at any time.


Physical conditioning cannot be overlooked, and it plays a large part in your ability to escape. Certainly, a regular workout program that combines cardio and resistance training is ideal but may prove difficult for some responders, particularly volunteers. Instead of thinking in terms of how fast you can run a mile or how much weight you can bench press, ask yourself how much injury your body can take. How far could you run to escape danger? How long could you fight? The average person has about 30 seconds to win or escape before fatigue will take over.„

Training must be as realistic as possible while maintaining an acceptable level of safety for all participants. Practicing trauma skills with moulage and skilled role players makes personnel actually assess an injury and inoculates them to the distracters that can derail effective response and treatment, such as screams of pain and grotesque injuries.„

The same philosophy is true for scene safety training. Teaching EMTs to simply say "the scene is safe" isn't enough. Props and threats may not be real, but they must be realistic. Place items inside the scene, such as ammunition boxes, outdoor magazines or hunting trophies, that may indicate the presence of traditional weapons, such as firearms and knives. Boxing gloves, martial arts uniforms or certain photos may suggest the patient or others have training in boxing, wrestling or martial arts. Uniforms, unit patches, awards and badges may indicate military or law enforcement training. Old medication bottles could be used to help show the possibility of a psychiatric condition. Items such as beer bottles, needles, spoons, plastic sandwich bags and scales may provide indicators of possible substance abuse. Give your personnel the opportunity to recognize these indicators of possible threats, and practice withdrawing from the area or calling for law enforcement assistance.

Seek hands-on training in physical defense and restraint techniques. While basic training may take place in a padded training room, real-life incidents like this will probably occur in cramped quarters, such as a residence hallway, bathroom or the back of an ambulance. Advanced training must safely simulate those conditions and locations.„

Many EMS providers have probably never been in a fist fight. Padded suits, like those used during police physical control training, provide personnel with a safe and effective method of practicing responses to violence, while preventing unnecessary injuries to personnel and role players. This gear allows participants to strike each other with nearly full force and overcome their inhibitions about striking another human being, especially one they were initially trying to help.


Make sure your personnel have the training they need to avoid a dangerous situation whenever possible. And when they find themselves in the midst of a violent situation, equip them with the confidence to fight back and escape.„

For more on survival tactics, read"Survive Your Next Shift"from July JEMS.„

Eric Dickinson,„ EMT-I(85), BS, is a senior police officer with the Vinton (Ioa) Police Department, a part-time EMT with Iowa County EMS and an adjunct instructor at Kirkwood Community College and Hawkeye Community College. He holds instructor certifications in various topics related to EMS response, officer survival and use of force. He has taught Survival Tactics for EMS Providers (STEP) to more than 500 providers. Contact him at„edickinson49@hotmail.com.


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