DT4EMS

Actually there have been more deaths "statistically" due to the MVC. As the driver, occupant or pedestrian around an ambulance the dangers are always present. The studies have stated more "injuries" from assaults. Plus remember "ambulance crash" gets way more publicity than a medic attacked. Ambulance crashes are at the top of the "legal" food chain because the driver can almost always be faulted. Driving with "due care" are the words that haunt EMS. The EMS Network keeps a running list of articles regarding both crashes and assaults. Here is a quote from the NAEMT........... A total of 1,356 NAEMT members participated in the survey, jointly commissioned by NAEMT and McNeil Consumer & Specialty Pharmaceuticals, and reported that: • More than one in two (52%) have been assaulted by a patient; • One in two (50%) have been exposed to an infectious disease; • Almost one in two (47%) have sustained back injury while performing EMS duties; and • One in five (21%) have contracted an illness from a patient. The survey showed 4 out of 5 EMS providers were injured on the job. I don't think 4 out of 5 were due to crashes. Again more fatalities and more news coverage of the crashes. The point I am trying to add to this......... there is EVOC and AVOC and CEVO to help with driving. Gloves to help with the infectious disease. Lifting and moving patients to help prevent back injuries. Give each it's due. Regarding crashes............ http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a3.htm "During 1991--2000, the most recent year for which data were available, 300 fatal crashes occurred involving occupied ambulances, resulting in the deaths of 82 ambulance occupants and 275 occupants of other vehicles and pedestrians. The 300 crashes involved a total of 816 ambulance occupants. FARS does not differentiate ambulance workers from passengers among those experiencing nonfatal injuries in fatal crashes; however, the seating positions for all occupants and the severity of injuries can be determined from FARS data"

I am going to use that in all of my presentations from now on. Thanks Dust!

How safe is your scene? These are just reports from the last couple of weeks. At what point did these EMS providers have an opportunity to check for scene safety? With the NAEMT releasing a study of 52% of injuries in EMS coming from assault…… it’s obvious EMS providers are assaulted on scenes they thought were safe. · A paramedic was sitting on the back of his ambulance in a bowling alley parking lot when police say a man walked out from a bar, drunk and stumbling. The man approached the paramedic grabbed the paramedic in the groin, twice, and offered sexual acts. · Bullitt County authorities are searching for two men they say attacked an EMT. Two guys opened the side doors of the vehicle and dragged her outside, yelling and screaming for morphine. She has a dislocated jaw, broken ribs, a concussion and knife cuts on her arm. · In Portsmouth six police officers subdued a suicidal man who allegedly held a knife to a paramedic's throat at Portsmouth Regional Hospital this morning. · A Carlisle man is facing an assault charge after state police said he attacked two emergency medical technicians as they were treating him in an ambulance in Cumberland County's South Middleton Twp. Police said the man became irate and combative when the technicians cut his shirt while in the ambulance. · Two men went on a rampage Friday, smashing vehicles with baseball bats, attacking firefighters and paramedics and slugging a woman on the street. What about the female medic shot while assisting the intoxicated man out of a vehicle a couple of months ago? Remember the female medic in Chicago that received a smashed face from a pipe? The point is…… while on duty, in EMS there is no such thing as a safe scene.

Well I will give you a quick .02 worth. Self-Defense in EMS is different than in any other field. Wherever you train think of 4 things to train for 1) The battle of your mind (when can I? Will I get in trouble? etc.?) Officers have extensive training in this area. 2) The actual physical battle. I am not going to start a debate of what system works best, but you better train in somethign that has been "pressure tested". 3) The battle of the media. (Headline reads :Paramedic beats up drunk patient) This it what makes EMS different from any other group. 4) The courtroom battle. If you don't follow local and/or Federal law you may find yourself on the losing end. If you don't train in all 4 areas you are setting up yourself for failure. I have taught hundreds of EMS providers DT4EMS. Based strictly from the EMS perspective. Not as a police officer or a martial artist (although I have a background in both). We use stress scenario training to help the EMS provider recognize limitations and don't blow smoke. The job of the EMS provider is to provide care. Training in techniques where you expect "pain" to cause a person to stop will not always be effective. Remember the people that assault EMS usually fall under one of the 5 D's Drunk, Drugged, Diabetic, Deranged and someone really amped at a Domestic. The best tool you have in any situation is your mind. Situational awareness is the absolute best thing you can do. Knowing when things are starting to get bad, having a code word or phrase between you and your partner and get out. Preparation is not paranoia Stay Safe. Kip Teitsort

I agree 100%. I thought you were refereing to "in the back of the ambulance". Even if it was the 250 lb crazed dude....... I still don't want to tie up with him. I train and have options if I did, but my mind set is always finding the way out. I spend a lot of time trying to help people recognize the "potential" in situations. More and more "anecdotal" stories are surfacing of how EMS providers are attacked on so called "safe" scenes. Believe me I have been there and done that. I have fought my share of people under the influence. As a police officer I never had a single scuffle with a sober person. As a paramedic my ambulance was car-jacked while I was in the back with a patient. So I don't just pull BS out of the air. Not being on a bad scene is the best you can hope for. The truth is, it is more likely than not the average EMS provider will face a violent encounter. So if you already hit the gym, train in some form of contact style self-defense and have a good understanding of what is legal you have a great base. It has to be up to you.

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.

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.

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

Situations like this very one arise almost daily. If it isn't incidental, it is purley accidental the average EMS provider ever even hears about it. Most of the time someone points it out it is usually during an anecdotal story. When the NAEMT released the numbers of assaults last year everyone jumped up and down saying t couldn't be that high. Now even others like OSHA and the National Fire Academy are starting to receive "Papers" written on the subject. (Not by me). I can tell you that most police departments have it IN POLICY that if a suspect complains of injury, they MUST be transported by EMS to an appropriate facility. The average offier "assumes" EMS are good at patient restraint. (It's not their fault). If you work in an area where there is only 1 deputy or officer for that sector, he/she will have to follow, not ride with. Be very, very cautious of anything restraint wise that restricts breathing of a suspect/patient. Just like Dust said, there are many "experts" now that will gladly take the $100.00 per hour to testify how all decision making folks including the NAEMSP have released position papers on patient restraint and restraint asphyxia. I can assure you this type of a call is a no win for either EMS or LEO.

Here is a PDF of our basic ground drill. Once they have the drill we introduce a knife or a buddy. We also start with one guy woofing he is armed with a stick or a knife and it's on like Donkey Kong. We do go hard core. Then we take the "principles" and pass them on. Somethings work and some don't. But since the world has seen BJJ and MMA can be devastating, it is easier for me to "testify" ....... "WHY" I had to cut, bite, rip etc to a Jury to explain how brutal the MMA guy could be so I feared for my safety when he placed me in guard. " I though he would choke me to death your Honor". That is why I plunged a knife into his groin or raked his eyes out. SO I don't have to be a great submission artist, but instead be great at defending the choke, the armbar, the triangle etc. Then try to create space to escape. See it doens't sound right to hear me or any medic talking about injuring someone. If I were in fear of my life, I would and I have in the past. http://www.dt4ems.net/files/basic_ground_drill.pdf Basic Ground Drill

I typed a huge response and got logged off.... I agree people need to get popped in the gym. But I also know EMS provider won't train at all if they were getting punched in the face to get CEU's. In my school where we train combatives every time we meet, in a situation where we are being choked from behind, a knife goes in their thigh, then the groin. ( Tactical Folding Knife). To pass the guard, we are brutal with eye gouges and groin Strikes. I have to work to feed 5 kids, I didn't enter into a fight willingly so we have to fight to win. When we train j=key locks, we do not let go when the partner taps. Instead we train to stop the forward motion until the situation is safe, but we don't let go. I don't sing the praises of MMA for EMS self-defense, because the goal of MMA is submission or knock-out. I have knocked people out in real life. I have faced a man armed with a machete, I have fought the crazed freshly released prison dude. So I too can say I believe in what I am teaching. We do teach ground skills, but for escape, not submission. We can't teach EMS sleepers, when most police officers have had it removed from their Use of Force Continuum. Otherwise we can show them how to kill a man in three moves only to lose their job and go to jail. We must also draw the line between patient and attacker. Other people don't teach that way, I do. I say train, I could care less if it is wrestling with your brother in the back yards, but know your laws too. Think about it a simple tactics like an ear slap can create space for a 105 lb female to get away from a 400 lb man. Would we want to teach her to take him to guard by choice? EMS self defense must be different. It can't be like police defensive tactics (arrest/control) is has to be only for escape or we are setting them up for failure. Krav-Maga and FMA are awesome for self-defense too. Keep up training and good luck to you. Stay safe. MadAxe, if we could get all of EMS to train, in any art, I would be happy.

I agree nearly 100% with what you said. That is why we have a FIST suit and actually attack the participants. It is definitely different that the huggy-kissy pressure point mentality. EMS providers have to have more than just "techniques" taught to them. Avoidance, Recognition and Escape must be taught. Not submission or compliance. An EMS provider should never use any defensive tactics against a non-compliant patient. There is a difference between training in Law Enforcement (Arrest/Control), Martial Arts (Sambo, BJJ, Karate etc) vs 100% escape training. This is why people get so confused. They think MMA is self-defense. If it was, why are guys like Blauer, Vunak, Cucci etc teaching exclusive MMA techniques? There is a whole different mindset to going to the ground (as a choice) in combat or self-defense. Don't get me wrong, I am just like everyone else who had to change the way we trained since the early 90's. You have to know how to escape the mount, pass the guard etc..... but not to compete. Remember a fight has to have at least two willing combatants. If the only goal is escape it becomes self-defense. Is the champ Chuck Liddel a master on the ground? Or does he train to "prevent and escape" the ground game. What if the person had a knife? What if there was more than one person? Escape, Escape, Escape........... that has to be the "goal" if you messed up and found yourself on an unsafe scene. If an EMS provider trains 2-4 times a week or more, this is a dead issue provided they follow the law when using their skills. We "pressure test" all of the stuff we do. That is why you see people going against a simulated attacker wearing the suit. We choke them, throw them down, slam them against a wall etc......... always forcing them to find the "out". Another point is this: If you teach people the "progression" of an assault you CAN help them prevent the first strike, slash, push, punch, grab etc. We do this all the time. How many fights start with a tackle? Something usually preceded it. (A push, poke, punch etc.) So if people can recognize the progression of the attack, they can work to get back to a safe zone. If we train them in submissions, they will enter willingly into something they may regret. I am not talking about those that train for competition or on a regular basis...... but if we are talking about the average EMS providers they need commonality in their escape training and his has to be legally sound.

TerrfyinFlyinSrvc your apology is respected and accepted. Beleive me I understand about the Bruce Lee mentality. The goal of DT4EMS is to prevent onne person, patient OR provider from being he victim of an assault. I believe there are a lot of cases where an EMS provider crosses the line and does something like put his knee across the throat of an uncooperative drunk.......... Well that's deadly force just because a drunk won't cooperate. It is stuff like that I try to prevent too. See I believe the training should be a part of every EMT and medic school. Again it isn't martial arts or law enforcment Defensive Tactics. It should be geared toward EMS with EMS and pateint safety in mind. There has to be a strong line drawn between patient and attacker. An EMS provider should never strike a patient........ but there is a time a provider may have to strike an attacker to escape (I hope that makes sense). See without training a green EMT or Medic may confuse the "Uncooperative drunk" with a drunk who is actually trying to hurt him. Either way the medic could lose. You must make sure the povider is also trained in the proper way to document and report (to LEO and supervisor) any time they were assaulted or used any type of force. The defense technique (tactic) is the easy part. It is all of the legal stuff surrounding the "when and why" that gets people in trouble when teaching or learning self-defense.

You are exactly right. But it is the "principle" I am trying to get across. Not the technique. Look at the common principle in all of the video clips and you WILL see it. You should never just watch a video and think you can do it.... Besides it is all the stuff we do BEFORE the assault takes place. The hands on is IF I SCREWED UP! See it is responses like that that keep me from posting. People immediately think DT4EMS is about cops or fighting............sheesh........ Scene awareness is number one. Treating people with respect is number two. Knowing how to escape is number 3. All you have to do is talk to one of the hundreds of EMS providers that have trained with me in person and see if I am blowing smoke up their butt. The idea is not NINJA skills..... but escape skills. Ands you are right about the Taser, OC etc......... no one person can be controlled by another without changing their mind. Did you see one thing about "control" We teach "Elbow Control:" to buy the provider a "second" to escape. Not for "Subject Control" like law enforcement. Know who I am before you accuse me of teaching karate or LEO DT to medics............ Please........ Talk to people that have actually attended one of the courses.......... here is a "Class Clip" notice the difference in the speed..... http://www.youtube.com/watch?v=DxN0jU6gZls I can assure you, the person in the FIST Suit simulates a DRUGGED attacker very well. The scenario here is the "provider" has foolishly allowed his exit to be blocked. The drugged attacker is trying to grab them , slap them etc. But the "attacker" is woofing them telling them he is going to kill them. Before the EMS Provider ever gets to this point in a class, they already learned laws, levels of force escape moves etc. The FIST Trainig does three things.... 1) Shows them a real fight SUCKS and 2) How fast you run out of steam when you are truly scared and 3) Just because you are tired Don't stop trying to escape.

Hi all, Since it was brought up (and I didn't do it) There are some real differences to EMS vs others using force. The difference is the media. Although I am a huge fan of O2 Therapy if the situation required it most medics and EM T's can't explain "When" would be an appropriate time to do such a thing. See any time someone starts a thread about EMS safety, it generally takes a turn for shooting, smashing or killing just to protect oneself. Deadly force may be justified in certain situations, but man are they rare. I am humbled because since 1996 I have been teaching DT4EMS. It is for EMS by EMS not cop stuff or karate. I get to teach it at the Missouri EMS Conference in April of 2007 and I was just contacted by the local Fox News to do a story on it. The other kicker is "Yes" practice is required to be proficient in anything. But with the way we present some of the "drills" you can practice anywhere with a partner without mats or gear. (Some stuff requires that but not all). Again, DT4EMS is like practicing to do a surgical cric....... you may never have to do it, but if you do, I hope you practiced. Stay safe all.