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Predicting & Dealing w/ Violence

When they think about maintaining their safety on the job, Emergency Medical Personnel, EMTs, Paramedics, nurses & social workers always want to know: Is it possible to predict who will be violent? What can I do to prevent a situation from becoming violent? And what should I do to protect myself if someone strikes out at me?

Predicting Violence

Are there factors common to those who commit violent acts? In fact, there are. Research has identified certain traits and factors that make people more inclined to violence:

Prior Violence. Each time someone commits a violent act, it is more probable that violence will happen again. Since this is the single best predictor of violence, it is a good idea to ask questions about past or current violent behavior during your initial contact with a child or family member. Specifically, you want to know about a person’s most violent act, and how often he or she has violent thoughts.

Certain Feelings. Several internal factors have been associated with aggressive encounters. These include fear, humiliation, boredom, grief, and a sense of powerlessness. To reduce risk, avoid putting clients in positions that embarrass them. Rather, give them knowledge that empowers them and help them see other, nonviolent options.

Physical Factors. Physical factors increase the risk of violence as well. These include lack of sleep, physical exhaustion, use of drugs or alcohol, brain trauma, heat, hunger, cold, physical disability, or chronic pain.

Situational Factors. Situational factors are also predictive of violence. Access to weapons, experiencing childhood abuse or aggression in the home, or feeling a sense of injustice or oppression can lead to violence.

Forced Removal. There is growing evidence that demonstrates that violence is more likely when children or adults are taken from their living situations, especially if they are removed in front of family or friends. Therefore, removals should always be planned events. Never conduct one alone.

What to Look for

Even if you do not have any information about a person’s past history or current emotional state, there are signs you can look for. Observe the person’s body: is she pacing or fidgeting? Clenching her fists or jaws? Does she have a “wild” look in her eyes? Is she out of touch with reality? Is she speaking in a loud voice or becoming verbally abusive? If you see these behaviors, take immediate steps to reduce the tension before it escalates.

Reducing Tension

You are on a home visit, and Mom’s boyfriend comes home. He glares at you and paces around the room. When you explain who you are and why are visiting, he yells at you. He begins cursing and gesturing, but stays away from you. What do you do?

Unfortunately, there is no “right” answer, no technique that will work in every situation. Ideally, though, you want to help the angry person “come down” from his or her anger.

The main rule (and it’s easier said than done) is to remain calm. A calm tone, demeanor, and presence transfers to others. Speak in a clear and direct manner, so the person can hear what you are saying through the anger.

It is not a good idea, however, to tell the client to “calm down.” By saying this, you communicate that you do not understand—if you did, you would understand why he or she is so upset. Instead, be empathetic. Talk about the frustration or problem that has come up. Reflect feelings and behaviors such as “you seem angry.” Take responsibility for your mistakes.

It may be easier to remain calm if you remember this isn’t personal—the person is angry at the situation, not you. Defensiveness on your part validates the angry person, increasing the tension (Horejsi & Garthwait, 1997).

Reinforce your calm tone with nonthreatening, non-confrontational body language. Move slowly. Avoid putting your hands on your hips. Position yourself to the side of the person, so you are not squarely facing them. Avoid extensive eye contact and physical closeness. Do not touch an angry person. Do not stand between the person and the door.

You can also use different strategies to help an angry person calm down. One method is to offer the person choices, such as talking later or agreeing on a cooling off period. Allow the person to save face—give him or her a way out.

Attempting to distract or change the subject can sometimes work, but be careful, as this may further anger people if they realize you are diverting them. Don’t use humor—in the haze of anger, it is too easily misinterpreted.

Even if the person seems to be calming down, be patient—it takes a person about 30 to 40 minutes to calm down from anger physiologically (Griffin et al., 1995). If you have done what you can and things still seem to be escalating, leave the situation and/or get help.

If Aggression Occurs

The angry boyfriend doesn’t calm down. Suddenly he comes at you, his hands outstretched. What do you do?

Anger and aggression cannot always be contained. If a person attempts to assault you, protect yourself. Your first step should always be to leave the room and get away from the situation. If you cannot leave, call for help and:

Protect yourself from head injuries. Block blows with pillows, arms, clipboard, etc.
If you fall, block the attack with your feet and legs.
If your arm is grabbed, break the hold by twisting quickly toward the person’s thumb.
If you are choked, raise both arms straight up and quickly turn around. Your arms and shoulders will break the hold.
If you are bitten, push into the bite, don’t pull away.
If your hair is pulled, press down on the person’s hand with both of yours.
Weapon: Never reach for the weapon. Encourage the person to talk. Focus on the person, and keep your distancem (Flick, 1996; Griffin, 1997).

Implications

Safety is essential to your success—you can’t help a family through a crisis if you are afraid for your own well-being. Therefore it is crucial to know how to identify potentially dangerous individuals and what to do when you encounter them. By maintaining your awareness and being proactive, you improve your ability to do your job, as well as stay safe.

Sources

Brady, E. (1993). Coping with violent behavior: A handbook for social work staff. Harlow, United Kingdom: Longman Group.

Brown, R., Bute, S., & Ford, P. (1986). Social workers at risk: The prevention and management of violence. London: British Association of Social Workers.

Dernocoeur, K. (1993, July). Tips on defusing a violent situation. JEMS, 78-79.

Flick, J. (1996). Defusing potentially violent situations: Keeping yourself and others safe. Unpublished. Presented at social worker safety training.

Fraser, M. (1995). Violence overview. In R. Edwards (Ed.), Encyclopedia of Social Work. Washington, DC: NASW Press, 2453-2460.

Horejsi, C. & Garthwait, C. (1997). Be careful out there: CPS worker safety in rural areas. Protecting Children, 13(1), 12-14.

Griffin, W., Montsinger, J., & Carter, N. (1997). Resource guide for administrators and other personnel. Durham, NC: ILR, Inc.

Hughes, D. (1994). Assessment of the potential for violence. Psychiatric Annals, 24(11), 579-583.

Murdach, A. (1993). Practice forum: Working with potentially assaultive clients. Health and Social Work, 18(4), 307-312.

Nadwairski, J. A. (1994). Inner city safety for home care providers. Journal of Safe Management of Disruptive and Assaultive Behavior, 2, 4-6.

Star, B. (1984). Patient violence/therapist safety. Social Work, May/June, 225-230.

Source: UNC Training – Childrens Services Practical Notes

Adapted & re-published by: Dave Heuthe, American Kobe Jiu Jitsu Federation Black Belt & Certified Instructor. Dave provides group personal defense classes where lessons are taught in various locations, privately, at Bob Malvagno’s School of Self Defense, and through in-house work programs (e.g. -Fire Department, employer, churches & synagogues, community centers, etc.) in the Nassau County and Sufflok County, Long Island (LI), NY area. Dave’s business is to provide programs that help his students (adults, seniors, teens & children) master self defense. BECOME A CLASS MEMBER TODAY!

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Dangers Faced by Emergency Medical Personnel

Apr 7th, 2009

by admin.

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EMS Workers Face Many Dangers

By: Dave’s EMS Headquarters

It never entered my mind when I began my career as a Paramedic, that my career would be shortened after becoming the victim of violence. But in fact my career was in fact shortened because I was assaulted by a patient who had overdosed on illegal narcotics and became violent. Scene safety was never discussed in the emergency medical education program. Today emergency medical services personnel wear bulletproof vests because of the increased violence against EMS workers.

A study conducted in 1999 concluded that during 12-years in EMS, those paramedics received an average of 9 assaults per paramedic. Assault injuries resulted in 170 cases of blunt trauma, 73 lacerations, 2 gun shot wounds, 10 stabbings, 1 burn, 8 fractures, 9 dislocations, 1 choking, and 56 cases of miscellaneous body injuries.” Emergency medical services personnel continue to face many dangers in the course of their profession and in the line of duty. The dangers faced begin upon receiving a call from their dispatcher for response to a medical or traumatic call. The emergency run poses a greater risk of becoming involved in an automobile accident causing injury or death then the chances of an EMT accidentally sustaining a needle stick and contracting HIV.

Once on the scene of a call the emergency medical technicians chances of becoming the victim of an act of aggression and violence. Danger can threaten EMS providers at any time and anywhere. There is no such thing as a “safe” neighborhood or a “safe” area of town. Emergency medical services personnel have been killed and or injured, in the line of duty. The causes and acts are becoming more and more random. They include injury and or fatal injuries resulting from motorists who have failed to yield the right away to the EMS vehicles equipped that are equipped with state of the art flashers, sirens, and intersection lights. Drivers do not pay attention to Emergency Vehicles, and are distracted by blasting stereos, driving while intoxicated, and talking on cell phones just to name a few.

Once on the scene, emergency medical personnel often are faced with hysterical family members, sometime including verbal and physical assaults from bystanders. Additional risks faced by the EMS personnel include being struck by cars while treating patients at accident scenes that have resulted in both critical injuries and deaths. Motorist fails to slow down, or operate their cars dangerously and aggressively in accident zones. Over the years, paramedics have seen in an increase in responses to more dangerous situations that have resulted from both foreign and domestic terrorism.

EMS personnel have been targets during the Columbine school shootings, the bombing of the Oklahoma Federal building, the 1993 World Trade Center Attack, release of gas in the New York subways, and the most recent attacks on September 11, 2001 of the World Trade Center, and the Pentagon. Emergency medical services personnel who are trained to save lives and operate under the EMT Oath taken to preserve life, EMS Personnel now face the uncertainty that Police officers and Firefighters that there is no guarantee of returning home to their families at the end of their shift. Paramedics and Firefighters do not carry a firearm their only means of safety is a Law Enforcement presence and that’s still not a safety guarantee.

Legislation is lacking in many states that provides strong legal consequences for causing injuries and or death of these dedicated men and women in Emergency Medical Services. As stated earlier the cost of a bullet proof vests is approximately $500.00 per vest, many private agencies as well as volunteer organizations do not provide these needed safety devices because of the cost, leaving the choice and expense of the EMT. Recently in my county a new policy was adopted by the Medical Control Director that states that EMS Personnel and Firefighters responding to violent and suicide calls must “stage,” [park several blocks away from the scene until police units have arrived and secured the scene] although this protects the responding medical personnel it does create the danger of delaying rapid treatment for the patient. EMS Personnel should incorporate the following criteria in their response to Dangerous calls.

1.) Dispatchers need to obtain as much Information as possible, i.e. is there a violent situation for patient? Is this an attempted suicide and by what means, if this is a shooting and or stabbing is the perpetrator still on the scene? Is the patient in possession of any type of weapon?

2.) The responding EMS crew and Fire personnel must be given detailed dispatch information, including frequent updates regarding Law Enforcement’s response as well as their estimated time of arrival. In addition, dispatch should update the crews as additional information becomes available.

3.) Upon EMS arrival, the EMS crew should overview the scene. i.e. is there any immediate danger, is law enforcement on the scene, and are there any visible dangers to the crew. Identify areas for a safe retreat.

4.) When on scene of a motor vehicle accident, survey the area before getting out of the rig is the scene secure. Are there any electrical lines down on or around the vehicle or vehicles, is there a vehicle fire, are there any vehicles involved there is transporting hazardous waste or chemicals? Is traffic congestion causing additional hazards? Place your Unit in a safe position that will protect you, the patients, and the scene.

5.) Do not put yourself in harm’s way; Always have open communications with your dispatcher. If the scene becomes dangerous remove yourself and your partner from the scene until security is reestablished by law enforcement.

The potential for scene violence & violent patients exists for all types of EMS responses, do not become complacent you must always remain vigilant. Since the attack on September 11, 2001 police officers, firefighters, and EMS personnel have had the publics renewed appreciation for the work that we do and the a unselfish sacrifices we make.

Source: EMS Dangers

DISCLAIMER - Please be advised, Dave Huethe is not the person noted, associated, or affiliated, with Dave’s EMS Headquarters. Re-publication of the above article should in no way be construed that Mr. Heuthe endorses, supports or approves of any of Dave’s EMS Headquarters website and/or its associated content.

Republished by: Dave Heuthe, American Kobe Jiu Jitsu Federation Black Belt & Certified Instructor. Dave provides group personal defense classes where lessons are taught in various locations, privately, at Bob Malvagno’s School of Self Defense, and through in-house work programs (e.g. -Fire Department, employer, churches & synagogues, community centers, etc.) in the Nassau County and Sufflok County, Long Island (LI), NY area. Dave’s business is to provide programs that help his students (adults, seniors, teens & children) master self defense. BECOME A CLASS MEMBER TODAY!

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Safety strategies for EMS

Mar 31st, 2009

by admin.

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How to Stay Safe

By: Dave Heuthe

How can we as EMTs and paramedics stay safe? Our job puts us in potentially dangerous situations every day. We deal with the public in a similar way that the police do. People call us for help and they expect us to solve problems or resolve disputes that they can’t resolve on their own. Though we don’t deal with criminals in the act of a crime, we do deal with people who, for a variety of reasons, medical and/or emotional, may see us as a threat.

Emergency situations can escalate very quickly into a physical confrontation. This is where the police have a big advantage. They have weapons. We don’t. They are trained and authorized to use deadly force. We are not. So how can we deal with the reality of our job? Is there a way we can stay safe with the limitations we have? I believe there is.

In a previous article entitled “Awareness: our first and Best Defense” I wrote about how to avoid dangerous situations, but as you know we are not always in full control, mistakes happen and we can find ourselves face to face with danger. What do we do then?

Here are some basic strategies to stay safe.

1) If you find yourself in a dangerous situation LEAVE. If it’s obvious that you won’t be able to treat the patient, GET OUT OF THERE and call for the police. You remember them, the guys with the guns. It’s nice to get a medal for heroism, but not posthumously. People will talk about how brave you WERE, but your family will still be without you.

2) Speak in a calm voice. Don’t allow your emotions to take over. Don’t shout or yell. The Bible says, “A gentle answer turns away wrath.”

3) Don’t challenge. If a person puts his fists up don’t mirror him. He’ll see that as a challenge, which could escalate into a fist-fight. Step back with your hands out, palms facing him, saying, “I’m just here to help you.”

4) Put your ego in your pocket. We can’t allow ourselves to take what people say, in the heat of the moment, personally. Others may insult or accuse you, but remember they don’t know you. It really doesn’t matter what they say so let it go.

As I said before mistakes can happen, but if you follow these simple rules, your chances of going home safe are greatly increased.

Published by: Dave Heuthe, American Kobe Jiu Jitsu Federation Black Belt & Certified Instructor. Dave provides group personal defense classes where lessons are taught in various locations, privately, at Bob Malvagno’s School of Self Defense, and through in-house work programs (e.g. -Fire Department, employer, churches & synagogues, community centers, etc.) in the Nassau County and Sufflok County, Long Island (LI), NY area. Dave’s business is to provide programs that help his students (adults, seniors, teens & children) master self defense. BECOME A CLASS MEMBER TODAY!

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