DANGER, DANGER
It’s been said that the back of an ambulance is a dangerous place to be. Providers tending to the patient may not be wearing seatbelts. Loose objects may fly off shelves in case of a sudden swerve, stop, or crash. And let’s not discount the germs! Of course, proper cleaning, storage of items, and using seat belts (or having a partner help stabilize you if you need to stand) can help to reduce some of the danger, hopefully.
What about violence? Maybe that sweet, innocent patient is also scared to the point of being irrational… maybe the patient is high or drunk… or maybe the patient has “plans” to steal drugs, or something else. Meanwhile, there you are in a confined space with the ambulance moving too fast to simply step out of the door to safety.
It’s been said that the fatality rate for EMS providers is higher than the national average for all workers; injuries on the job from vehicle accidents, assaults and attacks on EMS providers are frightfully high.
So, what can you do, in the back of a rig, or at a potential patient’s home, to protect yourself and your crew? De-escalation is the most often suggested – In order to de-escalate remain calm, keep your voice even without yelling; if possible, give the patient space; listen to what the patient is saying and empathize; don’t mock or argue.
And if that doesn’t work… Some places, like NYC, are providing protective gear (body armor) and yearly self-defense classes. There are a few agencies in the state enabling the teaching of the Israeli Krav Maga method of defense. Krav Maga teaches a variety of step-down and self-defense methods, but most importantly, the concentration is to escape the violence when possible.
If the EMT/Paramedic believes both de-escalation and escape are no longer options, and you need to engage physically, be sure to document fully and truthfully all interactions, attempts, and eventual resolve… you may have to defend your actions in a courtroom. As the “professional”, a court will often be harsher on your actions than those of a “frightened” patient… make sure your actions are completely detailed and honest.
While the NYSDOH does not specifically offer Krav Maga or other detailed self-defense classes, unlike NYC FDNY-EMS, it is something that individual councils can and should consider. Keeping your staff safe (paid or volunteer), teaching them how to successfully de-escalate a situation as well as having situational awareness at a scene… and even more importantly, awareness in the close quarters of a rig, will keep your crews healthier and able to respond to every emergency.
Even if your agency/employer does not offer self-defense training, individual EMS professionals can investigate this de-escalation and self-defense training for themselves. But remember, the most important aim is not to physically engage, but to minimize the situations when you might feel the need to defend yourself during an emergency call. The goal is always to get the necessary help for your patient and could go home yourself after your shift.
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