Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Surviving the Next Shift – Part II

Continuing from Part I of the discussion about what we need to do to go home safely at the end of our shifts.

On Surviving the Next Shift, Brad Buck, Matt Fults, and Dr. Chris Russi D.O. are joined by Eric Dickinson (author, police officer, EMT, and author of the article Tactics to Survive Your Next Shift) and Art Hsieh (of EMS1.com and author of the article On self defense and being a medic).

When is the scene safe?

The scene is NEVER safe.

Scene safety is just another EMS myth.

What can we do to make the scene more safe?

Awareness of the environment.

Anyone who has been violent can should be expected to be violent again.

If you are an abused spouse and you want to believe that your abuser really loves you because they say they really love you with the same sincerity that they say they will never hit you again – that is your fault. Wake up and call 911.

If you are EMS and you believe some violent person who says I won’t do that again, with even more sincerity than a drunk saying he won’t drink again – it is your fault when you get attacked, again. Wake up and call for police right away.

The best predictor of violence is a history of violence.

The best protection from violence is not a weapon, not body armor, but awareness.


Image credit. Alex is so fond of ultraviolence, he even attacks his droogies.

The best protection from violence is not a weapon, not body armor, but awareness.

Weapons can be used against you. If you are not an expert with the weapon, expect to be donating your weapon to the violent person.

Body armor slows you down. The police will be using body armor to protect themselves from the weapons you gave to the violent people.

The most dangerous weapon is whatever can hurt you, that you don’t think can hurt you.

Your pen can be used to kill you. Do you get signatures from violent people? If you do, you are asking to be hurt.

You carry a knife. Do you know where it is? You should probably leave it where it is, but do you know what part(s) of you equipment includes a knife?

One of the weapons mentioned is the monitor, because of its size. The older monitors had the defib paddles and these can be great for stopping someone dead in their tracks. Hit the charge button and most people will not come any closer. My boss was left alone with a prisoner, but thought the police were still behind him. When the prisoner came after him and he realized that he was about to have some quality cellmate time, he grabbed the paddles, pressed charge, and said, Come and get it. Defib pads probably do not have the same effect.

There is also the possibility of oxygen therapy. A portable oxygen bottle can be swung very effectively in a confined space. Most regulators can provide a good grip, but even a two-handed grip can allow you to do enough damage to allow you to get away.

Our goal is to be as violent as necessary for anyone attacking us to change their minds and let us go. The police would much rather have us out of the way before they come in with weapons drawn. We will probably be back after the violent people have been disarmed and cuffed. Somebody has to patch up their injuries.

Do not play with the emergency panic button on your radio, or on the radio of someone from another agency on scene. I used to work with some clowns who would stand beside you and get their thrill for the day by pressing that emergency button on our portable radios. Since we work in EMS, nobody takes this seriously and there was never any punishment. Boys will be boys was the attitude. That is fine – after they have left EMS for the exciting world of fast food order fulfillment.

Another thing that is mentioned is the foolishness of medical command permission requirements for EMS.

 

A treatment for a true emergency should never require medical command permission.

 

If we get into a situation where we feel the need to use violence, we probably did something wrong.

Go listen to the podcast.

If you do not believe me about the knives in our equipment, here are two examples –


Image credit. For BLS (and ALS), an OB (OBstetrical) kit has a scalpel, which is a knife.


Image credit. For ALS, many cric (crichothyrotomy) kits contain scalpels.

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Comments

  1. There isn’t any merit to the criticism that “body armor slows you down”. People are slower than bullets regardless. Not only does body armor protect against bullets, but it also reduces thoracic injuries in vehicle collisions. Wearing armor just makes good sense when on the job.

    • Marc,

      There isn’t any merit to the criticism that “body armor slows you down”. People are slower than bullets regardless.

      Was there any suggestion of anyone outrunning any bullets?

      Not only does body armor protect against bullets, but it also reduces thoracic injuries in vehicle collisions.

      You need to be shot, not just anywhere, but shot in the chest, for body armor to protect against a bullet. I do not see the need for body armor.

      In a vehicular collision, what difference does body armor make? It protects people who do not wear seat belts, but again, it only provides limited protection to the front and back of the chest. I’ll wear a seat belt.

      Wearing armor just makes good sense when on the job.

      For a police officer, wearing body armor makes sense.

      For a tactical medic, wearing body armor makes sense.

      For anyone else, wearing body armor suggests that the person is going into the wrong scenes prior to having police clear the scene.

      Body armor doesn’t slow you down?

      Body armor weighs nothing.

      Body armor does not restrict movement.

      Body armor does not raise body temperature (which is OK in a cold environment).

      Body armor does not have its own cooling accessories to counteract the overheating.

      If we were to equip all medics with body armor, we should expect more cases of medics needing to be treated for dehydration and heat related illness. Not that any of this would slow anyone down.

      We should also add helmets.

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