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Feature Story

Helping EMS Workers Protect Themselves From Violence

Violence against EMS workers is a serious and ongoing problem for the profession. Providing EMS workers with the skills to prevent assaults where possible, and mitigate those that do occur, is the mission of DT4EMS. Short for “Defensive Tactics for Escaping, Mitigating, and Surviving a Violent Encounter,” DT4EMS offers a series of courses teaching violence prevention to EMS, fire, and healthcare workers. The courses are taught at regional centers across America, which can be found using this interactive map.

violence prevention training
DT4EMS offers violence prevention training for EMS, fire, and healthcare personnel. (Photos: DT4EMS)

Jason Brooks is president and CEO of DT4EMS, as well as a 28-year EMS veteran. “The ‘4” in our name also stands for the four areas you have to win in every single patient encounter, not just a violent encounter,” he said. “They are the Mind, the Street, the Media and the Courts. The Mind is all about understanding the legal and ethical portions of self-defense in patient care, and the difference between an uncooperative patient and an attacker. The Street is the physical skills that work—more often than not—to help you escape from violent attacks. Nothing is ever a hundred percent, but we give you things that are reasonable in application. The Media refers to the fact that 90% to 95% of EMS providers’ working days are being caught on camera. And the Court covers the legal court and the court of public opinion.”

Brooks said it’s the severity of assaults against EMS workers that is increasing, not the number of assaults. “They're not beating us more; they're just beating us harder,” he said. “What is also going up is the fact that we're starting to report assaults more often. No longer do EMS providers say, ‘oh, well, it's part of the job.’ What they're actually saying now is, ‘it's happening. So we're talking about it and trying to make the situation change.’”

violence prevention trainingFrom Brooks' perspective, “The number one reason that we get assaulted is we don't understand the difference between an uncooperative patient or an attacker. An uncooperative patient could be somebody who is diabetic, who reaches out and tries to grab you but they have no intent to harm you. And then we have the attacker, someone who many times is under the influence of alcohol or drugs, or just a jerk who intends to harm you.”

In this last instance, the best strategy is for the EMS worker to physically get away from the attacker and leave them to be dealt with by law enforcement. “We should be only taking care of people who want our care and not forcing our care upon people who obviously don't want it,” Brooks said.

DT4EMS’ assault prevention courses are a mix of verbal instruction and hands-on training. “We literally lecture, practice, lecture, going back and forth,” Brooks said. “When we're lecturing, we're teaching tactics about how to recognize and avoid an assault. When we're practicing, we’re teaching actual physical techniques that are reasonable in application to buy the provider a moment of time to escape the attack. Our goal is for our providers to use their tactics, not their techniques.”

violence prevention trainingDT4EMS is not your typical self-defense course. “People walk into self-defense courses thinking they're just going to learn how to fight,” said Brooks. “In the EMS profession, if you ever get involved in a fight, you're already automatically in the wrong because a fight takes two willing combatants. EMS people aren’t here to fight. And we never want what we do in public to look like a fight. We want to be seen as healthcare providers here to take care of people, and that’s all. This is why DT4EMS teaches EMS workers reasonable escape techniques, to provide a moment of time for the provider to escape the encounter, not win a fight—not to make the other person submit nor take them into custody control, but just for us to escape.”

To this end, DT4EMS doesn’t teach its students to de-escalate potentially violent situations.

“Instead, we teach escalation control because the only person you can actually control is yourself,” Brooks said. “We can’t make other people calm down, but we can keep ourselves calm in our words and actions in order not to make things worse, and let the others calm down. And if they don’t, then that’s a good time for us to keep our distance and separate, because if we stay engaged with them, that's when we become more likely to be assaulted.

“We also need to display what we call ‘perceived neutrality.’ Perceived neutrality means treating the patient as a patient without reference to their interactions with law enforcement. We're not here to judge you; we’re just here to take care of you, period.”

This is also why EMS workers need to stay as professional and courteous as humanly possible, no matter what happens. “Good customer service is huge because when you're nice to people, it really does make it harder for them to want to punch you in the face,” Brooks said. “By being nice, I don't mean being fake nice. You need to treat everyone with dignity and respect. Because we all have bad days, and we're not here to be judge, jury, and executioner. We're here as healthcare providers to give them care, and that's what we need to remember.”

Brooks believes that EMS agencies must take responsibility for providing assault prevention training to their staff. “Sending EMS workers out into the field without this kind of training often results in what we refer to as ‘staff overreaction,’ where an EMS worker tries to act as if they are a police officer and take control, rather than escape,” he said. “We are not trained to take control, nor is it our job to do so. If an EMS agency doesn’t train its staff in escape techniques, then bad things can happen, be recorded on someone’s smartphone, and show up in the media and in court. This is why DT4EMS exists, to reduce the chances of this happening while helping to make EMS workers safer on the job.”