Self-Defence and Pre-hospital Care

“As I approach the scene, I use all of my senses to assess any hazards to myself or my partner.”

For paramedics and other members of the pre-hospital care team, these are some EMS-specific guidelines for making ourselves safer on-scene. It isn’t comprehensive, by any means, and if you’d like to add something to the list just slip it into the comments section. These points are without context, allowing for them to be applied to a wide variety of scenes and situations, and I would appreciate if any comments adhered to that framework. The more specific we get in text, the more limiting precautionary measures can seem. Class day is the best time to start applying specifics in scenarios. If you have questions, email me.

Approach with caution. All scenes, every time. Take the appropriate time (don’t run!) to assess for hazards. Add to the typical list of things we look for. Gas, glass, fires, wires, people, pets, exits, weapons and traffic:

• Stick together. You and your partner are a team; your partner is more important than your patient, and you are more important than your partner.
• When assessing those populating the scene or nearby area, pay attention to anything that stands out such as postures, positioning, agitation, etc.
• Trust (and develop) your “instincts.” Remember instinct is an amalgamation of the original five senses, not a sixth. As such, instinct can be developed into a skill used to avoid -or prepare for- conflict. If someone or something seems off, it’s worthy of your consideration before proceeding.
• Consider asking those on scene to move to an adjacent room (without blocking the exits), another location, away from primary exits, or to another building.
• The presence of animals should be noted. If you are concerned about a dog on-scene, ask for it to be removed or contact animal control, if available. A dog doesn’t necessarily need to be commanded to attack if it senses its owner is in danger.
• Check for alternate exits in case your original point of entry becomes inaccessible. Keep that exit-route in mind; it’s a fact most victims of fire are found near their original entry-point rather than a fire exit that was clearly marked. This same mindset can contribute to being effectively trapped on a scene, while simply making appropriate note of an exit route can lessen this likelihood. Don’t block the exit or allow it to be blocked by anyone else. If your patient or anyone else on scene wants to leave, they shouldn’t have to go through you to do so.
• Consider enlisting other services, including police, early and throughout your interactions – on-scene, en route, and even at hospital – as needed. Just as with your patient, it is better to over-treat than under-treat so do not hesitate to enlist backup if you sense the need.

Communicate on approach, taking note of responses/reactions to your presence. Treat your patient as you would expect -and deserve- to be treated.

Be respectful. Do not judge a patient’s predicament based on education, ethnicity, gender, class, lifestyle, mental status, police involvement or other such criteria including prior history of EMS contact. Know your place -to provide care to people where they are- is less about geography than it is about the intangible.

Identify yourself appropriately and state the reason for your presence (“My name is Gaz, I’m a paramedic, and I’m here to help”).

Ask permission before putting hands on anyone, even the patient who seems unresponsive. Remember, putting hands on someone prior to gaining permission may not only be seen as a threat by the individual but it also meets the legal definition of assault.

Communicate throughout your assessment, and give patients or family members an idea of what to expect (“I’m inserting an IV. You may feel a pinch” or “Just let me know if anything I do hurts or is uncomfortable.”).

Be willing to run from danger. The cost of replacing even the most valuable EMS equipment does not compare to the potential for loss of life or -even temporarily- manpower, so drop equipment and run when necessary.

Don’t take it personally. Personal involvement in someone else’s high-stress situation may lead to a loss of focus on the situation at hand and increase the likelihood of hostility. Don’t let their crisis become yours.

Know your worth, and remind yourself of it. In order to defend yourself, knowing who you are, your connections/relationships, goals, and aspirations are all-important. Like Tori Amos sang in Me And A Gun: “I haven’t seen Barbados so I must get out of this.”

If things go bad, it isn’t your fault. Only the person who initiates violence can be held responsible for those acts or any act deemed necessary to ensure the safety of others on scene. Yes, you have responsibilities -including legal responsibilities- and you will fulfill them to the best of your ability, but those responsibilities do not include risking your life and well-being when another’s actions put you at risk. Consider the emergency scene to be similar to a flight, complete with pre-flight instructions in the event of a change in pressure; the instruction, “Place your mask over your own nose and mouth before assisting anyone in your care” is just as valuable when we consider our safety on the emergency scene. We can help no one if we’re injured or unconscious.

Take a look at The Sixth Sense for more information on instinct and the defence decision.