Responding to Violence

      Violence can occur anywhere. Regardless of where you work, you will likely face the challenge of responding to a critical incident that includes acts of violence. These can be directed toward patients, bystanders and even emergency responders. This article is designed to provide a response checklist to help EMS providers prepare for and respond to calls for suspected or confirmed incidents of violence.

DISPATCH & RESPONSE PHASE

• When you're dispatched, the nature and location of the call are important. Get all the dispatch information available.
• Be aware that dispatching information is not always correct or can be very vague, due to the information the communications center is receiving.
• Typical procedures require law enforcement be dispatched to any incident with a potential for violence, but you may unknowingly find yourself on a violent scene due to a wrong address, victims coming to you, or your own discovery of an incident.
• If there are indicators of violence or a "red flag" location, request law enforcement as soon as possible.
• It is always important to listen for key verbal indicators and gain as much prearrival information as possible, such as that your responding address is in a high-violence area, you've been to a location before (such as a bar or club), reports of shootings, alcohol involvement, crowds, etc.
• Firefighters and medics should have access to body armor as PPE if responding to high-risk areas or situations.
• Never hesitate to call for law enforcement assistance if you even think you may need it.

ARRIVAL ON SCENE

• Fire and EMS should remain in staging areas until any dangerous scene is secured by law enforcement.
• Remember, there is a difference between "law enforcement on scene" and "scene is secure."
• Stay alert to your surroundings and maintain situational awareness at all times.
• Conduct a complete scene size-up during your "windshield survey."
• Maintain a good working relationship with law enforcement.
• Two arrival options: Park past the location when responding, which allows you to see three sides of the structure, or shut down your warning lights and siren and do not pass by or park in front of residence. Stop the unit about 50–100 feet from the residence and position it where it cannot be seen.

APPROACHING THE SCENE

• Maintain a constant sense of caution when dealing with suspicious individuals or situations.
• When possible, responders should always operate in two-man or "buddy" teams during these types of situations.
• Look for places to take concealment and cover if needed. Cover may protect you from bullets and thrown objects, while concealment hides you without offering any real protection.
• Remember, not everyone will greet emergency responders with open arms.
• Stop and take a moment to size up suspicious vehicles, occupants/contents and activities.
• Stop, look and listen before entering any suspicious situation, residence or structure.
• Do not rush in to help the victim of a shooting, stabbing or assault. Take a moment for a quick scene survey and see what potential danger you detect.

RESPONSE OPERATIONS

• You may choose to adopt a "load and go" response during an active incident to extract the victim and yourself from a high-risk situation.
• Work with the family/friends of patients. Try to understand where they're coming from, but remain capable of doing your duties.
• Recognize when verbal abuse could possibly lead to violence.
• Responders need to know how to avoid violence and how to react if and when it occurs. What do your guidelines and procedures say? Are these situations addressed?
• A person who is intoxicated may confuse firefighters or EMS personnel with law enforcement officers.
• What are your department's guidelines if you find a weapon on a patient or if a patient becomes combative in the back of your unit?
• If you arrive on the scene of an incident and the people you make contact with are belligerent, intoxicated or violent, you are not obligated to enter the scene until it is secured by law enforcement.
• Be aware of possible booby traps and improvised explosive devices in questionable surroundings such as clandestine labs and marijuana grows.
• Safety is the paramount value for all responders during these types of events!

   Hopefully this information will assist your agency's planning, training and response efforts. The more our public safety agencies prepare, the more safely they'll be able to respond to and effectively manage any type of situation that might arise.

Additional Information & Resources

• Vernon A. First Responders Critical Incident Guide. Red Hat Publishing, 2009, www.redhatpub.com.
• Krebs D. When Violence Erupts: A Survival Guide for Emergency Responders. Jones and Bartlett, 2003, www.jbpub.com.
• Gorski T, Miller M. The Management of Aggression and Violence: A Field Manual for Emergency, Medical, Enforcement, Psychiatric, and Detoxification Personnel. Human Ecology Systems, 1981.
• Defensive Tactics for EMS (DT4EMS), www.dt4ems.net.

August Vernon is a member of the International Fire Service Training Association's WMD/Terrorism Committee and conducts public safety training at the local, regional, state and federal levels. Employed in emergency management for nine years, he is currently an assistant coordinator for a county office of emergency management.