Small-town Shootings Claim Providers in Montana, New York State

     The shooting deaths of two small-town providers in separate January incidents proved a chilling reminder that any day on the job could potentially be your last.

     On January 17, EMT Melissa Greenhagen, 37, was shot in the chest by a stranger outside Frances Mahon Deaconess Hospital in Glasgow, MT. Police said Glasgow, population 3,500, hadn't had a homicide in at least 15 years.

     Then, 13 days later, EMT Mark Davis, 25, was fatally shot during a response to a private residence in Cape Vincent, NY. Cape Vincent has fewer than 1,000 people.

     Incidents like the latter are among the most troubling prehospital providers face. The alleged shooter, Christopher Burke, admitted EMS to his home and was reportedly being treated for an anxiety attack. As the call progressed, he became agitated, and eventually grabbed a rifle. He allegedly shot Davis as the providers fled.

     Despite the potentially life-or-death stakes, identifying patients who could abruptly turn so violent is always an inexact challenge.

     "NAEMT found in 2005 that 52% of EMS providers have been assaulted in the field," notes Kip Teitsort, a veteran paramedic and police officer who now teaches defensive tactics for prehospital providers (see www.dt4ems.net). "That means they're being assaulted on what they thought were safe scenes. It's easy to say, in a cold situation, 'Oh, well, they should have recognized something was wrong,' but that's not always true. Human conflict is dynamic—it doesn't follow a set plan."

     The basics of scene safety, however, are something providers should practice on every call. They're no guarantee that you'll emerge unscathed (and there's no indication the crew treating Burke did anything unsafe), but they'll maximize your chances. For some pointers, see the sidebar 10 Steps to a Safe Scene.

     Teitsort also offers some law enforcement tips:

• The 90/10 rule—If 90% of a person's demeanor is calm and unthreatening, pay attention to the other 10%. This may be a hand hovering subconsciously around a pocket (a tipoff that it contains something they're worried about, like a weapon or drugs) or some other almost-imperceptible exhibition of tension/anxiety.
• Parroting—Repeating your questions back to you ("What have you taken tonight?" "What have I taken tonight?") means they're thinking about something else.
• Danger rooms—Keep people out of their bedrooms and kitchens when possible. These are often where weapons are.
• L formation—As one crew member faces a patient, the other should be positioned 90 degrees perpendicular from the patient. This will buy time if the patient attacks.
• Retreat—For EMS, running is always preferable to fighting. Be aware of potential sources of cover and concealment before you enter a house. If you have to run, don't run in a straight line.

     Even more vexing is the Greenhagen case. The mother of four wasn't on a call when she was gunned down by a local recluse, Roger Sellers. Sellers also wounded a nurse and her husband who came to Greenhagen's assistance. He had no known connection to his victims.

     Officers tracked Sellers to a house on the outskirts of Glasgow, where he died several hours later following an officer-involved shooting.

     "Even the best-trained police officers on the street can still fall prey to a sniper attack," Teitsort says. "There's not a lot you can do, other than just be aware of your general surroundings."

     Citizens Bank of Cape Vincent
P.O. Box 277, Cape Vincent, NY 13618
315/654-2115
www.citizensbankofcapevincent.com

     First Community Bank
P.O. Box 191, Glasgow, MT 59230
406/228-8231, 800/645-5739
www.fcbank.net

     Tips for ensuring a safe scene, from Massachusetts EMT Eric Richards, published at www.fieldmedics.com:

1. Be aware of your surroundings and location.
2. Be aware of your partner at all times.
3. Be aware of the best egress routes to safety.
4. Be sure others know your location and activities.
5. Remain in communication with dispatch.
6. Trust no one.
7. When law enforcement is present, enlist their help in ensuring scene safety.
8. During assessment and physical exam, be alert for concealed weapons or sharp objects.
9. Consider wearing body armor.
10. Control patients' access to their belongings and others after initiating care.