Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany...
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Transcript of Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany...
![Page 1: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/1.jpg)
Keeping the Peace: Violence Against Emergency
Medical Providers
Rebecca Jeanmonod M.D.
Albany Medical College
Department of Emergency Medicine
![Page 2: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/2.jpg)
Almost all of you will be victims during your career.
![Page 3: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/3.jpg)
Overview
• Epidemiology
• Recognition
• Prevention
• Beyond prevention
• Self-defense
• Teaching points
![Page 4: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/4.jpg)
The Scope of the Problem
• Percentage of EMS calls involving violence to provider?
![Page 5: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/5.jpg)
The Scope of the Problem
• Percentage of EMS calls involving violence to provider?
5%
![Page 6: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/6.jpg)
The Scope of the Problem
• Percentage of EMTs injured per year?
![Page 7: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/7.jpg)
The Scope of the Problem
• Percentage of EMTs injured per year?
50%
![Page 8: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/8.jpg)
The Scope of the Problem
• Percentage of residents assaulted?
![Page 9: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/9.jpg)
The Scope of the Problem
• Percentage of residents assaulted?
33%
![Page 10: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/10.jpg)
Survey of 170 ED Directors
• 32% report verbal threats daily
• 18% report threat with weapons monthly
![Page 11: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/11.jpg)
In One Trauma Center
• 25% of trauma victims carry a lethal weapon• 8 incidents per year involving weapons• 4 patient fatalities in 15 years• 6 staff injuries in 15 years
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![Page 13: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/13.jpg)
1995 in US Hospitals
• 42 homicides
• 1463 physical assaults
• 67 sexual assaults
• 165 robberies, 47 armed
![Page 14: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/14.jpg)
What About Pre-Hospital?
![Page 15: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/15.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?
![Page 16: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/16.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total
![Page 17: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/17.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total– 170 blunt injuries
![Page 18: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/18.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total– 170 blunt injuries– 73 lacerations
![Page 19: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/19.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total– 170 blunt injuries– 73 lacerations– 2 GSW, 10 stabbings
![Page 20: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/20.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total– 170 blunt injuries– 73 lacerations– 2 GSW, 10 stabbings– 8 fractures, 9 dislocations
![Page 21: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/21.jpg)
What About Pre-Hospital?
• Survey of paramedics over 12 years
• How many assaults per provider?– Nine total– 170 blunt injuries– 73 lacerations– 2 GSW, 10 stabbings– 8 fractures, 9 dislocations– 1 burn
![Page 22: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/22.jpg)
Michigan 2005
• Violence more common against females
• 45% of assailants were intoxicated
• 33% of assailants were mentally ill
• 10% of assailants were not patients
![Page 23: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/23.jpg)
Michigan 2005
• Violence more common against females
• 45% of assailants were intoxicated
• 33% of assailants were mentally ill
• 10% of assailants were not patients
![Page 24: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/24.jpg)
Michigan 2005
• Urban equivalent to other locations
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Where Violence Occurs
![Page 26: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/26.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
![Page 27: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/27.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You are faced with an undifferentiated patient or scene.
![Page 28: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/28.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You may have limited visualization.
![Page 29: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/29.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You may have limited personnel.
![Page 30: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/30.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You have limited pharmacotherapy.
![Page 31: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/31.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You may have limited training.
![Page 32: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/32.jpg)
Where the Wild Things Are
• “Bad” area of town
• Bars
• Mass gatherings
• Everywhere else
You have a job to do.
![Page 33: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/33.jpg)
The Problem of Recognition: The Scene
![Page 34: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/34.jpg)
The Problem of Recognition: The Scene
![Page 35: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/35.jpg)
The Problem of Recognition: The Scene
![Page 36: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/36.jpg)
The Problem of Recognition: The Scene
![Page 37: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/37.jpg)
The Problem of Recognition: The Scene
![Page 38: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/38.jpg)
The Problem of Recognition: The Scene
• High-risk chief complaints
![Page 39: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/39.jpg)
The Problem of Recognition: The Scene
• High-risk chief complaints– Gunshot wound– Drug overdose– Bar fight
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The Problem of Recognition: The Scene
• High-risk chief complaints
• High-risk locations
![Page 41: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/41.jpg)
The Problem of Recognition: The Scene
• High-risk chief complaints
• High-risk locations– Poorly lit– Areas that could conceal or cover– Only one entrance or exit
![Page 42: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/42.jpg)
The Problem of Recognition: The Scene
• High-risk chief complaints
• High-risk locations
• High-risk times
![Page 43: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/43.jpg)
The Problem of Recognition: The Scene
• High-risk chief complaints
• High-risk locations
• High-risk times– Nights– Holidays– Weekends
![Page 44: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/44.jpg)
The Problem of Recognition: The Patient
![Page 45: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/45.jpg)
The Problem of Recognition: The Patient
Calm
Irritable
Verbal
Physical
![Page 46: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/46.jpg)
The Problem of Recognition: The Patient
Calm
Irritable
Verbal
Physical
Best time to intervene
Worst time to intervene
Hardest to recognize
Easiest to recognize
![Page 47: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/47.jpg)
Everyone Has a Breaking Point
![Page 48: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/48.jpg)
Reasons Why Patients Become Violent
• Altered mental status and medical illness– Seizure– Hypoxia– Head injury– Hypoglycemia
![Page 49: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/49.jpg)
Reasons Why Patients Become Violent
• Altered mental status and medical illness
• Fear or anxiety
![Page 50: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/50.jpg)
Reasons Why Patients Become Violent
• Altered mental status and medical illness
• Fear or anxiety
• Frustration
![Page 51: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/51.jpg)
Reasons Why Patients Become Violent
• Altered mental status and medical illness
• Fear or anxiety
• Frustration
• Drugs or alcohol– Cocaine– Ecstasy– PCP
![Page 52: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/52.jpg)
Reasons Why Patients Become Violent
• Altered mental status and medical illness
• Fear or anxiety
• Frustration
• Drugs or alcohol
• Just plain mean
![Page 53: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/53.jpg)
Recognition in the Calm Patient
• Prior history
![Page 54: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/54.jpg)
Recognition in the Calm Patient
• Prior history
• Substance use
![Page 55: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/55.jpg)
Recognition in the Calm Patient
• Prior history
• Substance use
• In custody
![Page 56: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/56.jpg)
Recognition in the Calm Patient
• Prior history
• Substance use
• In custody
• Mental illness
![Page 57: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/57.jpg)
Organized Violence
• Ink
• Clothing
• Gang colors
![Page 58: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/58.jpg)
Beyond Calm
![Page 59: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/59.jpg)
Signs of Trouble
• Complaining loudly
• Interrupting
• Agitated
• Pacing
• Can’t sit still
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Bad to Worse
• Sweating• Dilated pupils• Abrupt, angry movements• Accusations• Insults• Threats
![Page 61: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/61.jpg)
Point of No Return
• Standing and leaning into you
• Yelling
• Finger pointing
• Fist clenching
• Chest beating
![Page 62: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/62.jpg)
If you feel like smacking him, he’s probably thinking the
same thing.
![Page 63: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/63.jpg)
The Downward Spiral
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Prevention: Scene Approach
• Recognize scene potential
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Prevention: Scene Approach
• Recognize scene potential
• Turn off lights and sirens when near scene
![Page 66: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/66.jpg)
Prevention: Scene Approach
• Recognize scene potential
• Turn off lights and sirens when near scene
• Scan for cover and concealment
![Page 67: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/67.jpg)
Prevention: Scene Approach
• Recognize scene potential
• Turn off lights and sirens when near scene
• Scan for cover and concealment
• Park outside the “kill-zone”
![Page 68: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/68.jpg)
Prevention: Scene Approach
• Recognize scene potential
• Turn off lights and sirens when near scene
• Scan for cover and concealment
• Park outside the “kill-zone”
• Park so you can pull forward to leave
![Page 69: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/69.jpg)
Prevention: Patient Approach
• Recognize patient potential
![Page 70: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/70.jpg)
Prevention: Patient Approach
• Recognize patient potential
• Identify yourself
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Prevention: Patient Approach
• Recognize patient potential
• Identify yourself
• Respect the patient’s space
![Page 72: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/72.jpg)
Prevention: Patient Approach
• Recognize patient potential
• Identify yourself
• Respect the patient’s space
• Avoid tunnel vision
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Prevention: Patient Approach
• Recognize patient potential
• Identify yourself
• Respect the patient’s space
• Avoid tunnel vision
• Evacuate patient quickly
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Prevention: Patient Approach
• Recognize patient potential
• Identify yourself
• Respect the patient’s space
• Avoid tunnel vision
• Evacuate patient quickly
• Be alert to weapons on secondary survey
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Intervention in Early Stages
• Recognition
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Intervention in Early Stages
• Recognition
• Make eye contact
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Intervention in Early Stages
• Recognition
• Make eye contact
• Empathy and validation
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Intervention in Early Stages
• Recognition
• Make eye contact
• Empathy and validation
• Call the patient by name
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Intervention in Early Stages
• Recognition
• Make eye contact
• Empathy and validation
• Call the patient by name
• Don’t trap the patient
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Intervention in Early Stages
• Recognition
• Make eye contact
• Empathy and validation
• Call the patient by name
• Don’t trap the patient
• Call for help early
![Page 81: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/81.jpg)
Intervention in Early Stages
• Recognition
• Make eye contact
• Empathy and validation
• Call the patient by name
• Don’t trap the patient
• Call for help early
• Be cognizant of body language and tone
![Page 82: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/82.jpg)
Intervention: Defuse or Detonate
• Defuse– Show of force– Medication
• Detonate– Physical restraints– Chemical restraints
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Intervention: Defuse or Detonate
• Defuse– Show of force– Medication
• Detonate– Physical restraints– Chemical restraints
![Page 84: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/84.jpg)
One study showed reduction in aggression from 37% to 3% by instituting preventive training.
![Page 85: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/85.jpg)
A study in VAs showed 92% decline in violence by institution
of preventive measures.
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Rules of Engagement
• Rule 1: Protect yourself
• Rule 2: Protect your co-workers
• Rule 3: Protect bystanders
• Rule 4: Protect the violent patient
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If he has a gun and wishes to commit suicide, let him.
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Rules of Engagement
• Rule 1: Protect yourself
• Rule 2: Protect your co-workers
• Rule 3: Protect bystanders
• Rule 4: Protect the violent patient
In that order
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Protect Yourself
• Maintain access to the exit
• Communicate roles with partner
• Maintain visual contact with partner
• Keep your body at an angle to the patient
• Keep your hands in front of your body
• Wear gloves
• Don’t allow outsiders in and out of scene
![Page 90: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/90.jpg)
Protect Your Co-workers
• Communication
• Planning
• Support
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Protect Bystanders
• Isolation
• Control
• Speed
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Protect the Violent Patient
• Minimum necessary force
• Multiple providers
• Timing
• Follow-through
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When a Patient is Asking For It
• Be prepared to overwhelm the patient
• If he does not back down immediately, restrain him
• If he then bargains, restrain him
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Safe Restraining
• Identify a leader
• Body at an angle to patient
• Hands up in front of face
• Head down
• Gloves
• 6 providers
• Leader gives order and everyone acts simultaneously
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Who Does What
• “Leg, leg, arm, head, arm”
6th person gets supplies
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The Head
• Protect patient during take-down
• No strangling
• Once down, jaw thrust– Prevents biting– Prevents spitting
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The Arms
• One hand on wrist– Prevents scratching
• One hand on elbow– Prevents punching– Prevents sitting
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The Legs
• One hand on ankle– Prevents writhing
• One hand on knee– Prevents kicking– Prevents rolling
• Extra providers on knees
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The Goal
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Not the Goal
![Page 101: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/101.jpg)
Rules of Restraint
• Document necessity
• No prone positioning
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Sedative Medications
• Versed
• Valium
• Haldol
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Sedative Medications
• Versed
• Valium
• Haldol
Class D in pregnancy
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Sedative Medications
• Versed
• Valium
• Haldol
Lowers seizure threshold
Increases arrhythmias
Prolonged sedation
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If He Needs Restraints, He Needs Medication
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When There Are Weapons
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“Hey, Doc, wanna see my piece?”
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“No, no thank you, though I appreciate the offer.”
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Weapons in the Calm Patient
• Do not have the patient remove the weapon himself
• If police are present, have them remove the weapon
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Patients with Knives
• Police
• If attacked– Yell– Get close with your arm under knife arm– Hit with something blunt– Do not disarm and defend– Beware of lefties
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are at or near 9 feet…
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are at or near 9 feet…
Drop your gear
Run
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are closer than 9 feet…
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are closer than 9 feet…
Redirect gun
Keep talking
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are well beyond 9 feet…
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Patients with Guns
• Most fatal shootings occur within 9 feet
• If you are well beyond 9 feet…
Duck
Stay down
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If He Hasn’t Drawn the Gun
• One hand on gun hand preventing draw
• Other hand “subduing” patient
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If He Hasn’t Drawn the Gun
• One hand on gun hand preventing draw
• Other hand “subduing” patient– Eyes– Head– Groin
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Don’t Be Paranoid, But…
• Know places to duck in and around rig
• Know more than one way out
• Know where police station is
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Chance Favors the Prepared Mind
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In Summary
• Pre-hospital violence is common
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In Summary
• Pre-hospital violence is common
• Violence can be predicted and prevented
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In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
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In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
• Protect yourself and your co-workers
![Page 125: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/125.jpg)
In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
• Protect yourself and your co-workers
• Ensure scene safety
![Page 126: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/126.jpg)
In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
• Protect yourself and your co-workers
• Ensure scene safety
• If attacked with a knife, attack back
![Page 127: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/127.jpg)
In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
• Protect yourself and your co-workers
• Ensure scene safety
• If attacked with a knife, attack back
• If attacked with a gun, have a plan
![Page 128: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/128.jpg)
In Summary
• ED violence is common
• Violence can be predicted and prevented
• Organization and communication equals safety
• Protect yourself and your co-workers
• Ensure scene safety
• If attacked with a knife, attack back
• If attacked with a gun, have a plan
![Page 129: Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine.](https://reader030.fdocuments.net/reader030/viewer/2022032805/56649ef25503460f94c04153/html5/thumbnails/129.jpg)
The End
Thanks for Your Time and Attention