During my last shift, I responded to an “Unknown Medical.” As we arrived, dispatch told us that the caller thought there was something wrong with her son, and he was hallucinating. When I opened the door, I saw a teen male who was covered in sweat and acting quite twitchy. Mom states that she took him in for his methadone injection, that they gave him 25 mg, and that he started acting funny about a half hour before, she also says that he has been with her all day and he has not had any other drugs. As she was explaining this, the teen kicked me in the balls, then the fight started.
Any fight that begins with a kick to the balls is going to get nasty. My first hit was a hammer fist to his brachial plexus. He didn’t even flinch. He hit me several more times, and kicked my knee fairly hard. I followed with hits to his abdomen, kidneys, and a hard punch to the throat. Then I closed the distance, managed to get a grip on his arm, and got him in a headlock. Since I outweighed him by about 100 pounds, I took us to the ground. My partner (remember Paramedic George?) then decided to join the pile. My attacker decided it was time to start biting, and threw an elbow into my stomach. I had had enough, and I really felt that I was in danger. I grabbed him by the trachea and choked off his air supply until he stopped fighting, then I let go.
The two minutes it took the first cop to get there seemed like forever. We handcuffed him to the stretcher. He still began to fight, and bent the rails of the stretcher. He stuck his hand down his pants and started masturbating in front of the female medic that came in on the second EMS unit. She reached out to stop him, and he grabbed her arm. I pushed very hard on his parotid gland and he let go. He fought us nearly the entire way to the hospital, until the drugs finally kicked in. It took 10mg of Haldol and 5mg of diazepam to calm him down. His heart rate was 190, he was too combative for us to get a BP, RR 40.
His tox screen showed cocaine, methamphetamine, the diazepam, and the methadone. The cops asked if I wanted to press charges, but I didn’t bother. The four times that I have pressed charges, the actors got probation and a fine. Besides, I know he is hurting at least as bad as I am at this point. My back, left knee, my balls, and elbows are pretty sore. I have been physically attacked more times than I can count during my career.
This illustrates a growing problem in EMS: 52% of all EMS responders report having been attacked on the job. According to the University of Maryland, the risk of nonfatal assault resulting in lost work time among EMS workers is 57 cases per 10,000 workers per year. The national average is about 1.8 cases per 10,000 workers per year. So the relative risk for EMS workers is about 30 times higher than the national average. This isn’t just EMS getting hurt: in 1999, the Bureau of Labor Statistics estimated that 2,637 nonfatal assaults occurred to hospital workers–a rate of 8.3 assaults per 10,000 workers. Healthcare providers are twice as likely, and EMS workers 15 times as likely to be assaulted on the job than police officers or prison guards.
The Occupational Safety and Health Administration (OSHA) has identified violence in the medical setting as a potential hazard, and found the training of medical staff to identify and deal with potential violence ineffective. It is the the third leading cause of on the job injuries in EMS (only lifting patients and vehicle collisions injure more EMS workers) and the second leading cause of on the job fatalities (behind vehicle accidents), yet the only training we get is “don’t enter the scene unless it is safe.” This approach is obviously not working. There remains a reluctance on the part of EMS agencies and hospital administrators to provide training to effectively address workplace violence. Some may not recognize the extent of the problem, and thus don’t perceive the need for training personnel in basic defensive measures, while others erroneously perceive using defensive tactics as fighting, or a form of aggression.
My employer has no official position on self defense. Does yours?