Emergency Response to Domestic Violence

1. Emergency Response to Domestic Violence Rural Metro Fire Department Knoxville, TN

2. The myths associated with Domestic Violence The Definition of “Domestic Abuse” Domestic Abuse Dynamics The link between domestic abuse and child abuse How to identify a victim of domestic abuse Scene Safety Operating as a Safe Haven The definition of “Preferred Response” Information about Orders of Protection Students Will Learn

3. Question:What is the definition of “domestic abuse”?

4. Domestic Abuse • As used in this part “Domestic Abuse” means inflicting or attempting to inflict physical injury on an adult or minor by other than accidental means, placing an adult or minor in fear of physical harm, physical restraint, or malicious damage to the personal property of the abused party.

5. The Big Myths • Provocation • Loss of Control • Environmental Stressors • Victims like the Violence • Victims can Just Leave • Only Men batter Women

6. How Bad is Domestic Violence? • 95% of the victims effected by DV are women • Every 9 seconds a woman is beaten • 42% of the women who are murdered are killed by their intimate male partners • Battering is the leading cause of injury to women in the U.S., more than rape, robbery and auto accidents-COMBINED!

7. Why Batterers Batter Society says its OK – Society hasn’t held batterers accountable. It Works – The victim is so terrorized that they will say or do anything to survive. It's a Choice – Batterer chooses to use violence to control family members.

8. What Battering IS NOT Caused by: • Mental or physical illness • Genetics • Alcohol • Out of control behavior • Stress • Anger • Victim’s behavior or relationship problems

9. The Dynamics of Domestic Violence • Dynamics of Relationship • Cycle of Violence • Power and Control • Warning Signs • To Stay or Go • Why victims stay • Barriers to leaving

10. Cycle of Violence Tension Building Honeymoon Explosion

11. Honeymoon This is the beginning of every relationship, marital or pre-marital. Both people feel like they are on top of the world, like they have the perfect relationship.

12. Tension Building Victim denies abuse is happening; blames it on stress, work, outside family, drinking, drugs, financial problems. They attempt to calm partner, nurture, be silent/talkative, stay away from friends and family, cook favorite meal, clean Batterer is moody, nit-picky, isolating, withdrawing affection, putting down, yelling, drinking, criticizing, threatening

13. Explosion Victim protects self any way possible, police called, try to calm partner, try to reason with partner, leave, fight back, minimize injuries. Batterer may harm, or threaten to physically harm the victim, rape, verbally abuse, imprison, or prevent the victim from leaving.

14. Honeymoon Victim may agree to stay or return, stop legal proceedings, set up counseling, appointments for self and partner, feel happy and helpful Batterer begs for forgiveness, promises to get counseling (church, AA, NA) gives flowers or other gifts, promises to never do it again, repeatedly expresses love for victim

15. Violence Coercion and Threats Intimidation Male Privilege Emotional Abuse Physical Power and Control Sexual Economic Abuse Isolation Minimizing, Denying & Blaming Using Children Violence

16. DEATH DEATH Continuum of Family Violence Physical DEATH Pushing slapping kicking throwing objects choking using weapons Verbal Emotional Name calling criticizing ignoring yelling isolation humiliation Sexual Unwanted touching sexual name calling false accusation forced sex

17. Non-Violence Negotiation & Fairness Mutual Respect Economic Partnership Non-Threatening Behavior EQUALITY Trust & Support Shared Responsibility Honesty & Accountability Responsible Parenting Non-Violence

18. Warning Signs of An Abusive Personality • Jealousy • Controlling • Unrealistic Expectations • Isolation • Low Self-Esteem • Blames Others for Problems and Mistakes

19. Warning Signs of An Abusive Personality • Makes Everyone Else Responsible for His Feelings • Hypersensitivity • Cruelty to Animals & Children • “Playful” Use of Force During Sex

20. Warning Signs of An Abusive Relationship • Verbal Abuse • Rigid Sex Roles • Sudden Mood Swings • Past Battering • Threats of Violence

21. Warning Signs of An Abusive Relationship • Destructive Criticism • Blaming and Pressure Tactics • Abusing Authority and Male Privilege • Disrespect • Abusing Trust • Minimizing, Denying Blaming

22. Warning Signs of An Abusive Relationship • Economic Control • Isolation • Using Children

23. Why Victims May Stay • Hope for Change • Isolation • Societal Denial • Barricades to Leaving

24. Why Victims May Stay • Belief in Batterer Treatment • Dangers in Leaving • Economic Autonomy • Leaving is a Process

25. Children in Homes of Domestic Violence • Children in violent homes are 1000 times more likely to abuse as adults than children in non violent homes • Children in violent homes kill themselves at 6 times the national rate • Children in violent homes are 74 times as likely to commit crimes against other people and 24 times as likely to commit rape or sexual assault

26. Children in Homes of Domestic Violence • In a national survey of over 6,000 American families, 50% of the men who frequently assaulted their wives also frequently abused their children

27. INJURY ASESSMENTAND RESPONSE

28. Injury Assessment and Response • Behavioral Cues: • nervous or inappropriate laughter • crying • anxiety • defensiveness, anger • lack of eye contact • minimizes injury • overly attentive, aggressive partner

29. Injury Assessment and Response • Verbal cues: • Talks about “a friend” who has been abused • Refers to partner’s “temper” or “anger” • Tells about abuse

30. Injury Assessment and Response • Uses health care services repeatedly • Uses many different physicians/hospitals • Psychosomatic/emotional complaints • Reluctance to speak in front of the abuser • Child abuse in the family

31. Physical Examination When examining patient, note any: • Central distribution of injury • Bilateral distribution of injury to multiple areas • Delay between onset of injury and presentation for treatment • Multiple injury in various stages of healing • Extent or type of injury inconsistent with patient’s explanation • Chronic pain, psychological pain, pain due to trauma without visible evidence

32. Charting and Documentation: What the patient tells you What your assessment of the injury is if the explanation offered is inconsistent. A detailed description of injuries with a body chart

33. Charting and Documentation Documentation is important on every call. Documentation on calls involving domestic violence is vital. You are almost guaranteed to be subpoenaed to testify in court if you respond to one of these calls. The courts don’t accept speculation, so you need to document everything you see, hear, or do. A good rule to remember for documentation is if you didn’t write it down, it didn’t happen.

34. Standard of Care Our job as emergency responders is to be compassionate to our patients, but to only render care for what we have been trained to provide. Don’t make a bad situation worse by prodding, prying, and investigating what you might think is a domestic violence situation. Often times, when the batterer is still in the room, the victim will belittle their injuries. If you pry, you might cause the batterer to attack not only the victim again, but you as well.

35. Questions to Ask Treat this response just like any other, introduce yourself and ask: • How are you, what’s going on today? • Have you experienced this before? • What were you doing when this happened? • Have you been prescribed new medications recently? • Etc, etc,. Very direct, injury or illness specific questions

36. If the victim feels comfortable sharing the situation with you, let them do it themselves, don’t pry! If they do tell you things about the attack, tell them you are concerned right now for their injury or illness and encourage them to go to the hospital. Hospitals have, or have access to, personnel who are trained specifically for domestic violence cases.

37. Scene Safety • If you know of violence at a residence from previous calls, request PD response through the alarm room and stage • If you are advised to stage, stage. Never enter before the scene is deemed safe by the PD. • Leave yourself a way out if the batterer returns and becomes violent, or: • The victim becomes violent to “protect” the batterer

38. Scene Safety • If you respond to an abdominal pain, for example, and it turns out to be a domestic violence situation with an aggressive batterer still present, call for PD response immediately through CODE-O on the radio. Try to be nonchalant about it to not let the batterer know what you are doing.

39. Safe Havens Often times, victims come to the fire stations as areas of safe refuge. If you find yourself in this situation, contact the alarm room and take your station out of service. Your primary responsibility is to provide care for the victim. The alarm room should contact the local police department, the appropriate social services, and an ambulance if necessary.

40. Safe Havens Remember, the victim came to you. Be compassionate, but try not to counsel them. You might give misinformation or bad advice that could cause the situation to be worse once the victim leaves. Encourage the victim to go to the hospital. Provide the victim with the Family Violence Helpline phone number.

41. COMMUNITY RESOURCES • SHELTER • LEGAL • COUNSELING • 24 HOUR LINES • POLICE • OTHER FAMILY VIOLENCE HELPLINE 521-6336

42. Domestic Violence Law Tennessee Code Annotated

43. Definition(TCA 36-3-601) Domestic relationships includes adult/minors who: • Are related by blood or adoption. • Are or were related by marriage. • Are or were dating. • Have or had a sexual relationship. • Are or were living together.

44. Question: What does “preferred response” mean?

45. Answer • TCA 36-3-601: “Preferred response” means law enforcement officers shall arrest a person committing domestic abuse unless there is a clear and compelling reason not to arrest.

46. Knoxville, Tennessee • 1989 -- 76% of homicides were domestically related In 1990, a pro-arrest policy was implemented. • 1990 -- domestic homicide rate was cut by 50%

47. Orders of Protection

48. What is an Order of Protection? • Civil Matter • Order by Court to not threaten to abuse or abuse • Permanent up to one year • Cost of Order of Protection

49. Who Qualifies? Victims who: • Are related by blood or adoption. • Are or were related by marriage. • Are or were dating. • Have or had a sexual relationship. • Are or were living together.

50. Types of Orders of Protection • Ex-Parte • Social Contact Order • No-Contact Order