Keeping the Peace: Violence Against Emergency Medical Providers

1. Keeping the Peace: Violence Against Emergency Medical Providers Rebecca Jeanmonod M.D. Albany Medical College Department of Emergency Medicine

2. Almost all of you will be victims during your career.

3. Overview • Epidemiology • Recognition • Prevention • Beyond prevention • Self-defense • Teaching points

4. The Scope of the Problem • Percentage of EMS calls involving violence to provider?

5. The Scope of the Problem • Percentage of EMS calls involving violence to provider? 5%

6. The Scope of the Problem • Percentage of EMTs injured per year?

7. The Scope of the Problem • Percentage of EMTs injured per year? 50%

8. The Scope of the Problem • Percentage of residents assaulted?

9. The Scope of the Problem • Percentage of residents assaulted? 33%

10. Survey of 170 ED Directors • 32% report verbal threats daily • 18% report threat with weapons monthly

11. 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

13. 1995 in US Hospitals • 42 homicides • 1463 physical assaults • 67 sexual assaults • 165 robberies, 47 armed

14. What About Pre-Hospital?

15. What About Pre-Hospital? • Survey of paramedics over 12 years • How many assaults per provider?

16. What About Pre-Hospital? • Survey of paramedics over 12 years • How many assaults per provider? • Nine total

17. What About Pre-Hospital? • Survey of paramedics over 12 years • How many assaults per provider? • Nine total • 170 blunt injuries

18. What About Pre-Hospital? • Survey of paramedics over 12 years • How many assaults per provider? • Nine total • 170 blunt injuries • 73 lacerations

19. 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

20. 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

21. 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

22. Michigan 2005 • Violence more common against females • 45% of assailants were intoxicated • 33% of assailants were mentally ill • 10% of assailants were not patients

23. Michigan 2005 • Violence more common against females • 45% of assailants were intoxicated • 33% of assailants were mentally ill • 10% of assailants were not patients

24. Michigan 2005 • Urban equivalent to other locations

25. Where Violence Occurs

26. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else

27. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You are faced with an undifferentiated patient or scene.

28. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You may have limited visualization.

29. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You may have limited personnel.

30. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You have limited pharmacotherapy.

31. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You may have limited training.

32. Where the Wild Things Are • “Bad” area of town • Bars • Mass gatherings • Everywhere else You have a job to do.

33. The Problem of Recognition: The Scene

34. The Problem of Recognition: The Scene

35. The Problem of Recognition: The Scene

36. The Problem of Recognition: The Scene

37. The Problem of Recognition: The Scene

38. The Problem of Recognition: The Scene • High-risk chief complaints

39. The Problem of Recognition: The Scene • High-risk chief complaints • Gunshot wound • Drug overdose • Bar fight

40. The Problem of Recognition: The Scene • High-risk chief complaints • High-risk locations

41. 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

42. The Problem of Recognition: The Scene • High-risk chief complaints • High-risk locations • High-risk times

43. The Problem of Recognition: The Scene • High-risk chief complaints • High-risk locations • High-risk times • Nights • Holidays • Weekends

44. The Problem of Recognition: The Patient

45. The Problem of Recognition: The Patient Calm Irritable Verbal Physical

46. The Problem of Recognition: The Patient Calm Irritable Verbal Physical Hardest to recognize Best time to intervene Easiest to recognize Worst time to intervene

47. Everyone Has a Breaking Point

48. Reasons Why Patients Become Violent • Altered mental status and medical illness • Seizure • Hypoxia • Head injury • Hypoglycemia

49. Reasons Why Patients Become Violent • Altered mental status and medical illness • Fear or anxiety

50. Reasons Why Patients Become Violent • Altered mental status and medical illness • Fear or anxiety • Frustration