By Walt Settlemyre, ATCEMS Clinical Specialist

VIOLENCE IN EMS A New Strategy

What makes our chosen profession inherently Service is also certainly at risk for violence howev- dangerous? You could name the big ones that er a fire crew's numbers, usually four, if the come to mind, driving code 3, exposure risks to department follows NFPA 1530, can help mitigate disease, blood and respiratory pathogens, as well physical violence secondary to their numbers how- as the ever presence of PTSD. These all certainly ever it does happen. pose great risk and the list is varied and fairly Sadly the evidence also shows that violence long, however we as First Responders, more so against medical personnel and again more so with those of us in EMS systems have one job risk that EMS workers, is highly under reported! There isn't is not only rising in its frequency but is increasing a tremendous amount of data actually for this very in scale and severity. It's violence. reason. Health care workers often do not report Violence isn't new to our profession by any means. these incidences unless they receive some kind of If you've been in this job for any length of time severe injury. you've likely been both a witness and victim to Most seem to assume that bumps, bruises, and a some level of violence. Statistics show violence little pain are part and parcel with the jobs they've toward medical personnel, especially First chosen. EMS professionals, Nurses, and Doctors, Responders in EMS are not only rising, but the severity of these attacks is also increasing. Fire

10 of those were death by animal however the statis- tics I viewed didn't detail what the nature of those animal incidences were...but I'm curious! Falls, slips, trips were a close third with 849 incidences but you get the point. Remember these are just the fatalities for 2016. These do not include inju- ries. According to statistics kept by OSHA, the Federal Occupational Health and Safety Admin- istration, serious workplace violence was more common in health care than any other private sec- tor industry. EMS workers are little different. The NAEMT found that four in five EMS workers have experienced some kind of on the job injury with the majority, 52%, coming from assault.

The problem of violence against EMS personnel is not only widely underreported but it is overlooked by EMS executives, researchers, and educators as well as practitioners. Our profession is not like that of Law Enforcement and Fire Service where they highly promote a culture and training geared specifically to personal survival. In EMS we are patient safety centric and the vast majority of our training goes specifically towards patient care and other operational considerations. And, honestly the problem of violence towards medical providers while slowly escalating over the years was rarely addressed by anyone in the profession because of especially in Emergency Rooms are the front lines the stigma involved. Much like PTSD reporting in of medicine in our society and while these groups the field of health care, admitting there's a prob- bare the greatest amount by percentage, violence lem by providers and administrators alike has his- towards Doctors, Nurses, and Technician type jobs torically been slow in coming. such as Xray, Respiratory, and many others also have their fair share of both physical and or verbal abuse from patients and family members. DEFENSIVE TACTICS

The ATCEMS system is a rare one in that our

VIOLENCE IS THE SECOND LEADING CAUSE cadets receive training in defensive tactics while in OF INJURIES FOR MEDICAL PERSONNEL the academy. That's actually very progressive compared to the rest of the country in regards to In a study published 2017 by the US Bureau of our profession. Recently some of us here in Labor Statistics, Fatal Occupational Injuries by ATCEMS have been working towards making train- Major Event For Medical Personnel for 2016 ing available to our employees who want to learn showed that violence was the second leading self defense and how to better control a combative cause. Transportation being first with 2083 patient. deaths. Violence was 866 incidences. Oddly, some

11 About a year ago, Clinical Specialist Will Adams oped by Tony Blauer, a long time martial artist and began an off duty program here called First self defense coach. He's been coaching people on Responder Jiu Jitsu. He wrote a proposal to the how to be safer for over 30 years. What makes department and was able to persuade them to Spear so unique is it is based in human psycholo- purchase mats for Medic 17's station where he gy, physiology, and the startle flinch response all now holds training regularly. humans possess. Spear, is an acronym for Sponta- neous Protection Enabling Accelerated Response. For those of you who don't know him, Will is a high level Purple belt at Paragon Jiu Jitsu here in Austin In Coach Blauer's own words, “The Spear System and has trained for years in BJJ and striking. He utilizes the speed and reliability of the startle flinch saw a need for this kind of training and is teaching mechanism to convert the sudden attack into a our people on a regular basis. tactical counter. It's a bridge between the reactive brain and the cognitive brain. This improves Going to a Jiu Jitsu school can be a bit intimidat- reaction time during confrontations. The Spear ing, especially if you've never trained before. His System combines the old brain's most important program allows folks to come and learn in a friend- function, to survive, with the new brain's ly, non-threatening environment with friends and intelligence, to think and decide, this awakened a colleagues they know. And it's free. nonperishable personal defense system that can Dr. JR Pickett, ATCEMS Deputy Medical Director, make every human safer!” has come on board and is also a Black Belt. What it means for us as First Responders is that it He also offers Judo classes to any employees who allows us to gain and maintain positional want to learn! It's quite rare that an EMS system dominance in a violent encounter, especially the has that kind of talent much less offering free “ambush” or surprise attack. Arguably the most training to the employees. dangerous of attacks because it's the attack you Building on Will's program, Andre Thompson and aren't prepared for or expecting. myself, both Jiu Jitsu practitioners as well, wanted Spear methodology utilizes a thought process to offer something a little different. We were look- regarding violence called the Three Ds: Detect, ing for a program that incorporated not only the Defuse, Defend. The best self defense move physical tactics but more importantly fear is to avoid the need for self defense. psychology, pre-fight contact cues, and ways to de-escalate potentially violent encounters. So the first D, Detect, refers to understanding those moments before violence occurs, not only We put in a proposal to our union, Austin Travis the pre fight contact cues but that weird Co. EMS Employees Assoc. to fund a train the “something is wrong' feeling that most people trainer class for self defense. We saw an amazing describe getting before a situation turns violent opportunity to attend a course that offered all that but often dismiss. we were looking for, was easily taught, easily learned, and was in line with what the body The second D, Defuse refers to tactics to defuse a already does in the “jack in the box” moment of possibly violent person, whether that's verbal judo, sudden violence, the startle flinch response. The walking away, or however you can defuse and association agreed and we were able to attend The de-escalate the situation. Spear Certification Course. And finally Defend, the physical aspect of the WHAT IS SPEAR? Spear System. Spear takes what the body does naturally using the startle flinch response with the Spear is a very unique self defense program devel- hands coming up to protect the head and face and

12 weaponizes the flinch response to push away danger. Tony Blauer often describes this as an organic airbag deploying! In fact the Spear thesis statement is, “What does the body want to do naturally prior any training? Does this response have a combative application? If so, why aren't we integrating it? This sums up the use of the startle flinch response as a self defense mechanism very well.

Another aspect of the Spear training that I found invaluable is the Cycle of Human Behavior, or The Neuro-Circuitry of Fear which is a schematic that Blauer came up with that will actually help you understand not only how and where you are in the fear loop but gives you a better understanding on how to get out of it.

Further, there are five basic tenets of Spear and these explain very well why the Spear System is such an excellent program for not only First Responders, but anyone wanting to be safer!

BEHAVIORALLY BASED SELF PROTECTION

First, science. The Spear System is the only behaviorally based self protection method based entirely on physiology, kinesiology, physics, and psychology.

Second, its simple. All the Spear movements are based on how humans actually move. Spear does not teach memorized patterns or any compli- cated techniques.

Third, the legal issue. In real world confron- tations force must parallel danger. The Spear Sys- tem is in line with all moral, ethical, and legal di- rectives. This is exceptionally important as a First Responder where the line between a patient and an assailant must be defined and is often a grey area. More on this later.

Fourth, Totality. The Spear methodology is a holistic approach to self defense. It is based on emotional awareness, intelligence, modern psy- chology, as well as practical and functional move- Series of SPEAR program movements ment. It also teaches how to avoid, deescalate, 13 and if necessary how to protect ones self.

And lastly, it's proven. Coach Blauer has been training law enforcement and military personnel since the early 90s, but actually formed the base of what is now the Spear System back in the 1980s. He and his staff have been training LEOs, military, and civilians around the globe.. The system has been field tested and proven in many departments and agencies throughout the world.

At the end of this article I will provide links to studies and information on the safety and efficacy of the Spear System including medical information and scope of technique on use of force. Yet another reason we leaned toward the Spear System is the amount of research and self analysis Tony Blauer and his company do.

RELEVANT FOR THE EMS ENVIRONMENT

One unexpected bonus to this training Andre and I found came in the form of the gentleman who taught our class. James Pierson, who is the recent- ly retired Police Chief of Henderson, in East Texas. Chief Pierson spent 29 years in law enforcement before retiring this past July. Although these days he's an Adjunct Professor for the Police Academy and does occasional work as an investigator for the DA as well as expert witness work, he's been teaching the Spear System since the mid 90s and has been with the Spear Mobile Training Team training instructors since 2016. Walt & Andre with Instructor James Pierson His experience in law enforcement was certainly helpful but it was his teaching style, his breadth of life experience, and his life long quest for learning that really brought another dimension to the class. Whenever you come across an instructor that cares about the knowledge they are passing on and is able to look at that knowledge from an open- minded vantage point, it speaks volumes. Many people in any community of training will make whatever it is they do, teach, or practice a dogma. Often not opening their mind or body to any other disciplines or thought processes.

14 From the very beginning this was not Chief Pierson! He discussed his interest and training in multiple and fitness in the form of power lifting and how they all lend something to both his life philosophy and his self defense thought process. In fact he's a high ranking black belt, 7th Dan, in the Korean style of and still competes in that martial art.

However, unlike many martial artists he has sought out other disciplines to be more well rounded. He's trained in , Brazilian Jiu Jitsu, and the Filipino Martial Art of which consists of stick fighting and edged weapons.

Just a few weeks before his retirement he won the State Powerlifting Title at the Annual Texas Police Games as well as two Bronze Medals in at the same games. Bringing that kind of experience and knowledge to a class on self defense as well the body mechanics and propri- oception needed to articulate how the Spear System can interweave with whatever your own personal style of self defense is, is priceless.

To that point, one of the main tenants of Spear is that it is not a martial art. It is adjunct to whatever system or style you want to use what- ever that may be. Chief Pierson was also able to make the class relevant for the environment of EMS for Andre and I. For someone with such an extensive law enforcement background and given that we were the only two EMS providers in a class full of LEOs he very effectively showed us excellent examples of the applications of Spear methodology in relation to the types of situations we in EMS find ourselves everyday. He also gave us some great examples of training evolutions and methods he has utilized for Fire and EMS in Henderson in the past.

Though we were extremely fortunate with having Chief Pierson, these are the main reasons we chose Spear as the best program to learn and bring back to train our folks here in ATCEMS and the region.

15 The efficacy of the techniques and the easy appli- apply more strength, more power, and go to baser cation to the EMS work environment. instincts of striking when the technique is ineffec- tive. Also it's noteworthy to mention here to never When Andre and I were researching this project let ego or pride dictate your actions in any hostile our end goal was to have techniques and a or violent encounter. methodology that worked and was effective in our environment, the back of an ambulance, one that The risk and implications of allowing this to occur we could pressure test under duress, did not com- are all bad. Real violence looks nothing like the promise patient or provider safety, was easy to movies and mutual combat is not what routinely learn and employ, and was usable by most any occurs. Sudden violence is just that. Attackers look provider regardless of weight, size, gender, and for the element of surprise and act impulsively. ability as well having ambidextrous applicability. When speaking of use of force, especially in But especially the pressure tested issue! regards to First Responders, force must parallel Most self defense systems and techniques are danger. You must apply the minimal use of any taught as both some kind of pain compliance and, technique to gain and maintain positional or learned gross motor skills and are scenario and dominance. Striking or kicking a patient should be situation dependent such as getting out of head- an absolute last ditch effort where a provider truly lock or bear hug. These moves not only require fears for their life in a violent encounter. Again this repetitive drilling once learned correctly, but again shows the need for us as a profession to better are entirely situation dependent. We felt that define not only what constitutes, but what avoiding the headlock or bear hug for example by separates a patient from an assailant. seeing, interpreting and acting on the pre fight contact cues to move away from danger would have a much higher amount of efficacy than teach- IN ANY VIOLENT CONFRONTATION OR FIGHT, ing someone first how to be in a headlock or bear THERE ARE ACTUALLY THREE FIGHTS hug then getting out. I realize that seems very Spear teaches that in any violent confrontation or simplistic but think of most any self defense train- fight, there are actually three fights. The first is ing you've received. Were you taught to detect and the realization that the situation could turn violent. avoid danger or did you learn what to do if some- This is an emotional attack. Your heart rate one put you in a specific hold? Do you still increases with the adrenalin spike you feel and remember the moves if that was the case? your body begins the pathophysiology of fight or

While getting out of headlock or bear hug have a flight. The second is the actual fight itself. When valuable place in self-defense, for what we do as the violence occurs. The third is the fight after the EMS professionals, these techniques not only fight, the confrontation with your supervisor, the rarely occur but must be drilled repeatedly to department, and even the judicial system possibly. maintain competence. Further, most use of force You must be able to articulate why and how the violations occur because a technique that was actions you took were necessary. If the force you taught and drilled on a compliant training partner applied does not parallel the danger you faced you rarely if ever works on an uncooperative and com- can be held liable for damages and injury as well bative person resisting with all their strength. as your employer if you're on duty. In this day and When a technique is applied to an actual high age of cell phones and videos going viral quickly, stress, high intensity situation where a person is the court of public opinion can carry a lot of combative and actively fighting and that technique weight. isn't working, the natural human tendency is to

16 We as First Responders must be able to detect I emailed his assistant, Jenny Montes, who is these incidences as they are playing out and be always helpful in answering my many questions. It able to deescalate them and if necessary be able was Tony himself that asked us to jump on a call to use nonviolent postures that can easily and with him to answer our questions and see how he effectively segue to defensive techniques that could help us! That’s not something you see a lot allow us to gain and maintain positional domi- of CEOs of any company doing! He asked that we nance. This is the one of the very best aspects of send him some videos of what we were doing with the Spear methodology and why we are so Spear in the ambulance environment to see both passionate about bringing it to our providers! what we had come up with and how he might improve on what we were doing! Again, I don't When both myself and Andre pitched our idea to know of any CEO that takes that kind of personal the Association we offered to pay our own travel interest! Coach Blauer runs his company and still expenses to the course in Grand Prairie, near teaches both nationally and internationally. To say Dallas. When we announced our plans to go to the he's busy is an understatement, yet he took that Spear course after the Association graciously valuable time for us. We were already Spear agreed to pay our tuition, a very interesting thing advocates however Coach Blauer's personal assis- happened! Many of our fellow medics here in tance certainly sealed our conviction. ATCEMS as well as a Hays Co. EMS employee and a few good family and friends donated their own money for our travel expenses! This was not only SO WHERE DO WE GO FROM HERE? unexpected but a bit overwhelming. When we entered in to this project, we had no idea how Andre and I are planning on offering Spear classes much support and interest we would ultimately in the same delivery model that Will has pioneered receive. It's been pretty amazing to say the least! for his Jiu Jitsu classes. We've also spoken with the CE folks about possibly offering a Spear class as In fact, while initially working on this project I part of CE in some capacity. contacted Tony Blauer himself via email explaining what Andre and I saw as the issues facing our We may also be offering Spear training at the particular job specialty and how we had adapted Union Hall. Something we've also been working on Spear techniques to the back of the ambulance is bringing this training to other departments in before we had any formal Spear training. Basically the region. Our larger goal is to help not only our we got in the back of ambulance with MMA gloves people here at ATCEMS be safer, but all of our First and boxing head gear and truly pressured tested Responder brothers and sisters. what we saw as the most common situations we I've already spoken with Hays Co. EMS as well as a encounter. We found using the limited understand- few key individuals with Star Flight who are ing we had of Spear to be highly effective! Much to personally interested in learning some of the Spear our surprise Coach Blauer himself responded to my methodology and we are working on coordinating email and wanted to speak with us personally over with them on possibly doing some Spear introduc- the phone to see what he could do to help us with tion training with some of their folks who are inter- our research and answer any questions we may ested. have! In fact we ended up speaking several times Andre and I also had the opportunity to show a via phone and email. Coach Blauer is the founder few of the folks from both Cedar Park Fire and and CEO of his company, Blauer Tactical Systems. Westlake Fire some of the Spear Proof of Principles He certainly has plenty of well qualified instructors Drills. These drills and the explanations behind the that could have spoken with us. Honestly I was never so bold as to ask to actually speak with him. 17 system along with the thought process are pretty We hope to see you at one of upcoming training remarkable in their ability to convince folks of the sessions. We are working on better ways to sched- efficacy of Spear in its application to sudden ule and put out information on when and where. violence. Till then be safe, keep your head on a swivel as they say, get some training, and we'll see you out FREE SPEAR CLASSES there! While reading this article you may feel as though I am working hard to sell you the Spear program Contact Walt or Andre with any questions: and in a way I am, but not for money. The classes Andre and I are offering are no charge! The [email protected] ATCEMS Employees Association was kind enough [email protected] to finance our Train the Trainer class and our mission is quite simple: we want to make our people and all First Responders safer! Our profes- sion is already fraught with danger and uncertainty however, we can mitigate a great deal of that danger if we approach these issues in very methodical and thoughtful ways. That is our main objective.

We've started a Facebook page called First Responder Defensive Concepts w here w e post information on training opportunities and articles of interest on violence and self defense in the realm of First Responders as well as advocate for getting formal training of some kind. We want to make all First Responders safer. No small task!

If you're interested in learning more or have ques- tions for Andre and I about training, like and sub- scribe to our Facebook page or you can contact us via email listed below. There are some restrictions on where and who we train for liability reasons regarding training locations and liabilities and we are not a “for profit” training group in any way.

Whether you get to one of our Spear training sessions or Will's and Dr. Pickett's training or not, it's important to learn some kind of self defense strategy as well as keep a situationally aware mindset. Most violent confrontations can be avoid- ed with simple situational awareness and good judgement but a pressure tested skill set and an understanding of human behavior can certainly tip the odds in your favor.

18 Class photo of Walt and Andre with Grand Prairie PD, Grand Prairie Texas

Links to Spear Information

Spear website https://blauerspear.com

Spear medical information https://blauerspear.com/medical

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