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 Judo 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.