Violence on the Rise Against Fire/EMS Personnel
Introduction
With the Center for Disease and Control (CDC) reporting an increase in total violence in recent years, including the categories of homicide, youth violence, domestic violence, and workplace violence, it is no surprise that emergency responders are being summoned to hostile environments at an alarming rate. Homicides are occurring so frequently in the United States, that they currently rank along side medical ailments, such as cancer and heart disease, as one of the top fifteen causes of death to the American population. As the total number of injuries and death from violence increases, so to does the risk undertaken by responders.
Violence Towards Responders
While not an easily quantifiable statistic, many in the emergency response community are noting an increase in violent actions directed towards their crews. A glimpse of a few recent examples serves as evidence of their inclination. While the motivations for attacking responders vary — among them, mental illness, confusion, anger, and mistrust — the end result of these attacks, has at times, proven to be fatal for those in the fire and EMS communities.
Just two days ago, a patient in Birmingham Alabama fires three shots at paramedics, before stealing their ambulance. Three weeks ago firefighters from LeRoy Fire Department in New York were shot as they arrived on the scene of a house fire. While no injuries to responders were reported in these two most recent examples, they are symptomatic of a growing trend. For example, in May 2010, a firefighter/paramedic with the Los Angeles Fire Department was stabbed when kneeled over what he thought was an unconscious patient. In July of 2010, the homeowner of a fully involved fire building attacked fire crews in Spanish Colony Colorado, after he felt they did not do enough to save his property. In 2008, after arriving on the scene of a vehicle fire, probationary firefighter Ryan Hummert of the Maplewood Fire Department in St. Louis Missouri was shot and killed stepping off of his apparatus.
Violence From Within
Regrettably, firefighters and emergency responders are also falling victim to another trend of violence that is experiencing an increase across the country — attacks at the workplace, against co-workers. On April 23, 1996, a Jackson, Mississippi, firefighter walked into the Jackson Fire Department administrative offices and fatally shot four officers, wounding two others. On March 8, 2000, a Memphis, Tennessee, firefighter shot and killed two firefighters and a Sheriff’s Deputy who answered a call to his house. In 2004, firehouse banter turned into an brawl at an FDNY firehouse, resulting in criminal charges of assault, harassment and possession of a dangerous weapon against one firefighter, and departmental charges of attempting to cover the incident up for several members of the crew and officers present at the time. Most recently, in March of 2015 a fired firefighter held his former colleagues hostage at gunpoint in their firehouse.
Responses to Potentially Violent Situations
As noted by the above instances of firefighter injury and death, violence can erupt on any call, despite what the initial dispatch was for. Because of this, a best practice for limiting a responder’s proximity to hostile actions is to treat all scenes — regardless of the nature of the call — with a defensive posture, using situational awareness to note the signs of potential threats. This proactive approach to unknown situations, similar to wearing gloves on every interaction with a patient, can become a routine safeguard for responders on the street.
The obvious physical signs of danger on the streets are usually easily recognizable. Examples of these include: a man holding a knife and refusing to let responders enter or exit a structure, a patient screaming threats at bystanders or agency personnel, objects thrown at or around responders or apparatus. In these cases, even the most novice firefighter or medic would know that the situation is unusually hostile and that it is time to leave the scene, and call for law enforcement support. Unfortunately, in several of the above situations, the responders are already in some degree of physical danger. Occasionally, because of the dynamic environment that 911 personnel operate in, these situations are sometimes unavoidable. However, the majority of threatening incidents can be mitigated long before immanent threats are present by observing the physical signs of the environment during the response phase of the call.
a. The Dispatch
Initial safety considerations begin with the information received from dispatch regarding the nature of the call. Obviously, dispatches to violent incidents require a certain protocol, such as staging until law enforcement secures the scene. However, more ambiguous calls present problems for responders as well. Consider a unit that is dispatched for a “person down” or “unconscious person” on a local parking lot. Responders do not know if this individual is “down” because they had a heart attack or have been shot in a domestic dispute.
In some cases, units can ask dispatch centers to attempt to ascertain additional information from the reporting party or transferring call center. In all cases, the responding units should respond defensively, and size up their surroundings as they near the scene. Additionally, in areas prone to high violence trends, most agencies allow for their units to call for a law enforcement escorts on ambiguous calls, such as “unconscious trauma victim” or “traumatic injury”, where a police presence may be required.
b. The Response
Defensive responses to calls are practiced regardless of the nature of the incident. Responders are continuously aware of their speeds, the traffic around them, the weather conditions, and the time of day. Combining all the factors of these elements allow firefighters and medics to draw a more complete picture of the situation they are involved with.
These same defensive techniques that are practiced daily should be continued when approaching an incident site. For example, personnel should slow their vehicle as they approach the address or physical location. Attention should be given to civilians around the incident. If there is a crowd, what are their reactions? Generally individuals do not stay in a dangerous place, so people streaming away from an incident site may indicate that it is not yet secure. What is the posture of those immediately around the patient? Are they consoling? Defending? Arguing? Those immediately around the incident can be a litmus test for responders and their physical actions should be monitored.
On the approach, responders should attempt to take their vehicle as close to the incident as possible, while still being able to drive away quickly if required. This allows rescue personnel to visualize as much of the scene as possible from the relative safety of their apparatus, and give them an accessible point of retreat if conditions deteriorate on the ground. When responding to physical addresses, units should slow as they approach, move in front of and then past the building, stopping roughly 20 feet past the dispatched address. This allows responders to see three sides of the building, including the gangways and sidewalks between the buildings without ever leaving their vehicle.
Once out of the apparatus, the situational awareness continues as responders approach. Long before patient contact is made, personnel should be scanning the area or building to note signs of potential violence. Are there signs of a struggle present? Specifically, do responders see broken glass, doors kicked in, or blood that would indicate a traumatic injury? Is any of the scene visible from the windows on the approach? Is it possible to discern how many people or voices are being seen/heard, and what is their posture or tone? Finally, note side doors, number of windows and mechanisms on the main entry door. In the case of a rapid egress, it may be beneficial to have more than one exit in mind.
When initiating patient contact, it is important to knock, and clearly announce the position or agency the responder is representing. Many in the public are not conscious on the subtle differences between law enforcement and fire/rescue personnel. Seeing an authoritative figure come through a doorway — complete with a badge, radio, and notepad — the patient or their family may not make the distinction between a firefighter and a police officer. It is very important to clearly announce “Fire Department!” or “Ambulance!” as responders knock on an entryway, to clarify what their intention is.
c. On Contact
As personnel enter a scene, they must move definitively, scanning the area a complete 360 degrees. This allows the rescuers to note not only the physical layout of the environment, including additional egresses or cover, but allows them to scan for obvious weapons as well as the total number of people in their immediate vicinity. If the individual answering the door is a close family member or friend, responders should ask them to lead them to the victim/patient as opposed to having them tell them where they are located. This not only allows for personnel to visibly keep this individual in their line of sight, but also allows the patient to feel more comfortable seeing a familiar face nearby while undergoing their emergency.
Once inside the room, the most secure position for responders is towards the door of primary egress. Provided patient care is not hindered, it is generally unacceptable to stack treatment bags or clipboards in the path towards an exit, or allow family members to stand directly in the doorframe leading out of the immediate area. In the event that a call turns hostile, these objects become an additional obstacle for responders trying to secure themselves a safe retreat.
Arriving at the patient, responders must quickly determine not only their extent of injury or illness, but any risks towards responders as well. As the firefighter or medic notes the patient’s injuries and signs or symptoms, they should also be looking for objects that can be used as a weapon. These include ashtrays, small caliber (and easily concealable) weapons, kitchen knives, bats, wrenches, or needles. As a general rule, if it can be used against responders, it should moved from within reach of the patient. Remember, violence is not limited to those who have only malicious intent. Responders have been severely injured by those who may not necessarily intend to cause harm, but are in a confused state due to head injuries, drug use, intoxicants, or other impairment. Securing dangerous commodities early in the response is beneficial to all involved.
Finally, do not spend more time on scene then is necessary for proper stabilization and transport preparation. Prolonged time in unfamiliar areas is never beneficial, as conditions can be changing without the responder’s knowledge. Family members who are unaware of treatment protocols can begin to get anxious about the wellbeing of their loved one, and begin to question why personnel have not started driving their loved ones to hospital. If medics anticipate an extended on scene time, and the patient’s condition allows it, it is an industry best practice to move the patient to the unit before starting procedures that could potentially add minutes to the on scene time, such as IVs, medication regiments, and intubations.
Early Mitigation of Violent Actions
Situations in public safety can change rapidly. A patient may experience changes in his or her mental state, an agitated, angry, or overly concerned family member can arrive on scene, or (in the case of the Colorado firefighters) members of the public can believe that emergency personnel are doing “too little” to save their property or their loved one. This section will discuss the techniques that can be employed by responders when they feel the situation is deteriorating towards a confrontational situation between patient and responders or patient and family members and/or bystanders.
a. Voice, Tone, and Language
The most effective tool in slowing or mitigating a confrontation is the responders voice, tone, and vocabulary. While there is no “one size fits all” saying or command that will work in every situation, there are key elements that responders can employ in dealing with a hostile party. First, the tone of any message should not be weak. While it is best to avoid sounding like a drill instructor, a responder’s message should be firm, collected, and moderately authoritative. While delivering the message, the sender should look the receiver in the eye as a sign of conviction. While remaining firm, the content of the message should remain professional and respectful. It is best to use terms such as “Sir” or “Ma’am” in lieu of words like “buddy”, “sport”, or “chick” which can appear condescending to some individuals, escalating their anger. The actual message conveyed will vary depending on the situation, but it is often best to use this message to separate parties. Generally this involves individuals physically moving to other sides of the room, still within sight of responders.
b. Body Positioning and Body Language
The way to approach and stand with or in front of individuals effects their perception of the responder’s intentions, and influencing their interaction with them moving forward. Body positioning focuses on the approach and initial interaction, while body language describes what messages are being conveyed as the interaction flows. Generally speaking the initial body positioning of responders should be open and alert. The message conveyed is that the responder is here to assist and is prepared for all actions. The converse (and inappropriate) position to this stance would be for a responder to enter a room with their arms folded, as if to show disinterest and hostility. Additionally, responders should be careful when approaching potentially agitated patients who are sitting or lying below them. Through no fault of responders, the difference in height can be a form of intimidation and unrest for the patient. In these situations it is often best to approach from the side if possible, and reaffirm the message that the responder works for a Fire/EMS service and is here to help. As the situation progresses, it may be appropriate for the responder to kneel or squat next to a sitting or laying patient. This should only be attempted if a rapport has been built with the patient, and even in these cases, responders should position themselves off to the side of the individual.
For an example of these techniques, assume that responders have been dispatched to a “person down” call in a popular row of nightclubs. Once arriving on scene, they see a man sitting against a wall outside of a club muttering to himself, and appearing confused. If a responder was to approach this man, position themselves directly in front of him with their hands on their hips to begin gathering information, they could very easily send the wrong message to the individual. In his inebriated state, it is very possible for him to confuse their presence with that of a law enforcement officer. Depending on the man’s prior interaction with law enforcement, this simple lapse in body positioning and body language can escalate a situation beyond what was expected. A more appropriate response to the same scenario would involve responders approaching from the side, announcing their role as “Fire Department” or “EMS”, and as the situation dictated, perhaps moving into a crouched position on the side of the patient so as to have a more personal interaction with the individual.
c. Situational Advantages and Distraction Techniques
Situational advantages and distraction techniques vary on a call-by-call basis. Essentially, they involve using a procedure or patient condition to distract from an escalating environment. One popular distraction technique is using a fictional medical event as a reason to move the patient from a residence to the unit. For example, while checking the blood pressure of a patient who continues to argue with her boyfriend in their home, one responder turns to their partner and says “her ‘biopic pressure’ is a little high, we should probably get her to the rig.” While there is no such thing as a “biopic pressure”, this established code word between partners gave them an excuse to move the patient to a non-threatening environment to perform an actual patient assessment.
Another situational advantage technique is to use medical procedures as a way of containing aggression between members in the residence or responders. For example, if a patient is agitated and swinging his arms widely, a responder can ask to take his pulse as part of his medical assessment. If the patient agrees, the responder can “take his pulse” for any length of time. This medical procedure is not only providing the vital signs of the patient, but is allowing the responder to control his or her arm in a non-threatening manner, while building a rapport with their words and actions. Similar to an extended pulse rate check, responders can use their equipment as a reason for containing a situation. In one specific case, units responded to a ‘panic attack’ and found a woman in a heated argument with her mother-in-law. While the two continued to trade verbal barbs at one another, a paramedic placed a pulse oximeter on the woman and announced “Ladies, this is a very sensitive, specialized piece of machinery and I need her absolutely calm in order to get a correct reading.” The two women silently agreed to the paramedic’s request, and in the lull of the moment temps cooled tremendously.
As responders, it is always best to remain as open and transparent about our actions as possible. However, in potential threatening situations, it is the responder’s duty to ensure that they, their partner(s), and their patients are provided with as safe of an environment as possible. Using situational advantages and distraction techniques to enhance on-scene safety is a method for protecting all involved.
d. Passive Law Enforcement Request
In some scenarios, where the threat of violence has not matured to actual violence but the above techniques are not working, it may beneficial to request law enforcement to the scene. In a “passive” law enforcement request, on scene responders can advise their dispatch that police intercession may be needed, and police officers should begin heading towards the unit to assist. In many cities signaling dispatch with a code number or other designation, so as not to alert citizens on the scene, which could potentially escalate tensions further, performs a passive request. While the fire service is moving away from 10-codes and encrypted messages, most passive law enforcement requests are still coded messages such as “10–1”, “10–99”, or a request for the “the blue supervisor” to respond to the unit’s location.
Responses to Direct Violent Action
Despite the best situational awareness and attention to detail, responders can still find themselves in situations where violence has taken hold. This includes both verbal and physical threats to responders, and requires members to take immediate actions to ensure their safety and notify law enforcement. It is important to remember that these types of calls, while rare, can manifest quickly and are not limited to calls that were dispatched as potentially violent. As noted early in this program, responders should be aware of their egresses, the position of people and objects around them, and the position of their partner.
a. Immediate Egress and Evacuation
In the event that a responder’s life or safety is immediately compromised, it may be necessary to evacuate the area as quickly as possible. In this case, they should notify their partner(s) of the immanent threat and immediately use the primary or secondary route of egress. This involves running, or moving as quickly as possible, to move to a safe distance. In these life-and-death situations, responders should leave their equipment — and if necessary the patient — in order to secure their safety and get additional resources to the scene.
If immediate egress is required, responders should do everything they can to remove themselves from the direct area. For example, if responders face an immediate danger inside of a residence, the most prudent form of action is to retreat outside, to their unit, as oppose to simply moving to another room in the structure. This action allows responders to not only place a good deal of distance between themselves and their attacker, but gets them back to their unit where they have access to cover, a radio to call for assistance, and the ability to move much further away quickly if the situation dictates.
b. Cover and Concealment
Occasionally, retreat and evacuation is not a feasible option for responders. In this case, personnel must seek cover and/or concealment. Again, early situational awareness is key in noting appropriate places for responders to seek shelter. Early identification of these areas, long before violence erupts, assists personnel in quickly getting to safety when a situation goes critical.
Cover is defined as objects or locations that are usually impenetrable to the most common caliber of bullets. This can include trees, telephone or electricity poles, dumpsters, vehicles, and fire hydrants. Some objects provide greater protection at greater strength points, such as protection behind the engine block of a car as opposed to just the door. Additionally, it is preferred to find cover where the responder’s body is completely covered, and they are in a standing position. The standing position allows the responder to run to another location quickly if the threat moves, or if better cover is available. Finally, personnel should only move to a different location if it provides a greater amount of cover, is further from the incident, or the threat is moving towards the initial cover. Responders must minimize themselves as targets and call for assistance as quickly as possible.
Concealment is defined as areas that offer little bullet resistance, but limit the view of the body. Concealment consists of tall grass, shadowy tree lines, foliage, interior walls of a home, or rows of crops. These options will not offer ballistic cover, but will limit an assailants view, making it more difficult to attack.
c. Direct Law Enforcement Request
In situations where there is an immanent threat to any on scene responders, the first action must be to clear the area as safely as possible, using direct retreat, cover or concealment. The second priority is notifying the communications branch that responders need urgent police assistance. In these cases, there is no need to use any 10-codes or encrypted messages, as plain-speak English is best suited for immediately summoning assistance.
As calmly as possible the on-scene units should notify dispatch of the unit calling, the fact that they have emergency traffic, and that they need help. A sample radio call in this scenario would be similar to “Unit 7 to Communications, Emergency Message! We are under attack! We need Police assistance immediately!” Be prepared to provide additional information regarding your current location, especially if you operating in a complex with multiple buildings, an outdoor open area, or have relocated to a new area as part of the initial retreat. Moreover, if on-scene personnel can forward any specifics regarding the nature of the attacker, such as the physical description, type of weapon, last known location, etc., to their Communications it will assist responding law enforcement in confronting the threat.
Summary
Regrettably, violence is one of the many risks faced by emergency responders. With statistics detailing the rising number of a variety of threatening actions, responders must remain aware of the signs of potential dangers on every call. Only through active situational awareness and a defensive mindset can personnel work to better protect themselves and their partners. While Fire and EMS units should never approach a known violent call without Law Enforcement first securing the scene, vigilance must be practiced on every call, regardless of the nature of dispatch. This awareness starts from the moment the unit receives the call, continues from the time a unit arrives, during patient contact, and through transport and transfer.
When responders recognize the events and actions that act as a precursor to violent actions they can take several step to deescalate the situation. Adjusting their language through changes in tone and message, they can help establish a new dialog in the atmosphere. Additionally, changes in body language and body positioning can reinforce the message the Fire and EMS units are here to help, not antagonize. Responders can employ distraction techniques in an effort to breakup a hostile conversation or threatening tone.
Unfortunately, in some rare cases, actual violence may be directed towards or around members who are on the scene. In these situations, it is imperative that members immediately retreat from the immediate vicinity, preferably to their unit and out of the area. In the event that members have limited egress or access to definitive retreat, they should immediately seek the most secure cover or utilize concealment to avoid becoming a target. Additionally, they should call for Law Enforcement assistance to help secure their passage to safety.
While no calls are truly “routine”, there is a pace and pattern to a career in the emergency services. By practicing defensive techniques towards one’s personal safety on all calls, the behavior soon becomes a part of the responder’s work habits. Early detection of violent actions and an attention to detail can lead to saving ones own life or that of their partners or patient. Vigilance and a commitment to safety must be employed on every scene, in every city.
Greggory J. Favre, MS is a Captain with the St. Louis Fire Department and an executive member of the FBI’s Joint Terrorism Task Force. Assigned to the Fire Chief’s Command Staff, he responsible for homeland security, special operations, and strategic planning initiatives across multiple bureaus. You can follow him on Twitter: @Gregg Favre
He is part of The White Hat Syndicate, a Medium account launched on October 26 that publishes thought-provoking articles about cutting-edge homeland security topics. The six authors come from a diverse array of professional and personal backgrounds: legal, fire, environmental health, federal transportation security, and law enforcement.
The Syndicate invites you to engage us in conversation, either here on Medium or via Twitter. We look forward to the discussion.
Opinions expressed in this essay are solely those of the author, and do not reflect the official policy of his employer, professional associations, the United States Naval Postgraduate School, the Department of Defense or the U.S. Government.
