Keeping the Peace: Violence Against Emergency Medical Providers - PowerPoint PPT Presentation

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Keeping the Peace: Violence Against Emergency Medical Providers

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  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

  12. 1995 in US Hospitals • 42 homicides • 1463 physical assaults • 67 sexual assaults • 165 robberies, 47 armed

  13. What About Pre-Hospital?

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

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

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

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

  18. 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

  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 • 8 fractures, 9 dislocations

  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 • 1 burn

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

  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 • Urban equivalent to other locations

  24. Where Violence Occurs

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

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

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

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

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

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

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

  32. The Problem of Recognition: The Scene

  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 • High-risk chief complaints

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

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

  40. 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

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

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

  43. The Problem of Recognition: The Patient

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

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

  46. Everyone Has a Breaking Point

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

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

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