KLA Risk Consulting. KLA Risk Consulting 12/30/2015. Patient or Attacker: Managing the Risk of Assaults on EMS/Fire

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Jack Randall
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entities, Fire/EMS, hospitals, construction companies Kim L.

1 Patient or Attacker: Managing the Risk of Assaults on EMS/Fire Kelly L. Austin Vice President-Training/Senior Risk Manager KLA Risk Consulting KLA Risk Consulting Risk management and safety consulting and training company (18 years) Public entities, Fire/EMS, hospitals, construction companies Kim L. Arnold, ARM, ALCM: President/CEO Risk management and safety consultant for 26 years Keynote speaker; author OSHA Outreach Trainer KLA Risk Consulting Kelly L. Austin, VP-Training/Sr Risk Manager KLA Risk Consulting: 9 years Training adults: 22 years Certified trainer: Escaping Violent Encounters for EMS/Fire Escaping Violent Encounters for Healthcare Providers MS, Psychology 1

2 This Session Overview of assaults on EMS/Fire. Risks associated with assaults on staff. Difference between a patient and an attacker. Tactics that help prevent an assault. Assault Response Guidelines 2

Husband and wife paramedic team News Stories Dickson paramedic attacked by two men Dec 2014 Drunken North Olmsted man accused of assaulting Westlake

worker, jumps from ambulance Mar 2015 Two Detroit EMS workers attacked Oct 2015 EMS assault fatalities: 7x higher than other healthcare workers Risk of

3 Husband and wife paramedic team News Stories Dickson paramedic attacked by two men Dec 2014 Drunken North Olmsted man accused of assaulting Westlake paramedic Jan 2015 Middleburg woman accused of threatening paramedics Feb 2015 Paramedics assaulted twice on the same call Mar 2015 Patient assaults EMS worker, jumps from ambulance Mar 2015 Two Detroit EMS workers attacked Oct 2015 EMS assault fatalities: 7x higher than other healthcare workers Risk of EMS non-fatal assault: 30x higher than national average Brian J. Maguire, DrPH, MSA, EMT-P Clinical Associate Professor University of Maryland Maguire, et.al,

NAEMT Study While performing EMS duties: 52% assaulted by a patient 50% exposed to infectious disease 47% have sustained a back injury 21% contracted illness from patient 2005 NAEMT/McNeil Consumer &

4 NAEMT Study While performing EMS duties: 52% assaulted by a patient 50% exposed to infectious disease 47% have sustained a back injury 21% contracted illness from patient 2005 NAEMT/McNeil Consumer & Specialty Pharmaceuticals Survey NAEMT Study And yet ONLY 21% ranked their personal safety as top concern 2005 NAEMT/McNeil Consumer & Specialty Pharmaceuticals Survey May 2015 Study Assaults on EMS: Verbal assaults: 88% Physical assaults: 80% 40% sought medical care 49% reported assault to police Fear for personal safety: 68% M. Furrin, et.al., May

5 Assault numbers on EMS/Fire too high Culture: Assaults are just part of the job. Stats: Likely higher assaults underreported PERRP and OSHA PERRP (OH) Role: Ensure public ees have safe and healthy working conditions. Employers: workplace free from recognized hazards that are causing or are likely to cause death or serious physical harm. OSHA General Duty Clause SEC. 5. Duties(a) Each employer: (1) shall furnish a place of employment free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees; 5

OSHA Workplace Violence Defined Workplace violence is: Violence or the threat of violence

Ranges from threats and verbal abuse to physical assaults and homicide.

6 OSHA Workplace Violence Defined Workplace violence is: Violence or the threat of violence against workers. Occurs at or outside the workplace. Ranges from threats and verbal abuse to physical assaults and homicide. Assault/Workplace Violence Definition NIOSH Violent acts directed toward persons at work or on duty. Workplace violence is any physical assault, threatening behavior or verbal abuse occurring in the work setting. Examples of violence - THREATS Expressions of intent to cause harm Verbal threats Threatening body language Written threats 6

Examples of violence - PHYSICAL Attacks Slapping

Firearms Bombs Risks Risks Associated with Assaults

Injury To EMS/Fire member To patient, others

7 Examples of violence - PHYSICAL Attacks Slapping Beating Biting Homicide Use of weapons Knives Firearms Bombs Risks Risks Associated with Assaults Believing assaults are part of the job Physical Injury To EMS/Fire member To patient, others Changes in the brain Increased activity in areas Other areas affected 7

Risks Risks Associated with Assaults Increased nonfatal injury days

Risks Associated with Assaults Psychological issues Stress,

assault that changed his career The physical injuries have healed,

Maine paramedic every day Mar 16, 2015 Risks Risks Associated with

8 Risks Risks Associated with Assaults Increased nonfatal injury days away from work Staff shortages Increased workers comp = $$ Risks Risks Associated with Assaults Psychological issues Stress, depression Anxiety Fear for safety Paramedic speaks out about assault that changed his career The physical injuries have healed, but the emotional pain of being attacked by a patient impacts a Maine paramedic every day Mar 16, 2015 Risks Risks Associated with Assaults Over-response/excessive use of force lawsuit Glendale Fire/EMS Negative press 8

Tactics Tactics of Prevention: Recognize catalysts and

9 Tactics Tactics of Prevention: Zero Tolerance Policy Understand patient versus attacker. Tactics Tactics of Prevention: Recognize catalysts and situations that increase likelihood of assault. Restraining patient Needles 9

10 Tactics Tactics of Prevention: Awareness Know behavioral cues of potential attackers. De-escalate by stance, distance, verbal skills. Tactics Techniques of Response Training: Reasonable response to assaults Defense-escape skills Tactics: A word about training 10

11 Patient v. Attacker A patient is: Cooperative Uncooperative (dementia, TBI, etc.) Attacker Combative Patient does not exist. Patient v. Attacker Definitions Patient A person receiving medical treatment Uncooperative Unwilling to help others or do what they ask 11

weapon Attacker Patient Confused due to medical emergency No intent to harm you Diabetic/SZ TBI Hypoxic Dementia Attacker Verbal Threats Apparent intent to harm you Movements

12 Patient v. Attacker Definitions Combative Ready or eager to fight; aggressive, antagonistic Attacker Set upon another in a forceful, violent, hostile or aggressive way, with or without a weapon Patient v. Attacker Patient Confused due to medical emergency No intent to harm you Diabetic/SZ TBI Hypoxic Dementia Attacker Verbal Threats Apparent intent to harm you Movements are acts of aggression Drunk Drugged Patient v. Attacker Your response is different Patient Attacker Show empathy LEAVE immediately Explain care Do not argue or try to Listen allow venting reason Great customer service Keep your hands open May need to protect and up yourself from injury as Call for LEO you continue providing care 12

13 Patient v. Attacker A word about duty to provide care Need consent to treat Expressed conscious, mentally competent Implied unresponsive or altered mental status Do you have consent to treat? Drunk patient is punching you? Drugged patient is threatening you verbally? Remember PERRP and OSHA Patient v. Attacker This is about your reasonable perception of who is in front of you! What the patient says The patient s actions Your reasonable perception Reasonable assists in managing potential liability. 13

Assault Response Guidelines Like Police Use of Force Continuum Clarifies complex subject of use of force. Useful to a jury when deciding use of force case.

14 Assault Response Guidelines Like Police Use of Force Continuum Clarifies complex subject of use of force. Useful to a jury when deciding use of force case. Assault Response Guidelines Assault Response Guidelines Reasonable thereasonable person standard is the standard of care that a reasonably prudent person would observe under a given set of circumstances. 14

Response Guidelines Reduces Risk of EMS/Fire members: Responding in ways that result

15 Assault Response Guidelines Reasonable self-defense the use of reasonable force to defend oneself or another from bodily harm from the attack of an aggressor Assault Response Guidelines Reduces Risk of EMS/Fire members: Responding in ways that result in more severe injuries to EMS/patients/others. Using excessive force in response to assault. 15

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Understanding and Preventing Workplace Violence. Alameda County Health Care Services Agency

Understanding and Preventing Workplace Violence Alameda County Health Care Services Agency Why WPVP Training? Raise awareness Understand County Policy Recognize warning signs Steps to prevent incidents