EMS Response to Domestic Violence 1 Improving EMS Response to Domestic Violence Adapted from the curriculum created by the New Hampshire Bureau of EMS,

EMS Response to Domestic Violence 1EMS Response to Domestic Violence

Improving EMS Response to Improving EMS Response to Domestic ViolenceDomestic Violence

Adapted from the curriculum created by the New Hampshire Bureau of EMS,

the National Health Initiative on Domestic Violence, and the Family

Violence Prevention Fund.

EMS Response to Domestic Violence 2

What We Want:What We Want:

Increased sensitivity and understanding of domestic violence

More referrals to domestic violence projects

Quality information and documentation for the criminal justice system


Definition of Domestic Definition of Domestic ViolenceViolence

Domestic violence:Is a pattern of behavior (physical, sexual,

verbal, emotional, financial, spiritual, etc.) used by one person to control another’s actions and feelings.

One way to think of these behaviors is as tactics, actions which are chosen and planned. An abuser is not “out of control” – the abuser is trying to control the victim.


Domestic violence occurs in all types Domestic violence occurs in all types of relationships and occurs across all of relationships and occurs across all

demographicsdemographics

Dating, living together, or married. Current or past relationships. Race/ethnicity Gay, lesbian, bisexual, transgender or heterosexual. Income level Class Education/occupation Age – elder, adult, and adolescent Physical ability


Power and Control WheelPower and Control Wheel

Courtesy Domestic Abuse Intervention

Project

Duluth, MN


Maine Coalition to End Maine Coalition to End Domestic Violence (MCEDV)Domestic Violence (MCEDV)

9 agencies statewide 24-Hour toll-free hotlines One-on-one support & advocacy Support groups Emergency shelter or safe house Transitional housing Legal advocacy and referral Information & access to public assistance Community and School Based Education Children’s Programs Batterer Intervention Programs


EMS ResponseEMS Response

If yes, Stage and

advise PD of your arrival

Enter only as directed by police

If no,Stage and wait

until police arrive and scene has been secured

If dispatched as a domestic assault: Are police on scene?


EMS ResponseEMS Response

Since many DV calls are not identified as such, evaluate every call, every patient, and whether there is a need for law enforcement involvement.

Scene Safety AssessmentPatient Safety Assessment


Scene Safety AssessmentScene Safety Assessment

Presence and condition of children and pets

Evidence of:StruggleWeaponsSubstance abuseAttempts to conceal information

Upon approach, and entry look for:


Scene Safety Assessment Scene Safety Assessment (cont.)(cont.)

911 hang-up or difficulty getting info from callerHistory of suspicious callsYou are met at the door or denied entry by someone who says the victim is fine & doesn’t need medical care

Be particularly careful if:


Scene Safety Assessment Scene Safety Assessment (cont.)(cont.)

Don’t hesitate to return to ambulance to discuss options, notify police, or contact Medical

Control. Consider using cell phone vs. radio.


Scene Safety StrategiesScene Safety Strategies

Identify yourself as EMS providersUse team approach (never split the team)Be aware of surroundingsAttempt to sequester patient

If decision is to proceed:


Scene Safety StrategiesScene Safety Strategies

Avoid treating patient in bedroom or kitchenLimit number of people presentLet occupants leadDon’t be afraid to use the ambulance

If decision is to proceed:


Scene Safety Strategies (cont.)Scene Safety Strategies (cont.)

The abuser may view your presence as a threat. Remember to:Avoid touching or crowdingBe non-threatening (non-judgmental)Stay calmMaintain a safe distance


Primary Health IssuesPrimary Health Issues

Keep in mind that medical issues are first priority.


Behavioral CuesBehavioral Cues

Is fearful or anxious around partnerIs reluctant to answer questions, provides

conflicting informationHas delayed seeking medical help

Observe if patient:


Observe if partner or caregiver:Observe if partner or caregiver:

Is angry, belligerent or indifferent to patient’s needs

Refuses or hesitates to allow transportFocuses on own minor health issuesAttempts to control patient’s

interaction with EMS


Assessment CuesAssessment Cues

Has injuries during pregnancyHas multiple, vague complaintsProvides inconsistent medical history

Observe if patient:


Trauma AssessmentTrauma Assessment

Resulting from defensive actionIn shape of objectsOn areas normally hiddenOn other victims (children, elderly, pets)

Look for injuries:


Medical AssessmentMedical Assessment

Physical symptoms related to stress, anxiety, or depressionPersistent headachesChest, back, pelvic or abdominal painExacerbated chronic illness (hypertension, diabetes,

asthma, angina)Substance abuseSuicidal ideation

Potential medical complaints:


Transport vs. Non-TransportTransport vs. Non-Transport

If patient accepts transport:Consider advising hospital securityExplain medical consequencesProvide support & referral to a DV project


Transport vs. Non-TransportTransport vs. Non-Transport

If patient declines transport:Be non-judgmentalProvide first aidProvide support & referral to a DV projectDocument well


Crime Scene ConsiderationsCrime Scene Considerations

Minimize your effect on potential evidenceAdvise police of injuries discovered during assessment

of patientHave all personnel use same entrance.Tell police anything you witnessed (see, smell or hear)

at the scene. Provide police with contact information.


Ask About AbuseAsk About Abuse

Keep in mind:Ask patients in confidential settingsBe non-judgmentalEncourage & support

EMS Response to Domestic Violence


AAsk Direct Questionssk Direct Questions

Has anyone at home hit you or tried to injure you in any way?

Do you ever feel unsafe at home?In addition to [medical condition], I notice

you have a number of bruises. How were you injured?

Because violence is so common in many women’s lives, I ask about it routinely…



AAsk direct questions (cont.)sk direct questions (cont.)

Getting a disclosure is not the objective:

Asking the question and offering resource information is the objective.


AAsk direct questions (cont.)sk direct questions (cont.)

If the patient answers yes:Listen and ask questions non-judgmentallyValidate their experienceDocument their statements

If patient answers no, or will not discuss topic: Be aware of physical, behavioral cues Document inconsistencies Make referrals discreetly



DDocumentationocumentation

Write legibly and use quotation marksRecord an objective description of the

abuse as observed and described to you.

When documenting what victim states, write “victim stated…” instead of “victim alleged…”

Patient statements are not hearsay.Record all pertinent physical findings.



DDocumentation (cont.)ocumentation (cont.)

Your EMS report may be the only record of: Inconsistencies in reporting Delays in seeking treatmentObservations of environment Statements made by patient and partner


DDocumentation (cont.)ocumentation (cont.)

Potential evidence preservation/collection:Collect evidence such as ripped clothing or

handful of hairExplain options to patient re: use of evidenceUse paper bags for evidence collectionDescribe shape, location of injuries


Ask about indicators of escalating risk:Ask about indicators of escalating risk:

Increase in the frequency or severity of the violence?

Increasing or new threats of homicide or suicide by the partner?

Gun or other weapon present or accessible?Threats to children?Abuse of pets?


Indicators of escalating risk:


RReview Options, Offer eview Options, Offer ReferralsReferrals

Did you know that there are organizations in the community that can help you?

All their services are free and confidential.The local domestic violence projects have

24-hour toll-free helplines staffed by people who care.


Things to say when making a referral:


RReview Options, Offer eview Options, Offer Referrals (cont.)Referrals (cont.)

Additional helpful things to say to a victim:I’m concerned for your safety and the safety of

your children.You do not deserve to be treated this way.I’m sorry this happened to you. How can I help?Many people experience this. You are not

alone.



Mandated ReportingMandated Reporting

An EMS provider must immediately report to Child Protective Services any child whom you have reasonable cause to suspect has been abused or will be abused (Title 22 Subchapter II, Subsection 4011).

When, while acting in a professional capacity, an…ambulance attendant, emergency medical technician…has reasonable cause to suspect that an incapacitated or dependent adult has been or is at substantial risk of abuse, neglect or exploitation… then the professional shall immediately report…to the department” (Title 22 Chapter 1-A, Subsection 3477).

Maine Department of Human ServicesCentral Intake1-800-452-1999



HoweverHowever

• No one is mandated to report violence of a competent adult unless it is a gun shot wound.

• The choice about whether to contact law enforcement, a domestic violence project, or anyone else belongs to the victim.


In SummaryIn Summary

Victims know their situation best and can best evaluate their safety and the safety of their children.

An EMS provider’s role is to offer the patient medical treatment, options, support and referral information.

You can make a difference!



Thank youThank you


HandoutsHandouts

Power & Control Wheel Myths: Why Does Battering Happen? Signs to Look for in a Battering Personality 6 Things to Say to Victim & 8 Actions to Take MCEDV Map of Domestic Violence Projects EMS Safety at the Scenes of Domestic Violence EMS Domestic Violence Indicators or Red Flags What to Look For: Common Diagnosis/ Clinical

Indicators Documenting Abuse How to Access EMT Records and Run Sheets Is DV an Issue for EMS?

Documents

EMS Response to Domestic Violence 1 Improving EMS Response to Domestic Violence Adapted from the curriculum created by the New Hampshire Bureau of EMS,