Self-Defense for Fire and EMS

By DAVID MILLS

I was first introduced to the fire service as a martial artist. At the time, Eagle River (CO) Fire Protection District Chief Charlie Moore was taking classes at a local martial arts school where I was an assistant instructor. While there, he apparently recognized some quality in me which he thought might make me a good fit as a firefighter. That is how I began my career as a proud member of the fire service. My background has helped me see firefighting from a martial artist’s perspective. In many ways, firefighting has made me a better martial artist and, likewise, my martial arts training has made me a better firefighter.

Martial arts has an ancient and proud tradition of rigorous training and preparation. It requires-from those who choose to follow its path-fierce loyalty, discipline, and commitment. For those who are willing to pay the price, the rewards are deep and vast. As a martial arts and fire/emergency medical services (EMS) instructor, I have noticed clear parallels between both traditions; at the heart of each lies a similar value system and approach to life. I believe the line between both traditions has begun to fade.

Since I began my journey as a firefighter, I have attempted to identify some way I might be able to share my martial arts experiences with other firefighters to possibly help them do their jobs better and more safely. For years, I missed the obvious. It was not until my captain, Ted Lilley, knowing my background, asked me a couple of years ago if I would be interested in teaching our department some basic self-defense techniques. This request arose following an incident where several of our firefighters were attacked during an “unknown medical” call by an adult female. The patient was suffering from a condition known as “excited delirium.” The class was effective and received high praise. It was then I realized how desperately the fire service needed self-defense training.

Several years before my “epiphany,” the National Fallen Firefighters Foundation (NFFF) recognized the need for “national protocols for response to violent incidents” in Life Safety Initiative #12. In the NFFF’s Final Report, published in October 2012, it presented a preliminary checklist that outlined what to do if confronted with violence. This common-sense checklist recommends that if you can avoid violence then, obviously, avoid it until law enforcement can bring it under control. The Final Report goes on to suggest that if you are confronted by violence and you cannot safely remove yourself, then you should defend yourself with “reasonable force.” The Final Report also mentions the Occupational Safety and Health Administration (OSHA) General Duty Clause, which suggests that fire departments may have a legal obligation to provide workplace violence training and engineering and administrative controls when the potential for workplace violence exists. It is glaringly obvious that the potential for workplace violence exists for firefighters and emergency medical technicians (EMTs).

BREAKING GROUND

Administrative buy-in for comprehensive self-defense training has been slow; this may be because of fear of civil liability. Many fire administrators may feel that if they provide self-defense training, they are giving their personnel the “green light” to use force on the people they are sworn to protect, and that is likely an uncomfortable feeling. They may also feel that self-defense training goes outside of the traditional role as firefighters, believing that it’s a police officer’s job. As indicated by the OSHA General Duty Clause, there are likely greater liability issues associated with neglecting to train firefighters on how to deal with violence. If we want firefighters to make good choices, they must understand their options, the standards to which they are held, and how to select the best available option based on the situation at hand. Most of us understand this. If it is true in every other aspect of our job, then it is true in regard to violence.

Thinking back to my initial civil service interview for my current position as a career firefighter, I recall my martial arts training being called into question. The interview panel members speculated that my training may make me more prone to solving conflicts with violence. Although I recall that interview, I find it ironic that martial arts training has proven to be my single greatest asset as a firefighter/paramedic and fire/EMS instructor.

There are an estimated 700,000 assaults on paramedics and EMTs annually in the U.S.¹ Because of the nature of their job, firefighters are much more likely to encounter violence than the average person. The question you need to ask is, Are we any better prepared to deal with violence than the average person? That answer should be a resounding YES. If it is not, then, as Gordon Graham, a leading expert in risk management, says, “That is a problem lying in wait.”

There is widespread evidence that the majority of firefighters and EMTs can expect to be assaulted at some point in their careers. However, the severity and timing of the assault are difficult to determine.

Most fire and EMS policies regarding responses to violence are for responses to known violence. This is like writing a garage fire standard operating guideline and trying to apply it to all house fires. It simply does not prepare you to deal with the full scope of the hazards and conditions you may face. Each department or agency needs a comprehensive policy on dealing with violence that includes the right for its personnel to defend themselves and steps to identify, avoid, or deescalate emerging threats.

MANAGING VIOLENT PATIENTS VS. SELF-DEFENSE

It is important to draw a clear distinction between violent patient management (VPM) and firefighter/EMT self-defense. During VPM, the patient/health care provider relationship remains intact. VPM should be viewed as a critical part of our treatment plan for patients who, as a result of their medical condition or traumatic injury, are combative. For instance, you apply oxygen on patients who have difficulty breathing; you establish intravenous (IV) access for patients who need IV medications and fluids; and, likewise, you control and restrain patients who are a threat to themselves or us. Establishing control of patients in the safest manner possible and effectively restraining them to perform necessary medical interventions and transport are critical components of patient care. If performed ineffectively, patient restraint procedures could lead to further patient and personnel injuries. In addition, the ineffective use of force will likely lead to an escalation of violence, suddenly forcing health care providers from a patient care situation into a self-defense situation. A self-defense situation exists when a firefighter/EMT believes he is in danger, in which case his mindset and objectives change from safely rendering patient care to getting home safely.

SITUATIONAL AWARENESS

My martial arts instructor, Sensei James Lee, taught me early in my training, “The best block in the world is not being there.” Like everything in the martial arts, that lesson has deeper levels of application, levels that are obvious for firefighters. It is pretty simple: When a roof collapses, a floor gives away, a room flashes, or violence erupts, don’t be there. Our greatest defense against life-threatening hazards from fire or violence is not being there when they happen. The ability to recognize or anticipate an impending attack or a sudden worsening situation and make sure you are “not there” is essential.

Situational awareness is an essential concept for both firefighters and martial artists. As a firefighter, I understand it as a deliberate, ongoing process of perception and evaluation to make informed decisions regarding an incident. As a martial artist, it is not just seeing what is there but seeing what could be there, not just seeing what is happening but what could happen, and having a plan. For a martial artist and a firefighter, the world is full of “what ifs.” It is time for firefighters to start asking themselves, “What if I am suddenly attacked?”

SCENE SIZE-UP

Whether responding to a structure fire, an unknown medical, or a motor vehicle collision, the initial scene size-up is critically important to establishing situational awareness. You must perceive-with your senses-what is occurring and analyze and evaluate that information to make decisions. You must get the “big picture.” However, many of us are terribly prone to tunnel vision at this stage and throughout the response. Anxiety can cause perceptual and cognitive decline, inhibiting our ability to perceive and evaluate information. Also, the brain is prone to selective inattention; when it tunes into something, it tends to tune out other things. By establishing and maintaining big picture awareness throughout any emergency operation, you can better ensure safety and effectiveness. Big picture awareness will come from effective incident oversight. From a self-defense perspective, effective incident oversight allows us to recognize emerging threats, anticipate them before they happen, possibly diffuse an escalating threat, or remove ourselves from a situation that is becoming dangerous.

From a tactical perspective, there are two types of personnel on an emergency scene: “task-dedicated” and “strategy-dedicated.” A task-dedicated individual has hands on the patient, the handline, and the tool and is inescapably prone to “tunnel vision.” Therefore, he cannot be expected to maintain big picture awareness. A strategy-dedicated person is “hands off”; he is ideally located remote from the operation, maintaining big picture awareness, and thinking two or three moves ahead. He is plan-dedicated and responsible for the overall cohesiveness of the response. He is also in the best position to recognize an emerging threat; give the order to withdraw when indicated; or coordinate a team-based response to violence, if necessary.

ESTABLISH A TACTICAL PLATFORM

“Standard precautions” is a well-known health care concept that defines the minimum safety precautions that you should apply to every patient regardless of appearance, race, gender, or age. In most cases, you cannot tell if a patient is a carrier of an infectious bloodborne disease just by looking at him. Standard precautions ask you to assume every patient is a potential carrier of a bloodborne disease. As a result, you should take minimum isolation precautions with every patient to reduce your vulnerability of exposure to infectious bloodborne agents. You can take this same concept and adapt it to self-defense.

During every initial citizen or patient interaction, take minimum tactical precautions-whether or not indications of violence are present-to reduce your vulnerability to a sudden attack. Understanding how and when you are vulnerable is essential to establishing a tactical platform for an effective response to violence.

Pressure Point Control Tactics (PPCT) Management Systems has developed a “survival reaction time model” that describes the steps involved with responding to a threat. It consists of the following four stages:

• Threat perception.
• Analysis and evaluation.
• Formulation of a response.
• Initiation of the appropriate motor action.

You must allow sufficient reaction time for this process to effectively occur. Also, a set of trained responses must be in place within your short-term memory for the quickest, most effective response. If any stage in this process breaks down, your response is likely to be prolonged and ineffective. If this seems like a fairly lengthy process, it is. As a martial artist, I know that if I am starting at square one during the initial phase of an attack, I will always be slower than my attacker. You cannot wait for an attack to occur and expect to react in sufficient time; it simply will not happen. You must be “primed” for motor initiation. Again, situational awareness, from a martial arts perspective, consists of anticipating an attack before it occurs and having a plan. This means that prior to an attack, if, while performing my duties, I briefly consider the possibility of a sudden attack and decide what my response to that attack will be, based on previous training, I will be “primed” for a motor response.

Ensuring you establish and maintain a substantial “reactionary gap” whenever possible is an essential part of a tactical platform. When an attacker does not have to take a step to reach you, there will not be sufficient time to respond. At a minimum, you should maintain a distance of six feet, when possible. (See the A/CME Minute instructional video “Reactionary Gap” at https://www.youtube.com/watch?v=QsKHJwqEhbQ.) Many times, this is not possible, such as when rendering medical care, in which case you must always avoid the inside position-the area between an individual’s shoulders. Ensure that you maintain outside position when taking a blood pressure, starting an IV, or conducting an interview. Outside position gives you a tactical advantage against a sudden attack. (See the A/CME Minute instructional video “Relative Positioning” at https://www.youtube.com/watch?v=GbQIFUp8GBs.)

USE OF FORCE

It may be difficult to discern one violent threat from another. To determine a “reasonable” response, understand how to evaluate a violent threat and determine its severity.

In general, you can place violence into one of the following three categories:

• Low-level threats. Includes facial expressions, body postures, hand positioning, gestures, and verbal threats that indicate aggression and possibly an impending attack.
• Moderate-level threats. Includes active aggression such as strikes, kicks, or any assault with “personal weapons” that are intended to harm the firefighter/EMT.
• High-level threats. Includes an attack that places the firefighter/EMT in fear of great bodily harm including an assault that could cause permanent injury, disfigurement, or death.

Remember, threat perceptions are subjective. A moderate-level threat for one firefighter may be perceived as a high-level threat for another. I have been kicked and punched more times than I can remember. For me, it is perfectly natural. For someone else, who may have no experience with self-defense, it may feel like a life-or-death situation.

Whenever evaluating a threat and attempting to determine the appropriate response, always consider common-sense variables such as your attacker’s age, gender, strength, and ability level; the number of attackers; the presence of a weapon; and the number of fire/EMS personnel on scene. For example, imagine you are cornered by a 100-pound, 80-year-old woman wielding a baseball bat; your threat evaluation would obviously be different than if it were a 220-pound, 20-year-old male in the same situation. As your perceived threat level changes, what is considered a reasonable response also changes.

PPCT is an international leader in legally acceptable use force training. It defines reasonable force based on the following four “Use of Force Justifications”:

• Was there a need for the application of force?
• Was the relationship between the resistance and level of force proportional?
• Was the extent of the subject’s injuries proportional to the subject’s level of resistance or threat to the firefighter/EMT or another?
• Was the force used in good faith, based on the perceptions of a reasonably trained person and objectively reasonable based on the facts the firefighter/EMT had at the time?

(See the A/CME Minute instructional video “Defending Self Defense” at https://www.youtube.com/watch?v=wG1_84oPA6c.)

CONTROLLED RESPONSES

Everything you do in the fire service is based on a process of evaluation. When following a threat evaluation, you must select the most appropriate response. Just as threat levels are placed into varying levels of severity, so are your responses to violent threats. A response option continuum is a system that helps emergency personnel select the most appropriate response to a perceived threat. It defines various levels of control including low-level responses such as a professional presence and verbal direction, moderate-level responses such as contact controls and compliance techniques, and high-level control techniques in response to active aggression and deadly force assaults.

A professional presence is one that expresses competence, confidence, and empathy verbally and nonverbally. When dealing with a potentially violent individual, it is important to strive to maintain a presence of “neutral authority.” I first learned this concept while working at a wolf rescue in Candy Kitchen, New Mexico. Wolves observe a strict adherence to pack hierarchy. As their caretakers, whether you like it or not, when you entered their pens to care for them, you were thrust into their pack dynamic. As caretakers, we strove to maintain a neutral presence, which meant we did not attempt to dominate them or allow ourselves to be dominated, as either extreme could lead to a dangerous escalation. I believe that same principle applies on an emergency scene. When confronted with an agitated or aggressive person, avoid attempts to dominate when possible, but do not appear submissive or fearful; either could lead to an attack.

During an emergency, ordinary people are often unexpectedly thrust into extraordinary circumstances for which they were not prepared. Whether dealing with a patient, a victim’s family, or a citizen who has just experienced a profound loss, empowering them with a sense of control when their world has been turned upside down may be extremely beneficial. Offering people choices under these circumstances may help to avoid violent escalations. Verbal direction should provide options and express a genuine concern for the people involved. In more extreme cases, it may involve just two options: the easy way or the hard way.

Contact controls and pain compliance techniques are not entirely new to us. It is amazing how an empathetic expression also provides a tactical platform to respond. Speaking with your hands, holding someone’s hand, or guiding them by the arm allows you to parry a blow or initiate a contact control quickly and effectively. Contact controls are also effective options when a single aggressor possesses a high pain threshold or you have sufficient personnel on-hand to initiate a coordinated, team-based response. Pain compliance consists of a series of controlled techniques that target peripheral nerve tissue to produce the desired response with limited to no long-term impact. The use of the stimulus pain is common practice in EMS; when confronted with an apparently unresponsive patient, we are taught to check for a pain response. When dealing with a violent aggressor, we use the stimulus pain to produce a desired response such as releasing his death grip on our partner’s hair.

Higher-level attacks require a higher level of control. When confronted with active aggression, you are justified in using a higher level of control. Targeting peripheral nerve tissue to stun or cause a motor dysfunction will give you sufficient time to escape or subdue your attacker, when appropriate. If confronted with lethal force, you are justified in using any means necessary to escape the encounter. If my partner was cornered by an attacker armed with a knife who, in my estimation, has demonstrated the ability and possessed the apparent intention of causing him serious bodily harm, I would be justified in using any means necessary to save my partner. (See the A/CME Minute Instructional Video “Basic Sidestep Parry” at https://www.youtube.com/watch?v=0OjTkE7K4D4.)

TRAINING REQUIRES MORE THAN JUST SHOWING UP

The essence of learning is the integration of new behaviors and perspective. Adaptation of new skills and perspective is only earned through many hours of disciplined training. To effectively execute a patient restraint procedure or a self-defense maneuver with proficiency, an ongoing commitment to training is required. Firefighter self-defense training should be facilitated by someone who is an experienced self-defense instructor and understands the unique challenges that firefighters and EMTs face.

A friend of mine summed up effective training when he said, “Amateurs train until they succeed. Professionals train until they cannot fail.” The essence of that statement was captured by Italian artist Michelangelo: “The greater danger for most of us lies not in setting our goals too high and falling short but setting them too low and hitting the mark.”

Training should help you to identify your limits and expand your capabilities. If you never traverse outside of your comfort zones, you will never truly realize what you are capable of. This is the essence of martial arts and firefighter training; it is why both traditions are what they are today. Violence is a real problem for the modern firefighter/EMT, and a commitment to comprehensive self-defense training at the hands of a qualified instructor is a big part of the solution.

A comprehensive policy regarding violence is necessary to establish a guide for self-defense training that deals with a full spectrum of threats. Policies that only address known threats or that solely rely on law enforcement are inadequate and are like trying to squash an elephant with a fly swatter. They simply do not prepare us for-or protect us from-the realties we face. Giving your personnel a fundamental understanding of self-defense will ultimately lead to better choices when confronted with violence. As a dear friend of mine says, “Hope is not a strategy.”

The ultimate self-defense goal for any martial artist is to anticipate the danger “waiting around the corner” and avoid it. For every firefighter and EMT, my goal is to do whatever I can to ensure you are “not there” when violence erupts.

Author’s note: Special thanks to Geoff Lassers, American CME, Anthony and Brenda Maltese, Robert Elizondo, “Little” Joe Ferrera, the White Lake Township Fire Department, and Oakland Community College.

REFERENCE

1. Violence Against Firefighters: Angels of Mercy Under Attack, 2006.

DAVID MILLS is a firefighter/paramedic and EMS I/C with the White Lake Township (MI) Fire Department. He is a 2nd Dan Traditional Taekwondo.

 

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