Getting off the X is a phrase used in the Tactical Emergency Casualty Care course that defines casualties and caregivers that are in the Hot Zone and exposed to life-threatening harm from the danger the situation poses. The goal is to get off the X as soon as possible. This past week provided two vivid on-the-X situations: an active shooter and a raging firestorm. Every week a crew that is operating at a routine incident suddenly finds themselves in a Hot Zone because of a new player or situation, most of these encounters do not make the news.

Do ems caregivers and firefighters “Run, Hide or Fight” when they are suddenly in a Hot Zone?

Discovering a propane tank shooting a tongue of flame from its relief valve while searching at a structure fire is probably a Run response. So is meeting the occupant of an apartment who aims a gun at you and orders you to leave. Or, in the case of Chicago Ambulance 75 last May, a crowd of relatives banging on the back of the ambulance. followed by gunfire.

But what do you do when you have placed the patient on the stretcher and a “cousin” shows up and threatens violence to the patient or the responders? An inner-city fire-based ambulance crew had the experience of a “cousin” coming up as the ambulance was about to close the rear doors of the rig and shoot the patient. The paramedic sitting in the captain’s chair felt a slug impact the seat frame between her legs. 

In 2015 a Detroit ambulance crew was attacked and severely injured by the companion of a patient. In May 2018, the Seattle Fire Department added a fire company to respond with an ambulance in the Pioneer Square community that includes shelters, camps, and a large homeless population. They are also acquiring ballistic vests and getting de-escalation training.

Kip Teitsort founder of DT4EMS provides this video “EMS/Fire Assault Compilation 4.17″ (use this link) 

What can you do?

Make a police report on every incident. Press charges. The literature indicates that most assaults against ems caregivers and firefighters are not reported or entered into the criminal justice system. We should follow Australia’s approach of reporting and prosecuting every incident.

Get trained to defend yourself from attack.

Improve your individual situational awareness and “street smarts”

Make changes in how your agency identifies and responds to calls in high-risk areas. Consider the use of body cams to document these encounters.

Establish a “may-day” response for crews in trouble.

Identify hot spots where the chance of assault is higher due to the community or activities within the community. For example, the London Ambulance Service sees a jump in assaults on ambulance staff during holidays where hundreds of drunk revelers stress the West End ambulance service with up to 300 calls an hour during the Christmas holiday.

In some states, we need to elevate the consequences of attacks on ems caregivers and firefighters to match the consequences from attacks on law enforcement officers.

Continue to work with fellow emergency service responders to provide a coordinated and integrated response to the no-notice violent situation, small and big.

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Dunne, Robert (2017 August) Detroit Fire Department Addresses Violence Against EMS Providers Following Attack. Journal of Emergency Medical Services  (42) 8 (graphic clinical pictures)

Scott, Hanna (2018 June 26) After  close call, Seattle Fire isn’t taking any chances in Pioneer Square. MyNorthwest.

Scott, Hanna (2018 June 28) Threats to firefighters in Pioneer Square, homeless camps escalating. MyNorthwest.