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Improving EMS Response to Domestic 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 What We Want:

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improving ems response to domestic violence
Improving EMS Response to Domestic 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

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 violence
Definition of Domestic Violence
  • 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.

EMS Response to Domestic Violence

domestic violence occurs in all types of relationships and occurs across all demographics
Domestic violence occurs in all types of relationships and occurs across all demographics
  • 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

EMS Response to Domestic Violence

power and control wheel
Power and Control Wheel

Courtesy Domestic Abuse Intervention Project

Duluth, MN

maine coalition to end domestic violence mcedv
Maine Coalition to End 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 Response to Domestic Violence

ems 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

EMS Response

If dispatched as a domestic assault:

Are police on scene?

EMS Response to Domestic Violence

ems response8
EMS 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 Assessment
      • Patient Safety Assessment

EMS Response to Domestic Violence

scene safety assessment
Scene Safety Assessment
  • Presence and condition of children and pets
  • Evidence of:
    • Struggle
    • Weapons
    • Substance abuse
    • Attempts to conceal information

Upon approach, and entry look for:

EMS Response to Domestic Violence

scene safety assessment cont
911 hang-up or difficulty getting info from caller

History of suspicious calls

You are met at the door or denied entry by someone who says the victim is fine & doesn’t need medical care

Scene Safety Assessment (cont.)

Be particularly careful if:

EMS Response to Domestic Violence

scene safety assessment cont11
Scene Safety Assessment (cont.)
  • Don’t hesitate to return to ambulance to discuss options, notify police, or contact Medical Control.
  • Consider using cell phone vs. radio.

EMS Response to Domestic Violence

scene safety strategies
Identify yourself as EMS providers

Use team approach (never split the team)

Be aware of surroundings

Attempt to sequester patient

Scene Safety Strategies

If decision is to proceed:

EMS Response to Domestic Violence

scene safety strategies13
Avoid treating patient in bedroom or kitchen

Limit number of people present

Let occupants lead

Don’t be afraid to use the ambulance

Scene Safety Strategies

If decision is to proceed:

EMS Response to Domestic Violence

scene safety strategies cont
Scene Safety Strategies (cont.)
  • The abuser may view your presence as a threat. Remember to:
    • Avoid touching or crowding
    • Be non-threatening (non-judgmental)
    • Stay calm
    • Maintain a safe distance
primary health issues
Primary Health Issues
  • Keep in mind that medical issues are first priority.

EMS Response to Domestic Violence

behavioral cues
Is fearful or anxious around partner

Is reluctant to answer questions, provides conflicting information

Has delayed seeking medical help

Behavioral Cues

Observe if patient:

EMS Response to Domestic Violence

observe if partner or caregiver
Observe if partner or caregiver:
  • Is angry, belligerent or indifferent to patient’s needs
  • Refuses or hesitates to allow transport
  • Focuses on own minor health issues
  • Attempts to control patient’s

interaction with EMS

EMS Response to Domestic Violence

assessment cues
Has injuries during pregnancy

Has multiple, vague complaints

Provides inconsistent medical history

Assessment Cues

Observe if patient:

EMS Response to Domestic Violence

trauma assessment
Resulting from defensive action

In shape of objects

On areas normally hidden

On other victims (children, elderly, pets)

Trauma Assessment

Look for injuries:

EMS Response to Domestic Violence

medical assessment
Physical symptoms related to stress, anxiety, or depression

Persistent headaches

Chest, back, pelvic or abdominal pain

Exacerbated chronic illness (hypertension, diabetes, asthma, angina)

Substance abuse

Suicidal ideation

Medical Assessment

Potential medical complaints:

EMS Response to Domestic Violence

transport vs non transport
If patient accepts transport:

Consider advising hospital security

Explain medical consequences

Provide support & referral to a DV project

Transport vs. Non-Transport

EMS Response to Domestic Violence

transport vs non transport22
If patient declines transport:

Be non-judgmental

Provide first aid

Provide support & referral to a DV project

Document well

Transport vs. Non-Transport

EMS Response to Domestic Violence

crime scene considerations
Crime Scene Considerations
  • Minimize your effect on potential evidence
  • Advise police of injuries discovered during assessment of patient
  • Have all personnel use same entrance.
  • Tell police anything you witnessed (see, smell or hear) at the scene.
  • Provide police with contact information.

EMS Response to Domestic Violence

ask about abuse
Ask About Abuse

Keep in mind:

  • Ask patients in confidential settings
  • Be non-judgmental
  • Encourage & support

EMS Response to Domestic Violence

a sk direct questions
Ask 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…

EMS Response to Domestic Violence

a sk direct questions cont
Ask direct questions (cont.)
  • Getting a disclosure is not the objective:
  • Asking the question and offering resource information is the objective.

EMS Response to Domestic Violence

a sk direct questions cont27
Ask direct questions (cont.)
  • If the patient answers yes:
    • Listen and ask questions non-judgmentally
    • Validate their experience
    • Document their statements
  • If patient answers no, or will not discuss topic:
    • Be aware of physical, behavioral cues
    • Document inconsistencies
    • Make referrals discreetly

EMS Response to Domestic Violence

d ocumentation
Documentation
  • Write legibly and use quotation marks
  • Record 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.

EMS Response to Domestic Violence

d ocumentation cont
Documentation (cont.)
  • Your EMS report may be the only record of:
    • Inconsistencies in reporting
    • Delays in seeking treatment
    • Observations of environment
    • Statements made by patient and partner

EMS Response to Domestic Violence

d ocumentation cont30
Documentation (cont.)
  • Potential evidence preservation/collection:
    • Collect evidence such as ripped clothing or handful of hair
    • Explain options to patient re: use of evidence
    • Use paper bags for evidence collection
    • Describe shape, location of injuries

EMS Response to Domestic Violence

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

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?

EMS Response to Domestic Violence

r eview options offer referrals
Review Options, Offer Referrals
  • 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:

EMS Response to Domestic Violence

r eview options offer referrals cont
Review Options, Offer 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.

EMS Response to Domestic Violence

mandated reporting
Mandated 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 Services
  • Central Intake
  • 1-800-452-1999

EMS Response to Domestic Violence

however
However
  • 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 summary
In 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!

EMS Response to Domestic Violence

thank you
Thank you

EMS Response to Domestic Violence

handouts
Handouts
  • 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?