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  3. EMS Preparedness for Tactical Violence Karen Wanger MDCM, FRCPC Regional Medical Director BC Ambulance Service CAEP 2009

  4. Disclosure • I do not have an affiliation (financial or otherwise) with any commercial organization that may have a direct or indirect connection to the content of my presentation. • And I am not Demi Moore...

  5. Learning objectives • Understand “tactical EMS” vs. “tactical EMS” • Learn what the perceived preparedness status is of front line responders in Canada

  6. Introduction • Paramedics are essentially the only medical personnel routinely at the scene of violent episodes • 8.5% of scenes are the result of some form of violence • Up to 90% of EMS staff report an episode of violence directed at them. CAEP 2009

  7. Tactical Violence • Defined as: • “the deployment of extreme violence in a non-random fashion so as to achieve a tactical or strategic goal” • Preparation for Tactical Violence is a routine part of training for police and military but not EMS CAEP 2009

  8. Tactical Violence • Tactical violence = multi agency approach • Targeted violence + law enforcement = change from “normal” EMS response mode • Safe and efficient functioning specific training including training with the other responding agencies. CAEP 2009

  9. Tactical Teams • A few • These teams are generally deployed in advance of a call when law enforcement is planning a tactical manoeuvre. CAEP 2009

  10. Tactical Violence • Violence that is “tactical” in nature employed by an outside “agency” as in terrorism would occur without warning. • The estimated time to scramble a specialist tactical team is roughly one hour • Front line paramedics would be required to manage the scene for that time. CAEP 2009

  11. Violence • Paramedics are experienced and well versed in dealing with interpersonal violence on calls. • Patient/patient or “perp”/patient. • Violence towards a paramedic is generally one-on-one from a patient and is understood by the paramedic CAEP 2009

  12. Tactical v. responders • A large component of “intentional/random” violence or violence directed towards responders changes everything. • Including subsequent processing. CAEP 2009

  13. Targeted tactical - management • Isreali paramedics approach tactical violence scenes differently from other MCI’s. It is understood that secondary devices aimed at responders are a reality. • Casualties are moved quickly and the scene emptied in minutes. CAEP 2009

  14. Are we prepared? • Survey of pre-hospital providers in BC and Ontario • January to June 2006 • Daniel Kollek and Michelle Welsford. • Addressed the self-reported training and readiness in the following areas: CAEP 2009

  15. Survey topics: • 1. Training for response to a tactical violence or terrorist scene; • 2. The level of comfort responding to a complex event (mass casualty, violent, etc); • 3. The level of comfort in detecting and dealing with the emotional impact of providing care; • 4. The added emotional impact caused by violence, clinical load, and child injuries at the event scene. CAEP 2009

  16. Topics and Methodology • Emotional impact was assessed by grading response to a variety of scenarios including violence and tactical violence, and the presence of combinations of adult and paediatric victims. CAEP 2009

  17. Population • Ontario and BC paramedics and first responders • Posted on a website only accessible by individuals knowing its complex address. • Invitation by email and poster in Ontario • In BC email invitations to paramedics through BC Ambulance. FR’s invited via FCABC distribution. CAEP 2009

  18. Survey questions • 3 basic areas: 1) Scenarios – quantify degree of distress 1 (“not distressing to any significant degree”) to 5(“distressing to the degree that you would not be able to deliver care”) CAEP 2009

  19. Survey questions • 2) Report degree of training and comfort in responding to the following events: • Fire • Response to an unstable building • Response to a terror event • Response requiring use of elevated PPE • Response to a tactical violence situation CAEP 2009

  20. Survey questions • 3) Ability to recognize emotional distress in self or partner and comfort with CISD CAEP 2009

  21. Results • 1028 respondents • Mostly male (75%) • Mostly PCP (55%) • Age 36-50 (48%) • Wide range of years of experience • Predominantly front line personnel CAEP 2009

  22. Results - training • Regarding “procedures to follow in responding to a tactical violence scene where there my be further violence” 77% of 876 respondent stated they had received no training. • 92% of 289 respondents stated police to be in control of site access in a tactical violence situation but 4.5% “did not know” who would be in control of the scene. CAEP 2009

  23. Results - training • “...trained to function under conditions of tactical violence”. 89% of 288 respondents – “never” (46%) or “>1yr” • Only 27% of 291 respondents had “..any field exercise with other (non-medical) first responders”. 37% had exercised more than 1 year ago and 36% “never” CAEP 2009

  24. Results – emotional impact CAEP 2009

  25. Results – emotional impact CAEP 2009

  26. Comfort levels – event response CAEP 2009

  27. Comfort level – distress recognition CAEP 2009

  28. Comfort level - support CAEP 2009

  29. Progress • MCI training • Awareness training

  30. Discussion • Targeted tactical violence is a reality • Some paramedics are trained to back up police in tactical situations organized and controlled by PD • A paucity of front line paramedics are trained to respond in a situation of tactical violence targeted at first responding crews. Some don’t even know who would be in charge. CAEP 2009

  31. Discussion • Even the “lesser” of the factors in the scenarios more than doubled the emotional impact of the event as rated. • These factors are not unusual (child injury, assault, etc) • Emotional self care is not part of standard training for paramedics CAEP 2009

  32. Discussion • Monitoring for psychological impact is not routinely carried out although some services have implemented post incident debriefing. • 97% of respondents admitted to occasional unwanted memories of distressing events with 31% stating it would take up to a week to process the event and 15% stated they did not think they would “ever get over witnessing such an event” • 26% stated they would process the event immediately and it would not bother them for any significant length of time. CAEP 2009

  33. Tema Conter Foundation CAEP 2009

  34. Conclusions • Inadequate numbers of EMS personnel are prepared to function at a scene of terror or tactical violence directed at responders. Awareness and education should be provided • The emotional effect on paramedics of violence requires greater attention

  35. Thank you for your attention