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Improving EMS Response to Domestic Violence

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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 ... – PowerPoint PPT presentation

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Title: Improving EMS Response to Domestic Violence


1
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
2
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

3
Definition of Domestic Violence
  • Domestic violence
  • Is a pattern of behavior (physical, sexual,
    verbal, emotional, financial, spiritual, etc.)
    used by one person to control anothers 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
4
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
5
Power and Control Wheel
Courtesy Domestic Abuse Intervention
Project Duluth, MN
6
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
  • Childrens Programs
  • Batterer Intervention Programs

EMS Response to Domestic Violence
7
EMS Response
If dispatched as a domestic assault Are police
on scene?
  • If no,
  • Stage and wait until police arrive and scene has
    been secured
  • If yes,
  • Stage and advise PD of your arrival
  • Enter only as directed by police

EMS Response to Domestic Violence
8
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
9
Scene Safety Assessment
Upon approach, and entry look for
  • Presence and condition of children and pets
  • Evidence of
  • Struggle
  • Weapons
  • Substance abuse
  • Attempts to conceal information

EMS Response to Domestic Violence
10
Scene Safety Assessment (cont.)
Be particularly careful if
  • 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 doesnt
    need medical care

EMS Response to Domestic Violence
11
Scene Safety Assessment (cont.)
  • Dont 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
12
Scene Safety Strategies
If decision is to proceed
  • Identify yourself as EMS providers
  • Use team approach (never split the team)
  • Be aware of surroundings
  • Attempt to sequester patient

EMS Response to Domestic Violence
13
Scene Safety Strategies
If decision is to proceed
  • Avoid treating patient in bedroom or kitchen
  • Limit number of people present
  • Let occupants lead
  • Dont be afraid to use the ambulance

EMS Response to Domestic Violence
14
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

15
Primary Health Issues
  • Keep in mind that medical issues are first
    priority.

EMS Response to Domestic Violence
16
Behavioral Cues
Observe if patient
  • Is fearful or anxious around partner
  • Is reluctant to answer questions, provides
    conflicting information
  • Has delayed seeking medical help

EMS Response to Domestic Violence
17
Observe if partner or caregiver
  • Is angry, belligerent or indifferent to patients
    needs
  • Refuses or hesitates to allow transport
  • Focuses on own minor health issues
  • Attempts to control patients
  • interaction with EMS

EMS Response to Domestic Violence
18
Assessment Cues
Observe if patient
  • Has injuries during pregnancy
  • Has multiple, vague complaints
  • Provides inconsistent medical history

EMS Response to Domestic Violence
19
Trauma Assessment
Look for injuries
  • Resulting from defensive action
  • In shape of objects
  • On areas normally hidden
  • On other victims (children, elderly, pets)

EMS Response to Domestic Violence
20
Medical Assessment
Potential medical complaints
  • 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

EMS Response to Domestic Violence
21
Transport vs. Non-Transport
  • If patient accepts transport
  • Consider advising hospital security
  • Explain medical consequences
  • Provide support referral to a DV project

EMS Response to Domestic Violence
22
Transport vs. Non-Transport
  • If patient declines transport
  • Be non-judgmental
  • Provide first aid
  • Provide support referral to a DV project
  • Document well

EMS Response to Domestic Violence
23
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
24
Ask About Abuse
  • Keep in mind
  • Ask patients in confidential settings
  • Be non-judgmental
  • Encourage support

EMS Response to Domestic Violence
25
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 womens
    lives, I ask about it routinely

EMS Response to Domestic Violence
26
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
27
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
28
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
29
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
30
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
31
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
32
Review Options, Offer Referrals
  • Things to say when making a referral
  • 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.

EMS Response to Domestic Violence
33
Review Options, Offer Referrals (cont.)
  • Additional helpful things to say to a victim
  • Im concerned for your safety and the safety of
    your children.
  • You do not deserve to be treated this way.
  • Im sorry this happened to you. How can I help?
  • Many people experience this. You are not alone.

EMS Response to Domestic Violence
34
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,
    anambulance attendant, emergency medical
    technicianhas 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 reportto 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
35
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.

36
In Summary
  • Victims know their situation best and can best
    evaluate their safety and the safety of their
    children.
  • An EMS providers role is to offer the patient
    medical treatment, options, support and referral
    information.
  • You can make a difference!

EMS Response to Domestic Violence
37
Thank you
EMS Response to Domestic Violence
38
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?
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