A Patient Problem or a Training Problem?

By Shawn Henners, Safety Officer, Montgomery County Hospital District

Montgomery County Hospital District (MCHD) provides indigent care, 911 EMS service, and public health for a county of about 500,000 residents, the 13th fastest growing county in the nation. On the EMS side, we have about 200 EMS field personnel, and in 2015 we ran just shy of 60,000 calls. 

In 2014, the Safety Committee noted that the number of reported employee injuries caused by “combative patients” was starting to rise. That year, 14 of our 44 (32%) employee injury reports identified “combative patient” as the immediate cause. One of those incidents aggravated a pre-existing back problem, effectively ending the career of one of our paramedics and costing over $100,000 in workers’ comp claims. 2015 was not very different – 12 of 52 (23%) employee injury reports identified “combative patient” as the immediate cause, including a concussion caused when a paramedic’s head was slammed against a cement floor. Thankfully, that employee recovered quickly and fully.

In May 2015, the Safety Committee considered several training solutions on the market, both nationally and locally. In the end, we chose DT4EMS (Defensive Tactics 4 Escaping Mitigating Surviving). We chose this particular solution because it was designed for EMS/fire, and includes training on the legal and ethical responsibilities to our patients (and how to recognize an attacker vs. a patient), how to de-escalate a situation by providing great customer service (a high value at MCHD), and finally, how to physically defend yourself from an attack while minimizing liability to the organization or individual. The class is a perfect combination of lecture & practical skills – it seems like you’re never in your seat for more than 30 minutes at a time.
We hosted a train-the-trainer in October 2015 and trained nine employees (plus one local firefighter). After a few months of planning and looking at policies and SOGs that might need to change to better align with the training, our in-house trainers trained EMS command staff and some of our training department in January 2016. Although some of them were rather skeptical at first of the need for training, by the end of the 16-hour class, they were 100% behind it. We will begin training our field crews in March, integrate the class as part of our new employee training plan in May, and plan to extend the training to our call-takers and dispatchers as soon as possible.

Future expansion also includes training other first responder organizations in our region, and providing an 8-hour class to all of our non-EMS staff. We will be tracking our injury rate as we roll this training out, and we expect to see a significant decrease in the number of injuries caused by aggressive patients. And although our customer satisfaction scores are consistently very high, we expect to see those improve, too. Our employees will have the training they need to stay safe, we will make better use of taxpayer money as our workers comp insurance premiums go down, and our patients and their families will receive the best pre-hospital care possible. It really is a win-win.

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