The tragic news over weekend of Kansas City Fire Department Firefighter/Paramedic Graham Hoffman being fatally stabbed by a patient during transport to a hospital undoubtedly caused every EMT and paramedic that has ever been in the back of an ambulance with a patient to stop and reflect.
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Our first thoughts are for the grief his family, friends and department are feeling. Too many of our colleagues are being injured or killed each year from either unsafe working conditions or patient violence.
Naturally our next thoughts turn to ways we can stay safe ourselves and limit these events in the future. No one comes to work thinking they could be hurt during the shift and our families all need us to come home at the end of the day.
This article is not a review of what happened to Graham Hoffman, and it is by no means a criticism of anything that KCFD or KCPD did or did not do during that call. It is simply an opportunity to reflect on steps we can take to hopefully prevent or limit these sorts of attacks in the future.
Top five safety practices to limit patient violence
As I think about this terrible event, a handful of safety tips pop into my mind. Riding in the back of an ambulance with a patient should feel like a safe place where EMTs and paramedics are helping people feel better, but unfortunately, it should also be thought of as a confined space where danger lurks. Just like the confined spaces of grain silos, collapsed buildings or underground utility tunnels, providers must be aware of the hazards and put measures in place to mitigate potential risks. These measures may not eliminate the danger, but they can decrease the chances of an incident happening and increase the ability of the provider to protect themselves if it does.
1. Wear personal protective equipment
When I started my career some 30 years ago, I never imagined the need for EMS providers to be required to wear gear to protect us from patient attacks, but that time is here. Many EMS agencies now offer ballistic vests to their crews to protect them from gunfire and stabbing attacks. Not all tactical gear protects from both types of threats, so you need to assess your risk and wear the appropriate equipment. Body armor manufacturers are now offering gear designed specifically for EMS.
2. Perform a safety assessment sweep
Checking a patient for weapons is certainly easier said than done, but it is worth considering. Can you conduct a quick sweep as part of your patient assessment? Even if they have a medical complaint or isolated injury, let the patient know that it is important you check for any injuries or pain they don鈥檛 even realize they have. Alternately, blame quality assurance requirements and tell the patient that your boss will get on you if you don鈥檛 do a head-to-toe assessment on everyone. I sneak a quick sweep in while helping the patient onto the cot, securing the cot belts and tucking in their blanket.
3. Keep your eyes on the patient
There are a myriad of tasks that demand our attention during transport and take our eyes off of the patient. Increasingly, one of the biggest distractions is the patient care report (PCR). This is especially true if you are in a busy system and don鈥檛 have much time between calls to complete a report. There is pressure on us to fill out the PCR completely and accurately, and there is no shortage of check boxes and blanks required for each and every patient, no matter how minor their complaint.
Being eyes down tapping on the tablet not only puts you at risk for missing changes in the patient鈥檚 condition, but also gives them an opportunity to unbuckle belts, wriggle out of limb restraints and move toward a door to jump from the moving ambulance or position themselves to initiate an attack.
4. Take extra crew members along for the ride
Having an extra crew member ride along with you in the back with the patient can be a big help in many ways. Not only will a would-be-attacker think twice before trying anything, but the partner can also keep their eyes on the patient while you focus on patient care, call the hospital or start your patient care report.
I can hear many of you saying, 鈥渨e don鈥檛 have the personnel in our service to do this,鈥� but maybe that is a change we need to make. If our services want us to provide better care and be safer, then we need to advocate for the help to do it.
5. Position yourself out of reach
Keeping yourself out of reach of the patient is another tip that sounds good on paper, but is pretty tough to do in reality. Undoubtedly, you will need to be alongside and sometimes even reaching over a patient to perform assessments, provide care and push buttons on the cardiac monitor. I recently found myself kneeling in front of an intoxicated and somewhat uncooperative patient, checking his distal CMS. Realizing how easy it would be for him to kick me right in the face, I kept my arm up to protect myself. Luckily, he didn鈥檛 take that opportunity.
Whenever possible, position yourself in a spot that would be awkward for the patient to reach. Unfortunately, it is difficult to keep your distance from the patient when sitting alongside the stretcher during transport, but if you have any inclination that the patient is not to be trusted, sit as far away as you can or choose to sit up in the captain鈥檚 chair.
MORE | Situational awareness: Your primary weapon in violence prevention
Watch out for each other
Finally, whatever the scenario is and the safety steps you are able to take, be sure to also be watching out for each other. Even if we wear different uniforms on scene, when it comes to getting the job done safely, we are all on one team.
Stay safe out there.
