or Contact Promed of Muskegon at:Office: (231) 720-1804
Baker College Flint MI 313-767-7600
Great Lakes Jr. College of Business
320 South Washington Avenue
Saginaw, MI 48607-1158
517-755-3457
Westshore Community College
3000 North Stiles Road
Scottville, MI 49454-9716
616-845-6211
Montcalm Community College
2800 College Drive Southwest
Sidney, MI 48885-0300
517-328-1250
Macomb Community College
14500 East Twelve Mile Road
Warren, MI 48093-3896
313-445-7999
Emergency Education, Inc.
38140 Executive Drive North
Westland, MI 48185
313-326-0920
EMS PROGRAMS LOCATED IN THE STATE OF MICHIGAN
DOMESTIC VIOLENCE FACTS AND FIGURES
This page was last updated: March 22, 2008
DAVES EMS HEADQUARTERS
EMS ISSUES
MARCH 22, 2008
Today another woman died and not on a foreign field and not with a rifle strapped to her back, and not with a large defense of tanks rumbling and rolling behind her.
She died without CNN, & Fox covering her war.
She died without talk of intelligent bombs and strategic targets
The target was simply her face, her back her pregnant belly.
The target was her precious flesh that was once composed like music in her mother’s body and sung in the anthem of birth.
The target was this life
that had lived its own dear wildness, had been loved and not loved, had danced and not danced.
A life like yours or mine
that had stumbled up
from a beginning
and had learned to walk
and had learned to read.
and had learned to sing.
Another woman died today.
not far from where you live;
Just there, next door where the tall light falls across the pavement.
Just there, a few steps away
where you’ve often heard shouting,
Another woman died today.
She was the same girl
her mother used to kiss;
the same child you dreamed
beside in school.
The same baby her parents
walked in the night with
and listened and listened and listened For her cries even while they slept.
And someone has confused his rage with this woman’s only life.
Anatomy of Domestic Abuse Include:
Name-calling or putdowns
Keeping a partner from contacting their family or friends
Withholding money
Stopping a partner from getting or keeping a job
Actual or threatened physical harm
Sexual assault
Stalking
Intimidation
ANYONE CAN BE A VICTIM!
Victims can be of any age, sex, race, culture, religion, education, employment or marital status. Although both men and women can be abused, most victims are women. Children in homes where there is domestic violence are more likely to be abused and/or neglected. Most children in these homes know about the violence. Even if a child is not physically harmed, they may have emotional and behavior problems.
COMMON MYTHS AND
WHY THEY ARE WRONG
Domestic violence is not a problem in my community
Domestic violence only happens to poor women and women of color.
Some people deserve to be hit
Alcohol, drug abuse, stress, and mental illness cause domestic violence.
Domestic violence is a personal problem between a husband and a wife.
If it were that bad, she would just leave.
Guidelines for the Role of EMS Personnel in Domestic Violence
Domestic Violence is also known as partner abuse, spouse abuse and battering. It is part of a larger spectrum of family violence, which also includes sexual assault, child and elder abuse and neglect. It is estimated that 8-12 million women in the United States are at risk for abuse from a current or former partner. The FBI estimates that a woman is battered every 5-15 seconds. Prehospital providers encounter the victims of Domestic Assaults and must be aware of the unique problems inherent to this abuse. Initial and continuing education programs for emergency medical services (EMS) personnel must incorporate information about domestic violence, including identification of victims, special aspects of care, scene safety and documentation requirements. EMS Personnel must also be aware that in 95% of domestic assaults the perpetrator is a man. However, it should be remembered that men can also be victims of domestic violence.
SIGNS OF ABUSE: Domestic violence crosses all boundaries, including those of age, race, education, socioeconomic class and sexual orientation. Frequently the victim will not admit to being abused, and this seems to be more true of middle class homes. Abuse should be suspected when the injuries sustained do not fit the history, and when patients seem ashamed or embarrassed about their injuries. Accidental injuries tend to involve the extremities and periphery of the body, whereas injuries from domestic violence tend to involve contusions and lacerations of the face, head, neck, breast and abdomen. The perpetrator is often unwilling to allow the victim to give a history or allow the victim to be alone with the EMS personnel. Excessive delays between injury and seeking treatment, repeated use of EMS services, injuries during pregnancy, substance abuse, and frequent suicide gestures are also hallmarks of domestic violence. Any of these conditions should lead EMS personnel to suspect abuse and respond accordingly.
Treating The Victim: Physical injuries need to be cared for according to standard practice protocols. However, special attention should be directed toward the emotional needs of the victim. Domestic Violence tends to follow a cycle of three phases. Phase one is comprised of arguing and verbal abuse, phase two progresses to physical and sexual abuse, and phase three consists of denial and apologies. The last phase is often referred to as a "honeymoon phase". Intervention is best accomplished in phase two or three. Without intervention the cycle repeats itself, usually increasing in frequency and severity. EMS personnel must understand this cycle of violence in order to adequately assess the situation and care for the victim. They must understand that victims of abuse feel ashamed, humiliated and responsible for the violence. EMS personnel need to see that by treating a victim in a respectful, sensitive and sympathetic manner, by confirming that the victim is not at fault and does not deserve to be abused, and by ensuring the victim safety, they will become agents of change in helping to give the support needed to eventually leave the abusive environment. If the patient elects not to be transported to an emergency department, prehospital providers should have a written list of community resources, including shelters and hot-line numbers, which can be left with the victim.
SCENE SAFETY:Police officers state that scenes of domestic violence are one of the most dangerous calls to which they respond. This is no less true for EMS personnel. If it is known from dispatch information that the scene is one of domestic violence, law enforcement should be summoned and EMS personnel should not enter the scene until it has been "secured" by the police. . If domestic violence is not suspected until after arrival, the victim should be removed from the scene as quickly as possible. The victim and the perpetrator should be treated in a neutral and non-judgmental manner. No questions regarding possible violence, and no display of sympathy should be made until after the victim is in the ambulance and away from the perpetrator. Violence may be directed toward the EMS personnel, particularly if the perpetrator perceives that too much empathy is being directed toward the victim. It should be remembered that there is no safety in numbers, that no scene is ever "secure", and that removal of the victim is the surest way to provide safety for all. Training is essential for EMS Personnel and is needed in dealing with aspects of domestic violence, These educational programs should include scene assessment, management of violence, management of the scene and self-defense techniques for the EMS Personnel. The Federal Goverment and Several States have and continue to enact "PROTECTIVE," Legislation establishing harsher penalties for any assault on a Emergency Medical Technician.
THE PUBLIC NEEDS TO SUPPORT AND PUSH FOR MORE LEGISLATIONS.
DOCUMENTATION:Domestic violence is a crime. Therefore, the scene must be treated as a crime scene, and standard precautions regarding preservation of evidence should be exercised. Training in these techniques by law enforcement personnel is beneficial. Documentation should be comprehensive and exact. History obtained from the victim, alleged perpetrator and witnesses should be documented in written reports. The victims own words should be used. recording of injuries should be made, including type, number, size, location and explanations given a reported mechanism. Use the body diagrams on the EMS Report. Document the behavior of your victim and the "alleged perpetrator," do not accuse in your report remember that it may be used in court, it is a legal document, all of this is necessary should the case go to court. Document the names of law enforcement officers present should also be noted on the prehospital report.
REPORTING: Many States do not have mandatory reporting requirements for domestic violence. In fact it is not clear if mandatory reporting ensures or diminishes the safety of adult victims. However, it is important for EMS personnel to inform the receiving hospital of suspicions and observations. Such information should also be carefully documented in the EMS Run Form. EMS personnel must be familiarized with thier State Domestic Abuse reporting requirements. Keep in mind Child abuse and suspected Child Abuse MUST Documented and REPORTED.
DomesticViolence has reached epidemic proportions and EMS personnel will be called upon to evaluate and manage victims. EMS personnel must be educated in the cycle of domestic violence, special aspects of care, scene and medic safety as well as documentation requirements. This should be part of initial and continuing educational programs.
National Domestic ViolenceHotline (USA)
1-800-799-SAFE (7233)
1-800-787-3224 (TDD)
Are you or someone you know, being emotionally or physically abused? Advocates at the National Domestic Violence Hotline urge you to call, day or night. Toll free, above.
You Can Help.
Domestic violence is found in every community. As an EMS provider you probably have already responded to a call that involved domestic violence. It's important for you to know how to keep yourself safe. It's also important to know that there are many reasons a victim cannot leave a dangerous situation. But when the victim does decide to leave, he or she needs to know there is a well-defined support system ready to help. You can be part of this support system and can help victims who are ready for help, find the support they need.
PLEASE
PLEASE
EMS SAFETY AT SCENES OF DOMESTIC VIOLENCE
Enroute to Call
1.) Have police been dispatched? How far away are they?
2.) Have there been comparable calls to this residence in the past?
3.) Are both you and your partner prepared and equipped for this call?
Preparation includes not only equipment, but also mental and emotional preparedness. Have you and your partner practiced
what to do in potentially dangerous scenes? Approach of the scene with extreme caution.
Approaching the Scene
1. Approach with your sirens and lights off. Stop your vehicle a half mile from the
scene to gather additional clues before stepping from your rig.
2. What clues are evident before stepping out of your rig:
a. Are there items in the yard or driveway that indicate children might be present?
b. Are there any indications that firearms may be present at this residence (e.g.,
c. gun rack or bumper stickers on a vehicle)?
d. If at night, what lights are on in the house?
3. Is your vehicle parked so that an escape route is available if needed?
4. What is the level of noise at the residence? Is there yelling, screaming, or sounds of
struggle?
Entry into the residence
1. Don’t stand in front of the open door. As you enter a room, turn on the lights. Leave lights on in every room if possible.
2. Are there indications of alcohol or drug use at this residence?
3 Visually frisk everyone for possible weapons when you enter.
4.Identify how many people are in the residence and where they are located. Are there
neighbors that could be asked to leave. The less people, the better. Never walk
down a hallway with someone behind you. Let them lead.
5. If at all possible, do not work on people in kitchens or bedrooms:
a. Kitchens have numerous and a variety of weapons, including knives,
heavy cooking pots, boiling water, glassware.
b. Bedrooms usually do not have an exit or escape route. Many people
keep concealed, loaded handguns in the bedroom. Finally, if the
perpetrator has jealous nature, the bedroom may be viewed as an
intimate and therefore; threatening place.
6. Do not assume that just because the offender has been arrested at the scene, that the
situation is under control. The victim or members of the family, even children, have
been known to assault police and EMS personnel. Always stay alert!
7. Keep your partner in sight at all times.
8. Maintain link with your dispatch or communication system.
9. Determine location and condition of victim, and separate suspect and perpetrator, if
still at scene. Interview victim and any witnesses separately, especially if both are
injured.
10. Keep your exit path open at all times.
HHS GUIDANCE ON PATIENT'S PRIVACY PROTECTIONS:
PROTECTING THE PRIVACY OF PATIENTS' HEALTH INFORMATION
Overview: The first-ever federal privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers took effect on April 14, 2003. Developed by the Department of Health and Human Services (HHS), these new standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed. They represent a uniform, federal floor of privacy protections for consumers across the country. State laws providing additional protections to consumers are not affected by this new rule.
Congress called on HHS to issue patient privacy protections as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA included provisions designed to encourage electronic transactions and also required new safeguards to protect the security and confidentiality of health information. The final regulation covers health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions (e.g., enrollment, billing and eligibility verification) electronically. Most health insurers, pharmacies, doctors and other health care providers were required to comply with these federal standards began on April 14, 2003. Common questions about the rule, as well as explanations and descriptions about key elements of the rule and are available at: http://www.hhs.gov/ocr/hipaa.
PATIENT PROTECTIONS:The privacy regulations ensure a national floor of privacy protections for patients by limiting the ways that health plans, pharmacies, hospitals and other covered entities can use patients' personal medical information. The regulations protect medical records and other individually identifiable health information, whether it is on paper, in computers or communicated orally.
Key provisions of the new standards include:Access to Medical Records. Patients generally should be able to see and obtain copies of their medical records and request corrections if they identify errors and mistakes. Health plans, doctors, hospitals, clinics, nursing homes and other covered entities generally should provide access these records within 30 days and may charge patients for the cost of copying and sending the records.
Limits on Use of Personal Medical Information.The privacy rule sets limits on how health plans and covered providers may use individually identifiable health information. To promote the best quality care for patients, the rule does not restrict the ability of doctors, nurses and other providers to share information needed to treat their patients. In other situations, though, personal health information generally may not be used for purposes not related to health care, and covered entities may use or share only the minimum amount of protected information needed for a particular purpose. In addition, patients would have to sign a specific authorization before a covered entity could release their medical information to a life insurer, a bank, a marketing firm or another outside business for purposes not related to their health care.
Confidential communications.Under the privacy rule, patients can request that their doctors, health plans and other covered entities take reasonable steps to ensure that their communications with the patient are confidential. For example, a patient could ask a doctor to call his or her office rather than home, and the doctor's office should comply with that request if it can be reasonably accommodated.
Complaints. Consumers may file a formal complaint regarding the privacy practices of a covered health plan or provider. Such complaints can be made directly to the covered provider or health plan or to HHS' Office for Civil Rights (OCR), which is charged with investigating complaints and enforcing the privacy regulation. Information about filing complaints should be included in each covered entity's notice of privacy practices. Consumers can find out more information about filing a complaint at http://www.hhs.gov/ocr/hipaa or by calling (866) 627-7748.
The First organized Ambulance Service in the United States was started in Cincinnati in 1865 by the Cincinnati General Hospital.
The father of Modern EMS (In the mid-1950s) was J.D. "Deke" Farrington, MD, FACS. Dr. Farrington and Dr. Sam Banks developed in the mid 1960's a trauma training school for the Chicago Fire Department that served as the prototype of what later became the first EMT-Ambulance (EMT-A) training program.
The six points of the star were named by Leo Schwartz in the seventies, Schwartz was the Director of the U.S. D.O.T.
A new EMS act was passed in 1976 that gave money and responsibility to the U.S. Department of Health, Education, and Welfare. Chicago trauma surgeon David Boyd led this enactment, which resulted in the development of state and local EMS regions throughout the United States.
NEWNAVIGATION MENU 02-2008
Are all ambulance services the same?
No. Some are private providers, some are housed in fire departments, some are connected to another service like a hospital, some are run by municipal government. No studies have been done that show whether one type of service is more effective than another.
Though titles vary from state to state, typically the beginning level is made up of first responders who have basic first aid and emergency training.
Basic emergency medical technicians, or EMT’s, typically have about 150 hours of training that allows them to administer oxygen, treat wounds and immobilize spines. Advanced training might allow them to administer IV fluids, intubate patients and monitor heart conditions.
Paramedics would have an additional 1,200 hours of training and be qualified to do a number of more aggressive treatments and administer drugs.
Michigan has 389 first response services, which aren't allowed to transport patients but can help until an ambulance arrives; 175 basic life support services, which must have at least one EMT and one first responder on board an ambulance; 20 limited advanced life support services, which have at least one basic EMT and one EMT with advanced training; and 172 advanced life support services, which have at least one paramedic and one EMT.
What's the difference between an emergency medical technician and a paramedic?
Do companies hire people just to drive ambulances?
No. That job category was phased out years ago. Now, everyone on board has to be at least an EMT.
Are all ambulances the same?
No. One type is a conversion truck cab and chassis with a separated box and cab. Another is a van type with integrated cab and body. A third type is a cutaway van with an integrated cab and body. There is not enough in-depth analysis of ambulance crashes to know whether one kind holds up better in a crash.
What Type of Abuse?
Battering is a pattern of behavior used to establish power and control over another person through fear and intimidation, often including the threat or use of violence. Battering happens when one person believes they are entitled to control another. Assault, battering and domestic violence are crimes.
Definitions:Abuse of family members can take many forms. Battering may include emotional abuse, economic abuse, sexual abuse, using children, threats, using male privilege, intimidation, isolation, and a variety of other behaviors used to maintain fear, intimidation and power. In all cultures, the perpetrators are most commonly the men of the family. Women are most commonly the victims of violence. Elder and child abuse are also prevalent. Acts of domestic violence generally fall into one or more of the following categories:
Physical Battering:The abuser’s physical attacks or aggressive behavior can range from bruising to murder. It often begins with what is excused as trivial contacts which escalate into more frequent and serious attacks.
Sexual Abuse - Physical attack by the abuser is often accompanied by, or culminates in, sexual violence wherein the woman is forced to have sexual intercourse with her abuser or take part in unwanted sexual activity.
Psychological Battering -The abuser’s psychological or mental violence can include constant verbal abuse, harassment, excessive possessiveness, isolating the woman from friends and family, deprivation of physical and economic resources, and destruction of personal property.
Battering escalates. It often begins with behaviors like threats, name calling, violence in her presence (such as punching a fist through a wall), and/or damage to objects or pets. It may escalate to restraining, pushing, slapping, and/or pinching. The battering may include punching, kicking, biting, sexual assault, tripping, throwing. Finally, it may become life-threatening with serious behaviors such as choking, breaking bones, or the use of weapons.
Rural and urban women of all religious, ethnic, economic, educational backgrounds, of varying ages, physical abilities, and lifestyles can be affected by domestic violence. There is not a "typical woman who will be battered." The risk factor is being born female. Over 50% of all women will experience physical violence in an intimate relationship, and for 24-30% of those women the battering will be regular and on-going. Every 15 seconds a domestic instance occurs.
Are you a Victim of Domestic Violence?
Does your partner
Embarrass or make fun of you in front of your friends or family?
Put down your accomplishments or goals?
Make you feel like you are unable to make decisions?
Use intimidation or threats to gain compliance?
Tell you that you are nothing without them?
Treat you roughly - grab, push, pinch, shove or hit you?
Call you several times a night or show up to make sure you are where you said you would be?
Use drugs or alcohol as an excuse for saying hurtful things or abusing you?
Blame you for how they feel or act?
Pressure you sexually for things you aren’t ready for?
Make you feel like there "is no way out" of the relationship?
Prevent you from doing things you want - like spending time with your friends or family?
Try to keep you from leaving after a fight or leave you somewhere after a fight to "teach you a lesson"?
Men can also be victims of Domestic Vioelnce
CALLING 911 CRITICAL ISSUES
You, as the 911 caller, are a vital link within the EMS system. The information you provide the dispatch operator helps EMS help you. The following lists the guidelines for communicating the 911 call:
• Try to remain calm — emotions can deter effective communications.
• Speak slowly, deliberately.
• Respond to all questions presented by the dispatch operator.
• Give a brief, concise description of the emergency, including: the nature of the illness, for example, chest pain with difficult breathing; the mechanism causing the injury, for example, a fall from a 6-foot ladder; the number of patients involved and the types of treatment being rendered by bystanders or first responders.
• Know the complete residential or business address, including street number and community, especially if you are calling from a cellular phone.
• Assist emergency response to the address by ensuring the house number is visible from the street and turning on porch lights. You might send a bystander to meet the ambulance.
• Do not hang up until directed by the dispatch operator.
Deciding to become apart of an EMS workforce is a life changing decision. You must take into consideration many factors that will hamper your efforts and ability to perform your duties both professionally and correctly. The violence against emergency workers continues to alarmingly rate. Over the past several years EMT's and Paramedics have become targets in both urban and rural areas. EMS personnel frequently enter inner city war zones daily and face many various kinds of dangers such as assaults, shootings, and stabbings.
Gangs frequently associated with large cities, have today branched out into suburbs and small towns selling illicit drugs that have caused EMS personnel who responded to overdose calla and to be find themselves under physical attacks without provocation.
Recently EMS personnel have been ambushed or have come under fire after arriving on scene. EMS personnel are finding themselves in the middle of scenes the rapidly turn violent and find themselves in the middle of physical danger. EMT’s and Paramedics have found themselves in a quagmire as they are unarmed, and God forbid they attempt to defend themselves from an attack.
EMS Agencies have disciplined suspended and fired EMT’s and Paramedics because they have defending themselves. Patients, who have attacked EMS personnel, have turned around and filed suit or have sworn out criminal complaints because a medic choose to protect themselves from injury or death. Liability Attorneys attempt to line their pockets with money after medics have been forced to protect themselves and remember that EMS Personnel make between 10.00 to 14.00 hour where there actions save lives compared to EMS providers directors Agencies factory workers and EMS agencies.
EMT's and other EMS personnel put their lives in direct jeopardy to perform their jobs. Besides rioting and gang violence, EMS personnel are often faced with other more maniacal acts of violence, such as domestic terrorism.
An important part of EMS training is learning how to cope with the stresses of the job. In order to be a success as an EMT, it is recommended the EMT learn how to cope with the disaster or emergency. The EMT must learn how to cope with the stress. Counseling is usually effective to resolve emotional issues associated with stress. Another form of stress management is building a strong support system and support groups. Untreated stress can lead to psychological deterioration. In addition, if the stress is left untreated, the stress may also lead to the deterioration of one's effectiveness to perform the job.
EMT's contribute unique capabilities, perspectives and experiences to every individual emergency response. The purpose of the EMT and EMS personnel is to provide optimal, acute health care. Each day presents many physical and mental challenges. To be effective as an EMT, occasionally you must reflect on your past performances. You can step back and say to yourself, I've been hurt too much by what I've done and seen and I cannot do my job anymore. Conversely, you can put those feelings aside, re-dedicate yourself to your profession and begin each day anew. One must always keep in mind the life you save may turn out to be the life of a future world leader, astronaut or scientist.
Deciding to become a part of EMS Considerations to Think About
EMT & Paramedic Job Description
People's lives often depend on the quick reaction and competent care of emergency medical technicians (EMT’s) and paramedics, EMT’s with additional advanced training to perform more difficult pre-hospital medical procedures. Incidents as varied as automobile accidents, heart attacks, drowning, childbirth, and gunshot wounds all require immediate medical attention. EMT’s and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.
Depending on the nature of the emergency, EMT’s and paramedics typically are dispatched to the scene by a 911 operator and often work with police and fire department personnel. Once they arrive, they determine the nature and extent of the patient's condition while trying to ascertain whether the patient has preexisting medical problems. Following strict rules and guidelines, they give appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients with minor injuries on the scene of an accident or at their home without transporting them to a medical facility. Emergency treatments for more complicated problems are carried out under the direction of medical doctors by radio preceding or during transport.
EMT’s and paramedics may use special equipment such as backboards to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. Usually, one EMT or paramedic drives while the other monitors the patient's vital signs and gives additional care as needed. EMT’s also work as flight crew’s of helicopters that transport critically ill or injured patients to hospita
