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ROLE OF EMS PROVIDERS
Many EMTs and paramedics are drawn to emergency medical services because of the opportunity to make a dramatic contribution to persons in need. With adrenaline pumping, we respond to the scene and get great satisfaction when the person in critical need receives medical care and improves during transport to the hospital. We become partners with emergency physicians and nurses in a daily struggle to save critically ill or injured patients. But beyond the excitement of the moment is a more sobering reality. As health care providers involved in our community, we must look beyond the occasional dramatic rescue. EMS professionals are often the first or only medical contact with an injured victim of domestic violence. In some rural communities, we may be the most sophisticated medical people available to identify or refer a victim of domestic violence. Emergency pre-hospital care providers may have a unique opportunities for intervention of domestic violence, specifically in the identification of abuse and referral to appropriate resources. Unfortunately, the majority of battered women who are treated by EMS providers are not identified as victims of domestic violence and thus, are offered no assistance or information to deal with a potentially life-threatening problem. In addition, EMS may be the only witness to the home environment. EMS identification of domestic violence can be the first step in interrupting the progression of violence and prevent the development of a variety of other complex problems. To do this, EMS providers need an understanding of the definition, extent, and nature of domestic violence.
Historically, health care providers have dealt with domestic violence by ignoring it. Health care providers may feel intimidated by the batterer and are reluctant to get involved. In a small community, we may know both the victim and perpetrator and feel intrusive if we say anything. We may feel this is a family issue, not a medical one. We may also feel frustration or disgust when we see the victim return to the batterer time and again. We may feel that there is little or no community support and that the health care system is ineffective if the legal system doesn’t back its efforts.
Efforts to address domestic violence will require multi-disciplinary collaboration. Initial steps can be very simple. Individuals can examine their own behavior and educate themselves and their friends on violence-related issues. Careful consideration can be given to the content and messages of movies and television. We can encourage youth to avoid violence as a response and teach young girls that violence against them is unacceptable. We can support shelters that help battered women and refer suspected victims of domestic violence to these support services. We can begin the empowerment of the victim by concluding that, “Domestic violence is such a serious health problem that I ask all my patients: Has someone you know caused these injuries?”
Despite the criminal nature of domestic violence and unlike abuse inflicted upon children, battered women are independent and fully capable of making decisions that best meet their needs. The goal for intervention is to empower women with information, resources, and support. The decision to call police or pursue legal action is a decision that rests with the battered woman alone. You may not be able to stop the violence within a relationship, but you can offer help. By heightening your own awareness and offering support services that may be available to the victim, you can acknowledge that she is not alone, that she does not deserve the violence, and that there are resources to help her when she decides to leave the batterer.
Do not judge the success of your intervention by the patient’s action. It may be frustrating to you when a patient stays in an abusive situation but that is her decision. Be assured: if you have acknowledged and validated her situation and offered her the appropriate referrals, you have done what you can to help.
RESPONDING TO A DOMESTIC VIOLENCE SCENE
Calls to domestic violence are considered among the most potentially dangerous of scenes. Law enforcement agencies dispatch multiple officers to answer domestic disturbances as a strategy to reduce the potential of danger. Law enforcement’s approach to domestic disturbances require heightened awareness to all possible clues, ranging from the initial assessment of bumper stickers on vehicles (for example, “This vehicle protected by Smith and Wesson”) to tricycles in the driveway (presence of children) to recommendations to avoid bedrooms (most typical room for accessible firearm) and kitchen (room where most anything can be used as a weapon).
Similar warnings are relevant for EMS personnel. For example, the initial call may just not sound right -- whether an “unknown” or 911 hang-up -- or the calling party denies calling EMS when you arrive at the door. These are clues and should be used as signals to heighten your awareness in responding to the scene. As you approach, look around the yard. Notice, which lights are on in the house. Wait and listen as you approach: do you hear yelling or sounds of a struggle?
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