collected the stories of countless responders, including his own experience of having
his ambulance hijacked while he was caring
for a patient. He continues to improve the
DT4EMS training program based on these
Teitsort explains that a key part of the
success of the program is helping respond-
ers to “overcome the culture of
He reminds trainees that violence
isn’t socially acceptable in public places,
and it shouldn’t be acceptable in an
EMS rig or in an ED. This is a mes-
sage engrained more easily in new
medics, who haven’t yet developed the
“emotional armor” of seasoned medics,
who have many barriers to break down
before they can be effectively trained.
Taking advantage of a “train the
trainer” component of DT4EMS training
allowed for every medic that provides emergency medical support for the city of Detroit,
including those with private EMS agencies, to
be trained between February and April 2016.
Equipment was purchased to support ongoing training and the course was subsequently
added to the curriculum taught at the Detroit
The training center now has a cadre of
instructors for the program and all new employees receive this instruction. Psychological first
aid training is also provided and the department expanded on-call peer counseling services.
Sean Larkins, Detroit EMS superintendent,
is impressed with the results of the training.
“Our staff learned how to really talk to people,”
he said—something that’s not well covered in
Emergency responders in Detroit see horrific crimes and often care for severely injured
or neglected humans and animals. These experiences have an undeniable effect on daily life.
Physical well-being is of the utmost importance, and mental health also plays a part. Counseling is an ongoing need, as post-traumatic
stress disorder often goes undiagnosed in field
emergency workers. It can manifest as anger and
is often written off. There’s a need for forums
where experienced providers can share both
their frustrations and wisdom.
Detroit has begun to identify high-risk locations by coordinating police and fire/EMS data.
These are areas of the city where a history of
violence demands a tailored response, where
EMS providers must often wait for a scene
to be fully secured. But even calls that appear
generally safe require vigilant providers, as any
scene can go bad. To address this, the city has
now instituted policies to track police response
to medic requests.
In May 2017, the Detroit City Council approved the purchase of body armor for
all response personnel. However, additional
self-defense strategies are needed when vests
fail to protect them; often the only ally during
an attack is a partner. It’s imperative to train
providers in de-escalation techniques as well as
methods for disengaging and escaping safely.
Some support the use of other, non-lethal
self-defense tools, including energy weapons,
collapsible batons and chemical irritants; how-
ever, to date there’s no consensus on the effi-
cacy of these tools.
On Oct. 23, 2015, Michael Montgomery was
charged with two counts of assault with intent
to murder, two counts of assault with
intent to do great bodily harm, one
count of assault with intent to maim,
and one count of resisting and obstructing causing serious injury. Evidence
linked Montgomery to older crimes
including two counts of first-degree
criminal sexual conduct, kidnapping,
torture and felony firearm possession.
He was also charged with the sexual
assault and fatal stabbing of a teenage
girl in 2006. Montgomery plead guilty
to all the charges and was sentenced to
serve 40–80 years in prison.
Adams was often frustrated with the crim-
inal justice process, angry that Montgomery
hadn’t been aggressively pursued in the past.
Showing me a picture of her bloody face from
the night of the attack, she said, “He got all
Freddy Krueger with us … but he didn’t win.”
The problem of violence against EMS pro-
viders must remain front and center, and the
lessons we learn from violent attacks such as
the one experienced by Adams and Rojas can’t
be forgotten. This isn’t a problem that Detroit
is alone in experiencing. It’s up to all of us to
prevent future incidents. JEMS
1. Workplace violence in healthcare: Understanding the challenge.
(n.d.). Occupational Safety and Health Administration. Retrieved
June 20, 2017, from www.osha.gov/Publications/OSHA3826.pdf.
Robert B. Dunne, MD, FACEP, is the EMS medical director for
the Detroit Fire Department and the Detroit East Medical Control
Authority. He’s also the program director for EMS fellowship and
an Associate Professor at Wayne State University.
Hear from Kelly Adams and Alfredo Rojas
at the EMS Today Conference & Exposi-
tion, Feb. 21-23 in Charlotte, N.C.
Kelly Adams after her most recent—and hopefully
final—operation. Photo courtesy Kelly Adams
It’s imperative to train
providers in de-escalation
techniques as well as
methods for disengaging
& escaping safely.