2. EMS Preparedness for Tactical Violence
Daniel Kollek MD
Co-authors: Michelle Welsford MD
Karen Wanger, MD

3. Introduction
Paramedics are essentially the only medical personnel who are routinely at the scene of violent episodes
Reportedly 8.5% of scenes are the result of some form of violence
Up to 90% of EMS staff report an episode of violence directed towards them

4. Tactical Violence Defined as:
“ the deployment of extreme violence in a non-random fashion so as to achieve a tactical or strategic goal”
Preparation for T.V. is a routine part of training for police and military but not EMS

5. Tactical Violence
Response to a scene involving tactical violence involves multiple agencies.
The addition of targeted violence and law enforcement requires different operational procedures compared to more typical EMS responses
Safe and efficient functioning at such a scene requires specific training including training with the other responding agencies (e.g.ICS).

6. Methods Survey of pre-hospital providers in BC and Ontario
Survey addressed the self reported training and readiness in the following areas:

7. Survey topics
1. Training for response to a tactical violence or terrorist scene;
2. The level of comfort responding to complex event (mass casualty, violent etc);
3. The level of comfort in detecting and dealing with the emotional impact of providing care;
4. The added emotional impact caused by violence, clinical load and child injuries at the event scene.

8. Topics and methodology
Emotional impact was assessed by asking respondents to grade responses to a variety of scenarios including violence and tactical violence, and the presence of combinations of adult and pediatric victims.

9. Results
1028 respondents
77% of 876 respondents stated they had received no training “…in procedures to follow in responding to a tactical violence scene where there may be further violence”
4.5% of responders “did not know” who would be in control of such a scene

10. Results
89% of 288 respondents were “never” (46%) or “more than a year ago” (43%) “…trained to function under conditions of tactical violence.”
70% of 289 respondents had never reviewed the tactical violence plan in the community s/he serves

11. Scenarios. Raw data with weighted scores in parentheses
Not distressing
Slightly distressing
Moderately distressing
Would not be able to resume work
Would not be able deliver care at the scene
Total Emotional Impact Value
Average Emotional Impact Value
(weight 0)
(weight 1)
(weight 2)
(weight 3)
(weight 4) 1
1 adult injured/1 adult dead
342 (0)
492 (492)
0 (0)
12 (36)
1 (4)
532
0.63 2
1 adult injured/1 child dead
51 (0)
211 (211)
512 (1024)
75 (225)
1464
1.72 3
1 adult attacked/1 child dead
34 (0)
177 (177)
541 (1082)
99 (297)
1560
1.83 4
1 adult injured/1 child attacked and dead
27 (0)
137 (137)
520 (1040)
172 (516)
3 (12)
1705
1.98 5
20 adults killed accidentally, five injured
39 (0)
136 (136)
456 (912)
224 (672)
1724
2.01 6
20 adults killed purposely, five injured
31 (0)
84 (84)
432 (864)
297 (891)
12 (48)
1887
2.20

12. Duration of emotional impact
I never have unwanted memories of distressing events
3.1%
I would process the event immediately and it would not bother me for any significant length of time
26.4%
It will take me up to a week to process this event
30.8%
It will take me up to a month to process this event
13.2%
It will take me over a month to process this event
11.5%
I do not think I would ever get over witnessing such an event
15.1%

13. Comfort responding to event by event type
Very uncomfortable
Slightly uncomfortable
Unsure
Reasonably comfortable
Very comfortable
Fire
57 (7%)
61 (7.4%)
52 (6.3%)
224 (27.4%)
425 (51.9%)
Unstable building
113 (13.8%)
126 (15.4%)
173 (21.1%)
275 (33.6%)
132 (16.1%)
Terror event
153 (18.7%)
154 (18.8%)
266 (32.5%)
186 (22.7%)
60 (7.3%)
In PPE
103 (12.6%)
136 (16.6%)
166 (20.3%)
247 (30.2%)
167 (20.4%)
Tactical Violence
157 (19.2%)
196 (23.9%)
264 (32.2%)
99 (12.1%)

14. Conclusions
EMS personnel routinely respond to episodes involving violence, are frequently subject to violence personally, and are increasingly exposed to tactical violence
As assessed by this survey: Few EMS personnel in Canada have training in the response to tactical violence, many have a significant degree of discomfort responding to these scenes, and many predict significant distress from tactical violence scenarios.

15. www.ceep.ca For all lecture handouts and other disaster resources
Please go to