Violence can occur anywhere. Regardless of where you work, you will likely face the challenge of responding to a critical incident that includes acts of violence. These can be directed toward patients, bystanders and even emergency responders. This article is designed to provide a response checklist to help EMS providers prepare for and respond to calls for suspected or confirmed incidents of violence.

DISPATCH & RESPONSE PHASE

• When you're dispatched, the nature and location of the call are important. Get all the dispatch information available.
• Be aware that dispatching information is not always correct or can be very vague, due to the information the communications center is receiving.
• Typical procedures require law enforcement be dispatched to any incident with a potential for violence, but you may unknowingly find yourself on a violent scene due to a wrong address, victims coming to you, or your own discovery of an incident.
• If there are indicators of violence or a "red flag" location, request law enforcement as soon as possible.
• It is always important to listen for key verbal indicators and gain as much prearrival information as possible, such as that your responding address is in a high-violence area, you've been to a location before (such as a bar or club), reports of shootings, alcohol involvement, crowds, etc.
• Firefighters and medics should have access to body armor as PPE if responding to high-risk areas or situations.
• Never hesitate to call for law enforcement assistance if you even think you may need it.

ARRIVAL ON SCENE

• Fire and EMS should remain in staging areas until any dangerous scene is secured by law enforcement.
• Remember, there is a difference between "law enforcement on scene" and "scene is secure."
• Stay alert to your surroundings and maintain situational awareness at all times.
• Conduct a complete scene size-up during your "windshield survey."
• Maintain a good working relationship with law enforcement.
• Two arrival options: Park past the location when responding, which allows you to see three sides of the structure, or shut down your warning lights and siren and do not pass by or park in front of residence. Stop the unit about 50–100 feet from the residence and position it where it cannot be seen.

APPROACHING THE SCENE