Armageddon Medicine – Survival Medicine

The following post on self-defense and medical preparedness is second in a series by Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT. 

I’d be very interested in comments from those of you who have served in areas of civil unrest or societal collapse (see comment form below). – Doc Cindy

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In the first installment of this series, we discussed the importance of self-defense and protection for medical providers and their patients, as well as securing facilities, equipment and supplies while operating in difficult and/or hostile environments. We also examined some of the evidence in favor of taking such precautions, based on such recent disaster medicine scenarios as those seen in Hurricane Katrina, the Rodney King riots in Los Angeles, and in the recent series of robberies of pharmacies. Now that you know why devoting time and energy to this important subject is necessary, we can examine the specifics of how to go about assuring an adequate level of protection. 

Individual Self-Defense 

Most people who enter the medical or allied health professions or otherwise aspire to care for the sick and the injured do so, at least in part, out of a sense of compassion and mercy. Many caregivers simply assume they will never be confronted with violence or the threat of violence, and therefore do not concern themselves with learning self-defense. Some are ill-suited by temperament and belief to deal with violence, i.e., conscientious objectors and pacifists. There is considerable evidence however, that this is something of a denial of reality, because violence against medics and healthcare providers is on the upswing. 

Not only are pharmacies and clinics being targeted by drug addicts and dealers (see previous installment), but doctors, nurses, and other personnel are being attacked in emergency rooms and elsewhere in the conduct of their duties. Paramedics and EMTs in many major cities cannot answer calls in high-crime areas without a police escort. As wait times for care climb in understaffed hospitals and clinics, overstressed patients and their families sometimes resort to aggressive behavior. In a post-disaster scenario, normal restraints on violence can fall away. Military medics and corpsmen have always known that violence and danger are part-and-parcel of their profession. 

As medics, we cannot adequately care for our patients if we are under attack ourselves, or face the threat of violence. Likewise, a medic who becomes a casualty himself is no longer caring for patients or is doing so at reduced efficiency. What steps can we take to lessen the odds of becoming a statistic? There are numerous means of doing so – one of which is to learn personal self-defense. 

Space does not permit an in-depth discussion of specific martial arts, or other means of defense, such as those involving weapons. However, the following general guidelines apply:

1.  Develop situational awareness – There are many resources available via the internet, as well as books, DVD tutorials, and in-person workshops on how to develop this critical skill. If you are unsuccessful in seeking out resources and training, call your local police department and ask about the subject. In most jurisdictions, training breaks down along civilian and military/law-enforcement lines; unsworn personnel may not have access to specialist training received by cops and soldiers. However, there are plenty of other resources available to the common person. Seek them out. The best way to counteract violence is not to be there when it happens. That takes situational awareness.

2.  Develop conflict resolution and de-escalation skills – Knowing how to defuse a potentially violent encounter before or just after it happens is a critical skill for those likely to be in such situations. Conversely, you should also train to know when conflict cannot be avoided, and an attack or confrontation is eminent.  

3.  Learn a well-established, realistic martial art or hand-to-hand combat system. There are dozens of well-regarded and effective systems available to suit every temperament, preference and physique. Many soldiers and cops prefer systems such as hapkido, jujitsu, or Krav Maga, or similar, because these arts encompass everything from techniques that control but do not harm an attacker, to lethal methods capable of incapacitating or killing an assailant. Whatever system or art you choose, select an instructor with experience and verifiable credentials, who runs a good program – and then practice and train hard! Real-world experience in hand-to-hand self-defense is preferable to training alone, but training is the next best thing. Learn simple, easy-to-use techniques first. Complex, acrobatic moves look great in the movies, but some of the most effective martial arts techniques around are anything but spectacular… they just hurt! Remember – in the heat of the moment, and because of the physiological consequences of the stress response, even the simplest techniques may become difficult. Your techniques must be ingrained before you use them in action, for them to be effective.  Learning empty-hand self-defense is also useful in developing the warrior mindset. You go from being a victim to being an opponent.  

This writer is aware of more than one civilian medical provider who has had occasion to use martial arts training inside the hospital, such as subduing an ER patient on PCP. 

4.  Purchase a firearm, and become proficient in its use. In most jurisdictions, before you can lawfully own a firearm, you will have to get a permit or firearm owner’s ID card. If you an inexperienced shooter, your very first action upon buying a pistol or long gun (rifle, shotgun) should be to sign up for an NRA (National Rifle Association) workshop or its equivalent, to learn how your new purchase works, how to handle it safely and effectively, and how to load, aim, and fire your weapon. There are also many reputable private schools and instructors, in addition to the NRA. You should also learn the legal aspects of gun ownership and use of force in your jurisdiction. A gun is simply a tool, and like any tool, it becomes considerably less-useful if you do not practice and become proficient in its use. Shooting is a frangible skill, meaning that your ability to do it degrades rapidly if you do not reinforce it often. Once you have learned the basics, consider taking a tactical shooting course, or joining the International Practical Shooting Confederation (IPSC), which teaches practical, real-world marksmanship.  

Combat medics are taught that “The best medicine on any battlefield is fire superiority,” meaning that if you are under fire or under attack, neutralizing the threat is often the best thing you can do for yourself and your patient. It may also mean that you evacuate the casualty to a safer location before administering care, if possible. If you are alone, you may have to do both, i.e., drag or move your patient to safety or treat on location, while watching out for threats. If you have a partner or several people, deploy them to secure your perimeter while your head is down assessing the patient, or to provide cover for you as you evac the casualty.

5.  Do not limit yourself to ballistic weapons such as firearms; you should also think about and choose the edged or impact weapon that fits your needs, within the constraints of local laws and statutes, of course. Some of these devices are concealable, such as the kubotan, which is a short rod or staff of approximately 5.5 inches x 0.5 inch in dimension. A kubotan is a remarkably effective means of applying pressure-point techniques, for example. Again, consult your local laws before buying. Even a humble walking stick or cane is a very effective weapon properly-employed – and one does not need a permit to own it. 

6.  Concealment – Medics are often targets because would-be attackers identify them as medical providers, and thus a possible source of drugs, first aid supplies, etc. Depending on your situation, you may be lawfully able to disguise or conceal your identity, and thereby ward off threats. In some situations, such as a humanitarian crisis or disaster relief, it is imperative that you identify yourself clearly as a provider of aid – i.e., by the wearing of a Red Cross brassard, visible identification, distinctive clothing, etc. In other situations, ID’ing yourself as a medic can get you targeted. Use your best judgment and adapt to the situation.  

Important note: It is imperative that you familiarize yourself with the issues surrounding the use of force, including applicable local, state and federal statutes. Of particular importance is the continuum of the use of force, which governs how much force may be used against a resisting subject and/or an attacker. These guidelines (which are analogous to military rules of engagement) were developed primarily for use by law enforcement and corrections personnel, but they are also application to civilians. In brief, the continuum involves using a graded response in confrontations (if applicable), and also the principle of proportionality. To use a brief example, an intoxicated person admitted to an ER who becomes verbally abusive and pushes a staff member, may be legitimately restrained or opposed by a like level of force, but no more than necessary to contain the situation and protect individuals in the area. What is permissible and lawful will vary by circumstance and the particular scenario with which you are faced. It is situation-dependent.

Acquiring basic hand-to-hand and weapons training takes time and effort but it is only the beginning, because learning when and how to apply these skills also requires a great deal of training and practice. This is one reason many healthcare providers and organizations rely upon security specialists to handle their needs; it is too big a job to care for patients and handle security at the same time. However, one may not always have that luxury so it is best to be prepared for other contingencies. 

This concludes part 2 of our series. In the next installment, we will continue our examination of self-defense for medical providers. Until then, as always, feel free to submit your comments, suggestions, etc. to the website.

Copyright © 2011 Peter Farmer

 Self-Defense and Medical Preparedness – Part 1