Transcript Crime Scenes - Advocatehealth.com

Curriculum Update:
Crime Scenes
Behavioral Emergencies
Toxic Exposure
Abuse and Assault
Condell Medical Center EMS System
September 2006
Site code #10-7200-E-1206
Revisions by S Hopkins, RN, BSN
1
Objectives

Upon completion of the module, the EMS
provider should be able to:
describe approach to a crime scene and
steps taken to preserve evidence
 describe what a behavioral emergency is
and medical legal considerations
 list drugs that are abused and field
interventions that may be necessary

2
Objectives cont’d
list types of abuse and assault and the
legal considerations
 actively participate in case scenario
discussion
 review activation of cardizem syringe
 successfully complete the quiz with a
score of 80% or greater

3
Crime Scenes
4
Crime Scenes

Crime Scene Definition


A location where any part of a criminal act
occurred
A location where evidence relating to a crime
may be found
5
Crime Scenes

EMS personnel may be
mistaken for police




Uniform colors
Badges
Exiting a vehicle with lights
and sirens
Can initiate aggression toward
an authority figure
6
Approach to the Scene

Approach is part of scene size-up




Identification of possible hazards is part of
scene size-up
Key point – identify and respond to dangers
before they threaten
Safety concerns begin with
dispatch information
Use available resources
before arrival

Do not enter the scene until it
is safe and secured
7
Approach to the Scene
A secured scene can become
unsafe again - be on guard
 Retreat from the scene if the
scene cannot be made safe;
there is no such thing as a dead
hero!
 Know local protocols
 Begin observation several
blocks before the scene

8
Use of Red Lights & Sirens
Urban areas - excess use may draw
crowds
 Highway scene - lights required for
safety
lights can also be hypnotizing and
cause drivers to drive into the
lights

9
Known Violent Scenes

Stage safe distance from the
scene until police advise
scene “secure”
 Out of sight of the scene
 If you can be seen, people will come to you
 Entering an unsafe scene adds another
potential victim
 You may be injured, killed, or taken as
hostage
 You may become another patient
10
Violent Scenes

Coordinate your approach with police



Approach potentially unsafe environments
single file
If holding a flashlight, hold from the side


You do not want to be misidentified
Armed assailants often aim at the light
Stand to the side of doorways when
knocking

Standing directly in front of a door makes you
a target
11
Approach to the Scene




Remember non-violent dangers such as
hazardous materials, power lines,
dangerous pets, etc
Scene safety considerations must
continue throughout the call
Others could expect you to intervene in
violent situations
Remember to include “escape and
strategic escape plans” in your protocols
12
Crime Scene Preservation

Evidence

Prints
Fingerprints - ridge characteristics are left behind
on a surface with oils & moisture from the skin;
unique in that no 2 people have identical
fingerprints
 Footprints


Blood and body fluids
DNA and ABO blood typing possible
 Blood splatter pattern is evidence


Particulate evidence

Hairs, carpet & clothing fibers - leave sheets under
13
the patient in the ED (may hold evidence)
Crime Scene Observations


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


Patient (victim) position
Patient injuries versus marks you
added (ie: IV attempts)
Conditions at the scene
 lights, curtains, signs of forced
entry, anything moved or touched
by EMS
Statements of persons at the scene
Statements of the patient/ victim
Dying declarations
 place in quotation marks
“He done it!”
14
Evidence Preservation at Crime
Scenes

Patient care is the ultimate priority


Evidence protection is performed while
caring for the patient


You may be restricted to only 1 team member
for initial scene entrance
Carry in only necessary equipment
Evidence preservation techniques


Be observant
Touch only what is necessary for patient care
15
Use of Gloves At Crime Scenes

Wear latex gloves



Used for infection control
Prevents you from leaving
your fingerprints
Prevents smudging of other
fingerprints
16
Crime Scene Documentation





Note observations objectively, not
subjectively (ie: note color of bruising and
not “new” bruise)
Put patient’s or bystander’s words in
quotes
Patient care records are legal documents
Avoid opinions not
relevant to patient care
Patient care records
will be used in court 17
will your charting stand up?
Mandatory Reporting

EMS providers are required to report certain types
of crimes


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
Child abuse - DCFS must be notified
Suspected elder abuse (age 60 or older) and/or neglect
Domestic violence
 If a refusal, EMS is mandated by the State to report all
cases of domestic violence to the local police
 Offer an informational brochure to the patient
 Document your actions
Certain violent crimes (i.e. sexual assault,
gunshot, etc.)
Confidentiality needs to be maintained
18
19
BEHAVIORAL
EMERGENCIES
20
BEHAVIORAL EMERGENCEIS

“Normal Behavior”



No clear definition or
ideal model
Ideas vary by culture
or ethnic group
What society accepts
at the moment

“Abnormal Behavior”



Deviates from society’s
expectations
Interferes with well
being and ability to
function
Harmful to individual
or group
21
What Is A BEHAVIORAL
EMERGENCY?




General term to describe a broad range of
conditions of varying severity including
unanticipated or maladaptive behavioral
episode
Use of the word “abnormal” is very
subjective
Recognized as behavior requiring
immediate intervention
Not always a clear cut EMS
22
Behavioral Calls

Indications of a behavioral or psychological
condition include:



interference with core life functions (eating,
sleeping, ability to maintain housing,
interpersonal or sexual relations
posing a threat to the life or well-being of
themselves or others
significant deviation from the expectations or
norms of society
23
Responses to Behavioral
Emergencies



Most of your assessment skills will depend
on your interpersonal & people skills more
than use of diagnostic tools
Remember, on all calls your safety is #1
and your partner’s is #2
Will need to exercise observational skills



patient
family
bystanders
24
BEHAVIORAL EMERGENCIES

Incidence



Estimates vary with as much as 20% of the
population experiencing some type of mental
problem
Incapacitates more people than all other
health problems combined
1 person out of 7 will require treatment for an
emotional disturbance
25
BEHAVIORAL EMERGENCIES

Common misconceptions

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

Abnormal behavior is always bizarre
All mental patients are unstable and
dangerous
Mental disorders are incurable
Having a mental disorder is cause for
embarrassment and shame
26
Specific Psychiatric Disorders

Cognitive disorders



Schizophrenia



Organic causes such as brain injury or disease
Includes delirium (rapid onset disorganized
thought) and dementia (gradual development
memory & cognitive impairment)
loss of contact with reality
hallucinations, delusions, depression
Anxiety & related Disorders



panic attacks
phobias
post-traumatic stress syndrome
27

Mood disorders

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
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
depression
bipolar disorder (manic-depressive episodes)
Substance use/abuse
Physical symptoms with no apparent
physiological cause
Factitious disorders



intentional production of signs/symptoms
motivation to assume the sick role
external incentives are absent (ie: avoid police)
28

Dissociate disorders

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
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
failure to recall (psychogenic amnesia)
physically moving miles away (fugue state)
multiple personality disorder (2 or more
compete personalities)
depersonalization (loss of one’s self)
Eating disorders



anorexia - loss of appetite; excessive fasting
bulimia - uncontrollable bingeing & vomiting
or diarrhea
these patients are at risk for electrolyte
imbalance and dysrhythmia
29

Personality disorders



Impulse control disorders


acting odd or eccentric
dramatic, emotional, fearful, anxious patients
failure to control certain impulses that may be
harmful to the patient or others
Suicide/suicidal attempts
30
BEHAVIORAL EMERGENCIES

Management considerations
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Treat existing medical problems
Maintain safety
Do not confront or argue with patient
Control violent situations
Remain with patient at all times
Avoid challenging the patient’s
personal space
Avoid judgements
31
BEHAVIORAL EMERGENCIES

Medical Legal Considerations


Standard of care must always be followed
Obtaining consent may help avoid charges of
assault or battery
assault - a verbal or physical threat
 battery - patient force without consent


Limitations of legal authority


if in doubt regarding action, contact
medical control
Objective documentation will be
your best defense
32
Use of Restraints


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Methods of restraint
 Verbal de-escalation
 speaking in a calm manner
 avoid patient’s “personal space”
 Physical restraint
 includes soft (ie: sheets) and hard
restraints (ie: handcuffs, leathers)
Have enough man-power available prior to
beginning restraint procedure, if possible
Restraint in a prone (face-down) position can
make the patient susceptible to positional
asphyxia - watch for airway compromise!!!
33
Restraints


Once a patient is restrained, never leave
them unattended
Once restrained, frequently monitor and
document neurovascular assessments of
restrained extremities


need to maintain adequate circulation
EMS personnel need to contact medical
control as soon as possible when restraints
are being considered or have been used
34
Restraints


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Never compromise the patient’s airway
Do not further aggravate injuries or illness
EMS to clearly document the behavior that
led to use of restraints
Handcuffs are to be applied by police only
If handcuffed, a police officer must
accompany the patient in the ambulance
while being transported (CMC policy)
35
Taser Use By Law Enforcement


Use of propelled wires to conduct energy
that affects the sensory and motor
functions of the central nervous system
Overrides the central nervous system to
achieve incapacitation

previous weapons worked on pain compliance
which can be overcome by drugs, alcohol, or
focused & combative patients
36
Taser Use





Static discharge on a doorknob - 35,000 100,000 volts
Taser system - 50,000 volts
Does not cause electrocution in a wet
environment
Electricity will not pass to others in contact
with the subject unless contact is made
directly between or on the probes
Patient can be touched while Taser is active

do not touch probes or step on wires
37
Taser Use

Do not place yourself in the pathway of the
unit being discharged
38
Taser Probes

Probes are
embedded
in the skin;
they do not
continue to
give off
charges
39
Taser Probes



Law enforcement may remove/break wires
near probes
CMC EMS have not been authorized to
remove laser probes
Removal of probes most commonly
performed in the ED



probed grabbed firmly and pulled straight out
skin wiped with alcohol pad
Treat removed probes with precautions
similar to contaminated sharps
40
Transportation Against The
Patient’s Will


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Patient presents as a threat to themselves
or others
When ordered by medical control
Implemented by law
enforcement authorities
An incompetent patient will not be allowed
to make health care decisions
When in doubt, contact medical control
and document the contact
41
Transportation of Patients with
Psychiatric Issues



All patients must be evaluated in an ED
before psych admission can occur
Admission destination often based on
many factors including but not limited to:
diagnosis, available beds, insurance
requests
Just because one facility has a psych unit
is no guarantee a patient stays at that
facility if in the ED there
42
Petition for Involuntary
Admission




Completed by person(s) witnessing the
behavior (ie: police, EMS, family, hospital)
If petition not completed in ED and ED staff
have not witnessed behavior, patient may
be discharged
Petition may be completed by family only if
they witness behavior or conversation
Transporting authority acting in good faith
and without negligence shall incur no
liability, civil or criminal, due to transport 43
Most of form often completed as group effort with EMS
and hospital staff for accuracy & legal boundaries
44
This is the section EMS or other witness would be
expected to objectively describe behavior observed
45
Signatures important
Phone numbers may be
work numbers
46
47
Toxic Exposure
48
Multiple Forms of Toxic Exposure
Substances


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Biological
Nuclear
Irritants
Chemical
Nerve agents
Blister agents
Blood agents

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
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

Farm chemicals
Cleaning agents
Petroleum products
and by-products
Medicine/drugs
Inert gases
Explosion hazards
49
Alcohol

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
A central nervous system depressant
A common & favorite mood-altering drug
Affect on body influenced by:


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

age
gender
physical condition
amount of food eaten
other medicines/drugs taken
Is a toxic drug producing pathological
changes in liver tissue (cirrhosis) and can
cause death
50
Alcohol

Low dose effects

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
Medium dose effects

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relaxed feeling, reduces tension, lowers inhibition
impairs concentration; slows reflexes
reduces coordination; impairs reaction time
slurred speech, drowsiness, altered emotions
Higher dose effects

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
vomiting
breathing difficulties
unconsciousness
coma
51
Chronic Use of Alcohol

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Damage to frontal lobes of brain
Brain shrinkage
Vitamin deficiency (B-1 or thiamine)
 Wernicke’s encephalopathy - impaired
memory, confusion, lack of coordination
 Korsakoff’s syndrome - amnesia, apathy,
disorientation
Health deterioration of multiple systems
Fetal alcohol syndrome in newborn


alcohol passes thru placenta
normal brain development disrupted
52
Alcohol Withdrawal

Typically 6 - 48 hours after last drink

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Shaking (tremors)
Sleep problems
Decreased appetite, nausea
Anxiety
Increased heart rate, increased blood pressure
Hallucinations
Seizures
53
Delirium Tremens (DTs)
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Usually start 48 - 96 hours after last drink
20% fatality when untreated
DT's can produce fatal seizures, MI, stroke
Hallucinations - usually visual
Profound confusion, disorientation,
hyperactivity
Cardiac dysrhythmias
Seizures - true emergency
54
Treatment of DT’s
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Valium to stop seizure activity
Fluid resuscitation
Treat dysrhythmias per SOP
Increased risk of vomiting
 protect airway from aspiration
 have suction available
 consider transport of patient side-lying
55
Marijuana

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One of the world’s most commonly used
illegal drugs
Usually smoked; can be cooked/baked into
food
Interferes with normal function of certain
receptors in the brain (memory,
concentration, perception, movement)
Effects in 1-10 minutes; lasts 3 - 4 hours
High doses cause: hallucination, delusions,
impaired memory, disorientation
Metabolites detected 45-60 days after use56
Inhalants




Huffing or sniffing products which are easily
found & available everywhere
Damage the nervous system & other organs
(ie: lungs, liver, heart, & kidneys)
Vapors inhaled into lungs enter bloodstream
then travel to brain & other tissues
Immediate effects: relaxation, slurred
speech, euphoria, hallucinations,
drowsiness, dizziness, nausea, vomiting,
DEATH from heart failure or suffocation from
57
plastic bags or aspiration of vomit
Inhalants


Long term use effects: memory loss,
concentration problems, visual
disturbances, blindness, motor problems,
peripheral nerve damage
Products abused: hair spray, nitrous oxide,
cleaning fluids, typewriter correction fluid,
nail polish remover, gasoline, glue, rubber
cement, paint & paint thinner, lighter fluid,
room deodorizers, marker pens
58
Cocaine


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
A local anesthetic and central nervous
system stimulant
Can be chewed (leaves), smoked, inhaled
(snorted), or injected
Acts by blocking reuptake of
neurotransmitters dopamine, norepinephrine
& serotonin in brain
Affects peripheral nervous system: constricts
blood vessels, causes irregular heart beat,
pupils dilate
Risk of MI or stroke within 3 days of OD 59
Cocaine

Within a few seconds to a few minutes:


Various doses may also produce:

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euphoria, excitement, reduced hunger, feeling
of strength
dizziness, headache, movement problems,
anxiety, insomnia, depression, hallucinations
After the initial “high” (approx 1 hour)
users may “crash” into depression. Users
then seek more cocaine (cycle causes
addiction)
Withdrawal: depression, anxiety, paranoia60
Cocaine Overdose

Presentations that may be observed:

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tachydysrhythmias
stroke (from  blood pressure)
subarachnoid hemorrhage
chronic accelerated atherogenic disease
(coronary atherosclerosis in younger people)
agitation, paranoia, change in behavior
seizure activity
respiratory depression
hyperthermia
MI from acute vasospasm, dysrhythmia or
coronary atherosclerosis
61
Treatment Cocaine Overdose

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Evaluate and monitor ABC’s
O2 - IV - cardiac monitor - frequent VS
Check glucose level
Seizures treated with benzodiazepines (valium)
Agitation treated with versed (medical control
order)
Hyperthermia - routine cooling measures
Nitroglycerin okay for chest pain
Narcan used cautiously for respiratory
depression (consider smaller dose & slow IVP)
62
Heroin



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Illegal opiate drug; main ingredient - morphine
Effect is depression of central nervous system
Affects receptors in brain responsible for
breathing, pain & emotions
Brain manufactures its own opiates “endorphins” released during pain and stress
Smoked or inhaled as a powder
Can be mixed with water,heated, then injected
Crosses blood brain barrier x100 faster than
morphine
63
Heroin

Effects produced:



IVP - 7 - 8 seconds
IM or SQ - 5- 8 minutes
Short term effects

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analgesia
brief euphoria (“rush”)
nausea
sedation/drowsiness
reduced anxiety
hypothermia
reduced respirations; reduced coughing
64
Other Effects of Heroin

Long term:
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
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
tolerance - need higher drug dosages
addiction - psychological & physiological need
withdrawal - 8-12 hours after last dose are
symptomatic
risk of HIV/AIDS, hepatitis, infections
poisoning - from added product to heroin
increased risk of stroke
collapsed veins
lung infections
65
Speedballing


Combining cocaine with heroin use
Causes frequent & sometimes fatal
complications because of combining these 2
drugs


Deaths of John Belushi, River Phoenix, Chris Farley
Heroin injected or smoked followed
immediately by smoking cocaine
66
Treatment of Heroin Overdose


Support ventilations
Narcan


May negate sedative effect of opioid (heroin)
and leave stimulating effect of cocaine
unopposed which worsens toxicity
Use narcan to treat respiratory depression
 2 mg slow IVP; repeated every 5 minutes
to total of 10 mg
 consult with medical control for possible
smaller dose (to avoid increased agitation
and uncontrollable behavior in the patient)67
Amphetamines





Stimulants of the central nervous system
Many effects similar to cocaine
Addiction, withdrawal, & tolerance possible
Taken orally, injected, smoked, snorted
Common products





dextroamphetamine - dexies
benzedrine
ritalin
methamphetamine - speed, meth, crystal
OTC cold & allergy products no longer easily
68
accessible to the public due to abuse factor
Amphetamines

Originally developed to treat




asthma
sleep disorders (narcolepsy)
hyperactivity
Short term effects

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increased heart rate
increased blood pressure
reduced appetite
dilation of pupils
feelings of happiness and power
reduced fatigue
69
Amphetamines

Long term use effects

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insomnia, restlessness
paranoid psychosis
hallucinations
violent & aggressive behavior
weight loss
tremors
Popular abused drugs in the club and rave
scenes

rave - all night underground party
70
Treatment of Amphetamine Use

Scene safety very important



patients often agitated, hostile, paranoid
meth lab volatile environment with risk of
explosion and fire
Acute overdose produces
 seizures
 hypertension
 tachycardia
 hyperthermia
 psychosis,
hallucinations
 stroke, death
71
Barbiturates

Depresses central nervous system



“sleeping pills”
May lead to tolerance (need for increasing
doses) and dependence (feeling you must
use the drug; withdrawal symptoms occur
when you stop using the drug)
Easily cross blood/brain barrier
72
Barbiturate Effects

Low doses




Higher doses


reduces anxiety
reduces blood pressure, respirations heart rate
reduces REM sleep
increase some types of behavior and actually
act as a stimulant (depression of inhibitory
brain circuits)
Can cause excessive sedation, anesthesia,
coma, death
73
Drugs Abused For Sexual
Purposes





Added to drinks and food
Can be forced on the person by coercion
Known versus unknown ingestion of
substances
Self gratification or fulfillment of another
person
If called for one person at a
“party,” anticipate multiple
patients affected
74
GHB (Gamma
hydroxybutyrate)






Central nervous system depressant
Takes minutes for user to lose control,
have amnesia, or lose consciousness
Colorless, odorless, slightly salty taste
High can last 1 1/2 - 3 hours with a rapid
return to normal with no hangover
Can be extremely addictive
Used by body builders
75
GHB

Low doses (similar to alcohol intoxication)

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

drowsiness
hypnosis
dizziness
euphoria
High doses


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
vomiting
convulsions
hypotension, bradycardia, bradypnea
coma
76
Assessment GHB

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


Often called to a party of many unconscious
young adults
Powerful CNS depressant (often GCS is 3)
Skin will be hot and in some
cases dry
Pupils fixed and dilated
Nausea and uncontrollable vomiting
Gag reflex intact
Loss of recall of current events leading to
present condition
Duration 1-2 hours; full recovery 8 hours
77
Ketamine




Powerful anesthetic (tranquilizer)
used
for animals (derivative of PCP)
CNS depressant, sedative & amnesic
properties
Can be injected, consumed in drinks,
smoked, inhaled
Renders victim physically helpless, unable
to refuse sexual advances, unable to
remember events
78
Ketamine Effects

Low doses




High doses




impaired concentration, learning & memory
functions
feeling of floating outside body
increased heart rate & blood pressure
hallucinations
sensation of rising above one’s body
potentially fatal
Long term - flashbacks & shortened
attention span
79
Rohypnol (Roofies)






Benzodiazepine but 10 times more powerful
than equivalent of valium
Outside USA used as sleep aid & presurgical
sedative (sedative-hypnotic effect)
Illegal in USA
Tasteless, odorless, dissolves easily in food or
drink
Manufactured now to release a blue dye when
dissolved in a liquid
Onset 15-30 minutes, peaks 2 hours, last 6-8
80
hours
Rohypnol








As date rape drug, causes blackouts,
memory loss, removes inhibitions, long
lasting
Impairs judgement, confusion, amnesia
Dilated pupils
Respirations depressed (common)
B/P decreased, pulse increased
Impaired motor skills
Slurred speech
Seizures, coma
81
Assessment
Drugs Abused for Sexual Purposes





Watch for decreasing level of
responsiveness
Anticipate slow, shallow respiratory rate
Watch for apnea (dose dependant)
Frequent monitoring vital signs
and EKG
Monitor level of
responsiveness
82
Management Drugs Abused
for Sexual Purposes




Scene safety very important
Activate triage if multiple patients
Most EMS care is supportive
Control the airway





BVM use
Narcan may reverse respiratory depression
Vomiting precautions
Seizure precautions - valium as needed
Be prepared for cardiac arrhythmias
83
84
Abuse and Assault
85
Epidemiology
Incidence, Mortality/Morbidity





Abuse of spouse, elderly relatives, and
children is greater than most estimate
Only 10% of women report battering
incidents
Over 1 million children suffer from abuse
or neglect
Victims may die of the abuse or assault
Victims may suffer mental or physical
injuries
86
Abuse & Assault Estimates





4-6 million women are beaten
1/2 of all homeless women and children are
homeless as a result of domestic violence
15 - 25% of pregnant women are battered
63% of young men between 11 & 20 years
of age are serving time for killing their
mother’s abuser
In 1996 elder abuse affected more than 1
million elderly
87
Epidemiology
Risk Factors


Men and women who beat one
another are most likely beating
their children
Children of abusive and unloving
homes are more likely to become
spouse or child batterers and later,
abusers of their elderly parents
88
Types of Abuse





Physical abuse - physical force
Sexual abuse - nonconsensual sexual contact
Emotional abuse - anguish, pain, or distress
Financial/material exploitation - illegal or
improper use of funds, property, assets
Neglect

failure to provide adequate medical or personal
care or maintenance, which failure results in
physical or mental injury to a person or in the
deterioration of a person’s physical or mental
condition
89
Battered Women
Reasons for Not Reporting





Personal fear or fear for her children
A belief that the offender’s behavior will
change
A lack of financial and/or emotional
support
A woman’s belief that she is the
cause of the violent behavior
A belief that battering is “part of
the marriage” and must be
endured to keep the family together
90
Battered Women
Characteristics of Wife-Battering




Beatings do not stop
Beatings become more severe & frequent
Beatings occur without provocation
Violence can turn toward the children
91
Characteristics of Spousal Abusers







Low self esteem
Violence learned from their parents
Believe they are demonstrating discipline
They do not like being out
of “control”
Fail to see alternative
behavior
Unable to back down from
conflict
Feel powerless to change
92
Characteristics of Spousal Abusers



Alcohol abuse is often a factor
Mental illness occurs in less than 10% of
abusers
Occurs in all socio-economic
groups; but most abusers are
in lower socio-economic
groups
93
Characteristics of Spousal
Abusers




Abuser goes into sudden rages
Abusers feel insecure and jealous
May appear charming and loving
after the incident
History of financial problems,
holding a job and possible
legal problems
94
Risk Factors for Domestic Violence





Male is unemployed
Male uses illegal
drugs at least once a
year
Partners have
different religious
backgrounds
Family income below
poverty line
Partners are
unmarried





Violence toward
children
Male did not graduate
from high school
Blue collar job if
employed
Male age 18-30
Male saw father hit
mother
95
Battered Men
Overview






Men also rarely report incident
Humiliation is multiplied for a man
Men feel as trapped as women do
Same psychological & emotional
effects
Society is less empathetic
toward men
Fewer resources exist for men
96
Homosexual Relationships



Spouse battering occurs in homosexual
relationships as well
Homosexuals are conditioned the same as
heterosexuals
>150,000 men in the US each year are
victims of physical violence by a spouse or
partner (both opposite and
same sex relationships)
97
Legal Considerations for
Battered Spouses



Spousal abuse is a crime
Assault is a misdemeanor or a felony
Attacker may be released within hours of
arrest


Patient must be aware of this for their
protection
Victim-witness assistance programs are
available

Know resources in your community
98
Legal Considerations for Sexual
Assault

Take steps to preserve any evidence





use paper not plastic bags
Patient should not urinate, defecate,
douche, bathe
Notify law enforcement as soon
as possible
Remember there will be a
“chain of evidence”
Follow local & state protocols
99
Resources and Support


Nationwide 24 hour hotline toll-free for
domestic violence
 1-800-799-SAFE (7233)
 TDD # 1-800-787-3224
Elder abuse hotline
Elder defined as 60 or older
 1-800-252-8966 (M-F 0830-1700)
 1-800-279-0400 (all other times)


DCFS - 1-800-25-abuse (800-252-2873)
100
EMS Responsibilities




Document objectively
EMS mandated by the State to report all
cases of domestic violence to local police
EMS mandated to offer a referral brochure
to all patients that sign a release
Document all efforts offered and all
reports made to other non-EMS parties
101
102