5 ways to recognize a domestic violence survivor – and 4 ways to treat it

Domestic violence can be hard to recognize unless you're looking for it

By Sarah M. Smart
EMS1 Editor

Suppose you're called to a middle-class home for a female "unknown medical problem." You pull up in the rig, size up the scene and approach the home. But when you knock on the door, a man answers, saying she's "always overreacting," and sends EMS away.
Is this a domestic violence situation?

That's just one of the questions raised in Dan Batsie's presentation, "EMS and the Domestic Violence Patient," at EMS World Expo 2012 in New Orleans on Thursday.

The answer to that one is that yes, this is probably a DV event. Domestic violence is a pattern of behavior — physical, sexual, emotional, financial, etc. — used by one person to control another's thoughts, feelings and actions.

It occurs in all ages and sexes, but female victims are more prevalent and more often reported (one in four women will be victims of domestic violence, and female victims outnumber male victims nine to one).

But domestic violence can be hard to recognize unless you're looking for it. Here are five categories to evaluate when you suspect domestic violence:

1. Dispatch: 911 hangups, third-party calls, history of suspicious calls, suicide threats from the suspected batterer and difficulty getting information from the victim

2. Scene: mechanism of injury (a person doesn't get two black eyes from falling down the stairs, right?), inconsistent story and evidence of any of the following: a struggle, weapons, substance abuse and injury to pets

3. Victim: fear around partner, reluctance to answer questions, describing vague complaints that don't add up, obvious physical harm, history of calling EMS, isolation, delays in treatment (she's had a broken leg for two weeks, for instance), pregnancy

4. Abuser: cursing, clenched fists, barring access to the patient, attempting to interfere or control interactions, trying to refocus attention, anger/belligerence/indifference, hesitation or refusal to allow transport

5. Assessment: wounds in the shape of an object, defensive wounds, injuries to areas normally hidden (stomach, chest) and exacerbation of other chronic problems such as anxiety, depression, substance abuse or illness

If your findings hint (or scream) at domestic violence being an issue at play in the call, it's important to treat the victim without making the situation worse. Here's what to do:

1. Be a medic. Be an EMT. Be whatever your scope of practice is. Just tend to the medical issue first.

2. Consider your approach. Many domestic violence survivors are very sensitive to the issue of personal space, so ask permission to touch any part of their body. Present a calming influence, and monitor your body language to show you are taking the call seriously.

3. Consider your tone. If holding someone's hand is not your thing, don't fake it. Instead, try to remain nonjudgmental, and provide a safe, confidential, controlled setting.

4. Ask about domestic violence. You can use direct questions. You can name what you're seeing. Remember it's not an interrogation. If the patient assures you that there is no risk, document your assessment thoroughly, and offer resources for domestic violence survivors anyway. If the patient confesses to being abused, don't promise anything you can't deliver. Pass along the information when transporting, and refer the patient to local services. Most importantly, believe the patient.

Keep in mind that domestic violence victims are constantly managing risk. The time they are most at risk of being hurt or even killed is immediately after leaving the abusive partner. So take into account indicators of escalating risk: specific threats ("I will stab you with this knife tomorrow at work" vs. "I'm gonna kill you"), increasing frequency or severity of injuries, access to weapons, abuse of pets, strangulation and pregnancy-related violence.

Not every state mandates reporting of domestic violence, but Batsie recommends it regardless, especially when children are involved. EMS might be the only contact with a lifeline the victim will get before the unthinkable happens.

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