Emergency Response to Domestic Violence

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Emergency Response to Domestic Violence
Rural Metro Fire Department Knoxville, TN
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• The myths associated with Domestic Violence
• The Definition of Domestic Abuse
• Domestic Abuse Dynamics
• The link between domestic abuse and child abuse
• How to identify a victim of domestic abuse
• Scene Safety
• Operating as a Safe Haven
• The definition of Preferred Response
• Information about Orders of Protection

Students Will Learn
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QuestionWhat is the definition of domestic
abuse?
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Domestic Abuse

• As used in this part Domestic Abuse means
  inflicting or attempting to inflict physical
  injury on an adult or minor by other than
  accidental means, placing an adult or minor in
  fear of physical harm, physical restraint, or
  malicious damage to the personal property of the
  abused party.

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The Big Myths

• Provocation
• Loss of Control
• Environmental Stressors
• Victims like the Violence
• Victims can Just Leave
• Only Men batter Women

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How Bad is Domestic Violence?

• 95 of the victims effected by DV are women
• Every 9 seconds a woman is beaten
• 42 of the women who are murdered are killed by
  their intimate male partners
• Battering is the leading cause of injury to women
  in the U.S., more than rape, robbery and auto
  accidents-COMBINED!

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Why Batterers Batter

• Society says its OK Society hasnt held
  batterers accountable.
• It Works The victim is so terrorized that they
  will say or do anything to survive.
• It's a Choice Batterer chooses to use violence
  to control family members.

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What Battering IS NOT Caused by

• Mental or physical illness
• Genetics
• Alcohol
• Out of control behavior
• Stress
• Anger
• Victims behavior or relationship problems

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The Dynamics of Domestic Violence

• Dynamics of Relationship
• Cycle of Violence
• Power and Control
• Warning Signs
• To Stay or Go
• Why victims stay
• Barriers to leaving

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Cycle of Violence
Tension Building
Honeymoon
Explosion
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Honeymoon
This is the beginning of every relationship,
marital or pre-marital. Both people feel like
they are on top of the world, like they have the
perfect relationship.
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Tension Building

• Victim denies abuse is happening blames it on
  stress, work, outside family, drinking, drugs,
  financial problems. They attempt to calm
  partner, nurture, be silent/talkative, stay away
  from friends and family, cook favorite meal,
  clean
• Batterer is moody, nit-picky, isolating,
  withdrawing affection, putting down, yelling,
  drinking, criticizing, threatening

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Explosion

• Victim protects self any way possible, police
  called, try to calm partner, try to reason with
  partner, leave, fight back, minimize injuries.
• Batterer may harm, or threaten to physically harm
  the victim, rape, verbally abuse, imprison, or
  prevent the victim from leaving.

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Honeymoon

• Victim may agree to stay or return, stop legal
  proceedings, set up counseling, appointments for
  self and partner, feel happy and helpful
• Batterer begs for forgiveness, promises to get
  counseling (church, AA, NA) gives flowers or
  other gifts, promises to never do it again,
  repeatedly expresses love for victim

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Violence
Coercion and Threats
Intimidation
Male Privilege
Emotional Abuse
Physical
Power and Control
Sexual
Economic Abuse
Isolation
Minimizing, Denying Blaming
Using Children
Violence
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Continuum of Family Violence
Physical
DEATH
Pushing slapping kicking throwing objects
choking using weapons
Verbal Emotional
Name calling criticizing ignoring yelling
isolation humiliation
Sexual
Unwanted touching sexual name calling false
accusation forced sex
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Non-Violence
Mutual Respect
Negotiation Fairness
Economic Partnership
Non-Threatening Behavior
EQUALITY
Trust Support
Shared Responsibility
Honesty Accountability
Responsible Parenting
Non-Violence
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Warning Signs of An Abusive Personality

• Jealousy
• Controlling
• Unrealistic Expectations
• Isolation
• Low Self-Esteem
• Blames Others for Problems
• and Mistakes

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Warning Signs of An Abusive Personality

• Makes Everyone Else Responsible for His Feelings
• Hypersensitivity
• Cruelty to Animals Children
• Playful Use of Force During
• Sex

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Warning Signs of An Abusive Relationship

• Verbal Abuse
• Rigid Sex Roles
• Sudden Mood Swings
• Past Battering
• Threats of Violence

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Warning Signs of An Abusive Relationship

• Destructive Criticism
• Blaming and Pressure Tactics
• Abusing Authority and Male Privilege
• Disrespect
• Abusing Trust
• Minimizing, Denying Blaming

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Warning Signs of An Abusive Relationship

• Economic Control
• Isolation
• Using Children

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Why Victims May Stay

• Hope for Change
• Isolation
• Societal Denial
• Barricades to Leaving

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Why Victims May Stay

• Belief in Batterer Treatment
• Dangers in Leaving
• Economic Autonomy
• Leaving is a Process

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Children in Homes of Domestic Violence

• Children in violent homes are 1000 times more
  likely to abuse as adults than children in non
  violent homes
• Children in violent homes kill themselves at 6
  times the national rate
• Children in violent homes are 74 times as likely
  to commit crimes against other people and 24
  times as likely to commit rape or sexual assault

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Children in Homes of Domestic Violence

• In a national survey of over 6,000 American
  families, 50 of the men who frequently assaulted
  their wives also frequently abused their children

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INJURY ASESSMENTAND RESPONSE
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Injury Assessment and Response

• Behavioral Cues
• nervous or inappropriate laughter
• crying
• anxiety
• defensiveness, anger
• lack of eye contact
• minimizes injury
• overly attentive, aggressive partner

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Injury Assessment and Response

• Verbal cues
• Talks about a friend who has been abused
• Refers to partners temper or anger
• Tells about abuse

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Injury Assessment and Response

• Uses health care services repeatedly
• Uses many different physicians/hospitals
• Psychosomatic/emotional complaints
• Reluctance to speak in front of the abuser
• Child abuse in the family

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Physical Examination
When examining patient, note any

• Central distribution of injury
• Bilateral distribution of injury to multiple
  areas
• Delay between onset of injury and presentation
  for treatment
• Multiple injury in various stages of healing
• Extent or type of injury inconsistent with
  patients explanation
• Chronic pain, psychological pain, pain due to
  trauma without visible evidence

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Charting and Documentation
What the patient tells you
What your assessment of the injury is if the
explanation offered is inconsistent.
A detailed description of injuries with a body
chart
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Charting and Documentation
Documentation is important on every call.
Documentation on calls involving domestic
violence is vital. You are almost guaranteed to
be subpoenaed to testify in court if you respond
to one of these calls. The courts dont accept
speculation, so you need to document everything
you see, hear, or do. A good rule to remember for
documentation is if you didnt write it down, it
didnt happen.
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Standard of Care
Our job as emergency responders is to be
compassionate to our patients, but to only render
care for what we have been trained to provide.
Dont make a bad situation worse by prodding,
prying, and investigating what you might think is
a domestic violence situation. Often times, when
the batterer is still in the room, the victim
will belittle their injuries. If you pry, you
might cause the batterer to attack not only the
victim again, but you as well.
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Questions to Ask
Treat this response just like any other,
introduce yourself and ask

• How are you, whats going on today?
• Have you experienced this before?
• What were you doing when this happened?
• Have you been prescribed new medications
  recently?
• Etc, etc,. Very direct, injury or illness
  specific questions

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If the victim feels comfortable sharing the
situation with you, let them do it themselves,
dont pry! If they do tell you things about the
attack, tell them you are concerned right now for
their injury or illness and encourage them to go
to the hospital. Hospitals have, or have access
to, personnel who are trained specifically for
domestic violence cases.
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Scene Safety

• If you know of violence at a residence from
  previous calls, request PD response through the
  alarm room and stage
• If you are advised to stage, stage. Never enter
  before the scene is deemed safe by the PD.
• Leave yourself a way out if the batterer returns
  and becomes violent, or
• The victim becomes violent to protect the
  batterer

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Scene Safety

• If you respond to an abdominal pain, for example,
  and it turns out to be a domestic violence
  situation with an aggressive batterer still
  present, call for PD response immediately through
  CODE-O on the radio. Try to be nonchalant about
  it to not let the batterer know what you are
  doing.

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Safe Havens
Often times, victims come to the fire stations as
areas of safe refuge. If you find yourself in
this situation, contact the alarm room and take
your station out of service. Your primary
responsibility is to provide care for the victim.
The alarm room should contact the local police
department, the appropriate social services, and
an ambulance if necessary.
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Safe Havens
Remember, the victim came to you. Be
compassionate, but try not to counsel them. You
might give misinformation or bad advice that
could cause the situation to be worse once the
victim leaves. Encourage the victim to go to the
hospital. Provide the victim with the Family
Violence Helpline phone number.
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COMMUNITY RESOURCES

• SHELTER
• LEGAL
• COUNSELING
• 24 HOUR LINES
• POLICE
• OTHER

FAMILY VIOLENCE HELPLINE 521-6336
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Domestic Violence Law

• Tennessee Code Annotated

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Definition(TCA 36-3-601)

• Domestic relationships includes adult/minors who
• Are related by blood or adoption.
• Are or were related by marriage.
• Are or were dating.
• Have or had a sexual relationship.
• Are or were living together.

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Question
What does preferred response mean?
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Answer

• TCA 36-3-601 Preferred response means law
  enforcement officers shall arrest a person
  committing domestic abuse unless there is a clear
  and compelling reason not to arrest.

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Knoxville, Tennessee

• 1989 -- 76 of homicides were domestically
  related
• In 1990, a pro-arrest policy was implemented.
• 1990 -- domestic homicide rate was cut by 50

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Orders of Protection
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What is an Order of Protection?

• Civil Matter
• Order by Court to not threaten to abuse or abuse
• Permanent up to one year
• Cost of Order of Protection

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Who Qualifies?

• Victims who
• Are related by blood or adoption.
• Are or were related by marriage.
• Are or were dating.
• Have or had a sexual relationship.
• Are or were living together.

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Types of Orders of Protection

• Ex-Parte
• Social Contact Order
• No-Contact Order

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Scope of an Order of Protection

• Orders Batterer not to abuse or threaten to abuse
• Can order Batterer from coming around victim
• Can make Batterer move or pay for housing for
  victim and children
• Can give victim temporary custody of children
• Can order Batterer to counseling

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Violation of an Order of Protection

• Victim Should
• Call Police
• Advise of Order of Protection
• Have a copy of the order at all times
• Make a report
• File a Show-Cause

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Arrest for Violation of Out-of-State Protection
Order TCA 36-3-6

• Orders from other states are to be honored and
  enforced as if it were issued in Tennessee
• Victim from another state should provide a copy
  to local law enforcement, but it is not necessary
  for enforcement
• Civil and Criminal Liability Immunity

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Remember

• Listen without criticizing
• Ask specific questions about illness or injury
• Show concern for patients well being
• Encourage patient to go to the hospital
• Be safe and protect yourself!