Domestic Violence Calls: What Every Medic Should Know
Adapted from the Loud & Clear Domestic Violence Podcast Episode with Jim Schmidt.
Paramedic school gave you almost nothing for how to approach domestic violence calls. A paragraph in a textbook that hasn’t changed in a decade, no question on the state exam, no protocol, no language, no framework for recognizing what you are actually walking into at 2:00 AM. And yet over 80% of medics in the field report running these calls regularly. This post distills what Jim Schmidt — retired firefighter, co-founder of the Gabby Petito Foundation, and one of the few educators in the country teaching this to first responders — says every field trainer should be teaching a new medic before they run their first DV call alone.
The Prevalence You Are Already Responding To
The statistics have gotten worse, not better. One in three women and one in seven men will experience severe intimate partner violence in their lifetime. The FBI’s National Incident-Based Reporting System documented over 11,000 domestic violence homicides between 2020 and 2024 — and only three-quarters of law enforcement agencies report data into that system, so the real number is higher. Five to seven people are murdered every day by someone who is supposed to love them.
You are already running these calls. They come in as overdoses, psychiatric emergencies, falls, headaches, chest pain, vague complaints at strange hours. The question is not whether you respond to DV — it is whether you recognize it when you do.
Scene Size-Up: Reading the Room
Domestic violence is, by design, a private crime. Abusers are skilled at appearing calm, cooperative, even charming in front of first responders. The signs are in the dynamics, not the words.
Watch for:
- The partner doing all the talking while the patient stays quiet or dismissive
- The partner standing over the patient, controlling the physical space, volunteering information the patient has not offered
- Initial denial of entry or reluctance to let you speak with the patient alone
- A story that does not match what you see — mechanism inconsistent with injury pattern, timeline gaps, memory loss
- An apartment that is too quiet, too dark, too staged
These patients are not trying to intentionally deceive you. Their memory gaps are not on purpose. When the brain is in sustained survival mode, the hippocampus cannot encode events in chronological order. The patient who cannot tell you what happened may be the patient who is in the most danger.
Covert Communication with Dispatch
If you need law enforcement and don’t have them, do not key up on your portable radio. Be careful not to risk radio broadcasts that can be heard by the abuser on scene. That announcement will escalate the call — even if not tonight, then the next time you’re not there.
Build a covert pathway with your agency and dispatch before you need it:
- A code phrase like “code purple” or “I need the purple bag from the rig”
- Walking outside under the pretense of grabbing equipment and using your cell phone to call dispatch
- A prearranged signal between you and your partner
The first time your crew has this conversation should not be at 2:00 AM on the call itself. Lt. Brenda Cowan of the Lexington (KY) Fire Department was killed in 2004 responding to a DV call. The NIOSH investigation pulled the same recommendation we are still making: coordinated interagency communication and training.
Trauma-Informed Interview Technique
Trauma-informed means non-judgmental, interested, concerned, and empathetic. Empathy is going on an emotional journey with the patient without becoming emotionally attached to it — a distinction we already make on pediatric calls and rarely make on DV calls.
What this looks like at the bedside:
- Reframe questions away from blame. Not “Did he hit you?” but “I’m seeing some injuries that don’t quite match what you described. Can you tell me more about how that happened?”
- Avoid “why.” It sounds accusatory even when it isn’t.
- Ask open-ended questions that invite a narrative. Then let silence do the work.
- Offer choices. People in abusive relationships live in environments where choice has been removed. Giving them small control starts the process of restoring it.
The patient you connect with on the first call may not be the patient who gets the repeat call next month.
Strangulation: The Call That Doesn’t Look Like One
This is the clinical pattern that most reliably predicts death.
The numbers: An intimate partner who has strangled their victim even once raises that victim’s risk of eventual homicide by 750%.
Fifty percent of strangulation victims show no external marks on the neck. Any marks that do appear may take days to emerge and may be too faint to photograph.
The distracting injury on a DV call is the lack of injury. If you run a trauma assessment and see nothing, keep looking.
Ask specifically about:
- Voice changes — raspy, hoarse, constant throat clearing. Ask: “Is this how your voice normally sounds?”
- Dysphagia — difficulty swallowing
- Airway symptoms — stridor, coughing, dyspnea, subcutaneous emphysema
- Memory gaps during the event
- Loss of consciousness, even briefly
- Loss of bladder or bowel control — sentinel symptom of severe strangulation. Ask directly, gently, privately.
- Petechiae — look at the conjunctiva, the skin behind the ears, and the hard and soft palate. On patients with darker skin, petechiae and cyanosis are significantly harder to see — compensate with a detailed exam and direct questions.
These patients need to get to an ED for evaluation of the need for a CTA of the neck. They are at risk for carotid artery dissection and stroke that can present days to weeks after the event. If your receiving hospital has a Sexual Assault Nurse Examiner (SANE) on staff, that is where the patient should go — SANE nurses are certified in forensic evaluation of strangulation, not just sexual assault.
Documentation That Holds Up in Court
You are not the investigator. You are the medical provider. Document what you saw, not what you assumed.
- Describe, don’t interpret. Not “fingernail marks on neck,” but “parallel half-moon abrasions along the right side of the neck.” Not “bruises consistent with a chokehold,” but “area of ecchymosis, approximately 3 cm, at the angle of the left jaw.”
- Refusal language matters. “Patient refused transport” with no narrative is easy to dismiss in court. Instead: “Patient allowed field assessment. Exam noted [findings]. Risks of non-transport including potential lethal outcomes were explained. Patient declined transport at this time citing [reason]. Advised to call 911 if symptoms change or worsen, and to present to the ED on her own.”
- Under the medical hearsay exception, statements a patient makes to you in the course of receiving medical care can be admissible even if the patient later recants or is unavailable. You are not documenting for prosecution — but what you write may be the only contemporaneous record that survives.
Two years from now you will have run thousands of calls. The only thing standing between you and the witness stand is your chart.
Key Takeaways
- You are already running these calls. Recognizing them is the first skill, and it is entirely a mindset and pattern-matching problem.
- The distracting injury on a DV call is the lack of injury. Strangulation leaves no marks in half of victims and raises homicide risk by 750%.
- Be careful keying the radio for DV concerns on scene. Build a covert signal with dispatch and law enforcement in advance.
- Document objectively and completely, especially on refusals. The medical exception to hearsay means your chart may become the case.
- The patient you connect with on the first call is the patient who lives to get the second one.
Further Reading
- DomesticShelters.org — find local DV resources by address
- National Domestic Violence Hotline — 1-800-799-SAFE · text START to 88788
- Gabby Petito Foundation
- Dr. Jim Hopper — neurobiology of trauma
- NFPA 455 — upcoming standard on first-responder violence risk
