 As a public health field worker, there are a lot of people whose very well-being depends upon your safety. Your coworkers, family, and of course your patients. Dangerous situations can develop anywhere. And as a public health field worker, you need to be especially careful, because you'll often find yourself in unfamiliar settings. Therefore, personal safety should always be one of your top priorities. The first time you go into the field alone is always a little unnerving. I remember my first day like it was yesterday. Gayle, my supervisor, had really been impressing upon me the importance of personal safety. Our little motto was leaving to return. I'll never forget that. So, are you a little nervous about today? You mean about going out into the field alone? No, I think I'm ready for pretty much anything. That's what I like to hear, confidence. So, let's get down to business. What does your schedule look like for today? Well, since this is my first day, I kept my schedule a little bit on the light side. I've scheduled two field visits, one in the morning and one in the afternoon. My first scheduled appointment is Mr. and Mrs. Jarvis. They live in a trailer park about 15 miles out of town. They're part of a TB contact investigation that we're conducting. All right. And your second field visit? Pamela Robinson. Pam lives in the Bleecker apartments over on Willow Street. She's on directly observed therapy for TB. She's been on medication for two weeks in the hospital and has just recently been discharged. Looking at her medical record, she seems to be doing fine. Is this your first visit with her? No, actually I met her last week. But this is the first time I'll be visiting her at her apartment. I've called ahead. She knows I'm coming. Okay. Sounds like a good first day. Oh, I might as well jump right in. Hold on. Before you go, three things. First, be sure you sign out of the office and that includes what time you left. Got it. And your county ID? Always. Okay. And did you remember all your paperwork? Right here. Okay. If you have any problems, give me a call. Okay. I've learned firsthand that documenting all unusual activities that you come into contact with while you're out in the field is crucial to your safety as well as to others. If you don't document that a patient has a drug problem or a vicious dog that runs loose in their front yard, you're running the risk of endangering both yourself and the next field worker that happens to visit that address. Lesson number one. You can never over plan when going into the field. Having a map with the directions to the location, including an alternate route is absolutely essential. Why an alternate route? Remember, you're driving to an unfamiliar location and an accident or construction could throw you way off the beaten path. Bottom line, there's no excuse for not bringing a map along. And if you can't find one in the store, there are a lot of resources on the internet that will print out directions to virtually anywhere. Understanding public transportation is also important. Cars can and do break down. I work in the city and knowing the bus routes has come in very handy. Here are a few other handy items. An auto club card, cell phone and a phone card. You're going to find yourself in unfamiliar territory almost every day and Gales made it an office policy to call in at least once a day. So the ability to reach the office from the safety of my car or from a pay phone is extremely important. I know a lot of people might think this is overkill, but I always do a quick routine check of my vehicle before going out. You know, gas, oil, is my spare tire good, jumper cables, flares and a working flashlight. Blankets, gloves, matches, that sort of stuff. I also make sure to have my car checked out by a mechanic on a regular basis. Knowing that my vehicle is ready for a trip gives me peace of mind and the chance to focus on my field visit. I made my way out to the Jarvis's in no time at all and as I was pulling into the trailer park and up to the residence, I noticed one thing that you run into a lot more often in a rural setting and that's a chain dog. Good boy. Want to give your owner some information? I'll just be a couple of minutes. Good boy. You should never touch an unfamiliar or unfriendly dog. An animal can get angry or frustrated for lots of reasons. One of them from being chained up or tied up. But you can usually tell when an animal is dangerous. With a dog, for example, you have to be careful about an aggressive posture. You know, their ears stick straight up, their body and their tail become very stiff. They might growl or snarl and if they begin to bear their teeth or curl their lips, I'd say you're definitely in the midst of one angry dog. You'll also find plenty of dogs when visiting patients in the city. When I saw a dog appear at the entryway, I always made sure to place a bag, package or clipboard between the animal and me. And if that didn't work, I would politely ask the owner to restrain his pet. And politely is the operative word here. If you start yelling at an owner, you're very likely to provoke the pet. And one other little trick that always worked for me was keep one foot on the outside of the door so I could shut it quickly if I had to. My strategy with this dog was simple. Don't surprise him. Walk non-aggressively to the front door. Yes. Mrs. Jarvis? Yes. Mrs. Jarvis, my name is Tom Santos. I'm with the county health department. Who the hell is it? I think he's a salesman. Well, whoever it is, tell me don't want any. I'm sorry, sir, we're not interested. No, Mrs. Jarvis, you don't understand. I'm with the county health department. We're conducting a contact investigation. Someone you and your husband have recently been in contact with has been diagnosed with tuberculosis. It's very important that I give you some information. Charlotte, if you don't stop flirting with that salesman, I'm gonna give you something to cry about real quick. Is that your husband's voice, Mrs. Jarvis? You better come in. Honey, this man is from the county. He's here to talk to you about tuberculosis. What? Mr. Jarvis, I'm Tom Santos with the county health department. Yeah, to hell with all that nonsense. I'm gonna know where you got my name and what this has to do with tuberculosis. We're conducting a contact investigation. Someone you and your wife have recently been in contact with has been diagnosed with TB. If it was your brother Larry who gave us this, I'm gonna kill him. You leave Larry out of this. He's a good man. I mean good for nothing. Just like you, a pathetic waste. Mr. Jarvis, if you just give me a few minutes of your time, I can give you some information. No, it's Larry. I just know it. Stop! Please stop! Oh, stop your whining. Let's take this outside, buddy, huh? I knew the minute that Mrs. Jarvis opened the door that there was a problem. But my objective was to give them the information and then get out of there safely. Mr. and Mrs. Jarvis, I realize that this is an uncomfortable situation. I'm here as a representative of the county health department. If you give me just a little bit of your time, I'd like to share some health-related material with you. After things settled down a bit, I talked to the Jarvis's and gave them the health-related information that I needed to. At which point, Mr. Jarvis showed me the door. Skip works really hard for us. He has a bit of a short temper, but that's because he's over-tired a lot of the time. If he just would have given me the name of the person who gave him my name, this whole mess could have been avoided. When I spoke to the individual who gave me the Jarvis's name during the initial phase of the TB contact investigation, I asked the person for a physical description of the couple. Taking a physical description isn't as difficult as it sounds. When looking at height, compare the height of the person with your own, and that goes the same for weight as well. What color is the person's eyes and hair? How about their age? How about their ethnicity or the color of their skin? Could you describe the person's skin tone and complexion? Does the person have facial hair? If yes, what color is it and what style? Is it a goatee, a full beard, or a mustache? Does the individual wear glasses or have any discernible features like tattoos or scars? Does the person walk with a limp? Anything that might make this person stand out needs to be documented thoroughly. And finally, what about the person's name, or maybe more importantly, their alias? Many people have nicknames or street names that most people know them by. When Tom called in and told me about the situation at the trailer park, I asked him if he had documented everything he had seen, including the dog and the possibility of domestic violence. He said he had. Good work. After leaving the trailer park, it was back to the city for my second field visit. I had just enough time to get a bite to eat and wouldn't you know, I didn't have enough cash on me. So I had to make a quick stop at an ATM. We use ATMs all the time, but many of us don't realize the potential safety hazard it poses. You need to stand directly in front of a machine so your activity can't be observed. If you see anything suspicious, cancel your transaction right away. Once you've made the transaction, pocket your cash immediately. ATMs may not be safe places at night, so if you have to use one, don't go alone. Driving to a city location is quite a bit different than the country. After you've become familiar with the map and know exactly where you're going, you should take a few extra minutes to check out the neighborhood. Are there a lot of shrubs and trees for hiding places? Are there possible escape routes? Do you see any unusual street activities? Is the neighborhood busy or quiet? Have you identified any safe havens like a police, fire, or gas station? A shopping center or public building is another possible option. Becoming familiar with the surroundings before leaving your vehicle is really the first step in helping you stay safe once you get to your final destination. However, if you do find yourself in a situation where you need to ask for directions, roll your car window down only a few inches. Remember, the person you're asking directions from is a stranger. Parking is one of those issues that just requires some plain old common sense. Park your car in an area that's surrounded by other vehicles. Stay away from isolated spots like alleyways. Lock your vehicle and take anything of value and secure it in the trunk. Park your car facing the direction in which you want to leave. And don't forget, some locations don't provide public parking, so make sure you have change for the meters or a few extra dollars for the parking garage. I can't tell you how many times a week I address the issue of clothing and accessories. Here's a few tips. Dress comfortably but appropriately and let common sense be your guide. Chains and dangling earrings and glittery jewelry are a definite no since it could make you a target for a robbery. Wear comfortable shoes with flat heels so if you have to run, you can. And when it comes to money, carry a very small amount of it and keep it in a wallet, not a purse. As I was making my way to Pam's high-rise, I made sure to walk with a purpose like I know exactly where I'm going. I walked facing the traffic so I could see approaching cars near the curb and away from buildings and scaffolding because I wanted to eliminate the element of surprise. Hi Pam, it's Tom Santos. Great. I'd never been in this building before so after checking possible escape routes I went to the stairwell. I opened the door and the minute I saw how deserted it was I trusted my instincts and used the elevator instead. Now you're probably thinking, of course you don't go into a deserted or dark stairway but what if the elevator isn't working? In that situation a flashlight can come in real handy so I always make sure to have one in the car when I go into the field. However, if you do decide to take the elevator here's a quick tip. Always make sure you observe what floor the elevator is coming from and where it's going. If you need to get to the third floor the last place you want to find yourself is in an isolated basement. Hi Tom. Good afternoon Pam. We had an appointment right? Yes we did. Come right in. Am I disturbing anyone? No, it's just me and the cat. Okay, shall we get started? Sure, I'll get my medication, a glass of water and I'll be right with you. Make yourself comfortable. I always use the phrase am I disturbing anyone? Rather than are you here all by yourself? For this reason. From a safety perspective you can never assume that someone is alone in their residence and I feel phrasing it that way gives me a much better chance of getting an honest answer. I always appreciated the fact that Tom really stressed the whole idea of absolute confidentiality but since he was going to be visiting the neighborhood frequently I told him to say that he was a friend. This neighborhood can be pretty dangerous at times and once everyone in the apartment complex knows he's not a threat they'll be much more likely to keep him out of harm's way. Leaving a neighborhood can be just as dangerous as getting there. By the time I left Pam's apartment it was the middle of the afternoon and the streets were becoming a little busier. Hey Laura, is that your new boyfriend? I know he could be. Hey mister, are you married? Are you sure you're in the right neighborhood? He's visiting a friend. Maybe I know him, who is it? You guys have a nice day. What are you doing here? Can you slow down for a second? You have no business here. Can't you walk with somebody? Why don't you answer us? You have no business here. Whenever you're confronted by strangers you need to be smart. First, if an encounter appears to be dangerous end it immediately. Trust your gut instinct and avoid confrontation. As you walk away from the situation walk with some sort of low barrier between you and the individuals like a mailbox or a railing and as you become more familiar with the neighborhood it's very important that you get to know the trouble spots where drug trafficking takes place and where gangs tend to hang out. I made a mental note. This neighborhood could be very dangerous and in the future making an early morning appointment with Pam would be the way to go. I just bought an alarm for my car which is a good safety feature to have. However, it does present one problem. As soon as you turn off the alarm and that little beep sound goes off it's immediately given away your position to anyone who might be in the area. So it's important to make sure that you don't use it until you're very close to your car. As you're approaching your car take a quick look underneath and before you get in it's always a good idea to check the back seat as well. People have an incredible way of blending into the environment and you can never be sure that someone isn't hiding a few feet from your car or hasn't broken into it. Anyway, at the end of that first day there were only two things on my mind. Actually three. A hot shower, a big steak and the fact that if I could get through today tomorrow was going to be a cinch. When it comes to personal safety always go with your gut instinct. If something doesn't feel right it probably isn't. Personal safety is a matter of choice and it's not always going to be convenient. One day and maybe one day soon you could very well be faced with a situation that's going to require an immediate response. One could never cover every personal safety tip that's out there. But by becoming more aware of personal safety issues in general you'll dramatically increase your chances at making the right decisions when you're out in the field. A lot of people depend on public health field workers. Don't let them down. Make a plan now so you can leave to return.