Is EMS Still the Most Dangerous Profession?



Alexander L. Trembley, NREMT-P | David Page, MS, NREMT-P | From the July 2014 Issue | Tuesday, July 8, 2014

Time to Take Action
1. Maguire BJ, O’Meara PF, Brightwell RF, et al. Occupational injury risk among Australian paramedics: An analysis of national data. Med J Aust. 2014;200(8):477–480.
2. Maguire BJ, Smith S. Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehosp Disaster Med. 2013;28(4):376–382.

Kudos to Brian Maguire, DPH, MSA, EMT-P, and Peter F. O’Meara, BHA, MPP, PhD, for their long-term commitment to occupational injury research for EMS. It was in 2002 that Maguire was the lead author of a paper published by the prestigious Annals of Emergency Medicine calling attention to “Occupational fatalities in emergency medical services: A hidden crisis.”

More than a decade later, this crisis continues. Both Maguire and O’Meara are tried and true street paramedics who have put their street smarts to work in the academic world by earning PhDs and dedicating their careers to studying improvements to our profession.

Loyal research fans may recall that our November 2011 column, titled “The Most Dangerous Job: Study raises awareness about the many hazards of EMS,” looked at a study by Reichard showing EMS workers had similar, if not higher, rates of serious injury and mortality than police officers or firefighters. Now, three years later, has anything changed?

The study’s new data, collected in 2014 from Australia and 2013 from the United States unfortunately confirms the 2011 study.

The Australian research comes from Central Queensland and La Trobe Universities, and shows EMS worker fatality rate of 9.3 per 100,000 workers (Reichard reported 7.0 in 2011 in the U.S.). Nationally among all careers, the Australian EMS fatality rate was 1.6 per 100,000.

Maguire and O’Meara performed a retrospective descriptive review of data from Safe Work Australia, a national data collection point, from 2000 to 2010, evaluating injuries in which greater than one week of work time was lost. The most common injury was muscular stress while lifting, carrying or moving objects at 44%; the overall rate of injury per worker was 80 per 1000 with a 95% confidence interval of 57.7 to 106.9 per 1,000 workers.

Significant injury rates among paramedics in Australia were more than double that of police officers. Interestingly, the rate fluctuated during the study period, but remained consistently higher than the national average. In 2000–2001 the injury rate was 81.4 workers per 1,000 compared to 94.6 per 1,000 in 2008–2009 and 85.0 per 1,000 in 2009–2010.

In Maguire’s 2013 article published in Prehospital and Disaster Medicine, he evaluated five years of data (2003–2007) data from the U.S. Department of Labor and Bureau of Labor Statistics and found 21,749 reported cases of injury and lost work time. Among those, 21,690 involved nonfatal injuries or illnesses that resulted in lost work days among volunteer, paid, full-time and part-time EMTs and paramedics in the private sector. Two thirds of reported injuries involved muscular sprains and strains, 43% involved back injuries, and 37% were listed as the patient being the source of injury. During the same study period, there were 59 reported fatalities among all EMTs and paramedics. Of these, 51 (86%) were related to transportation, and five were listed as the direct cause of assault or violent crime. This also works out to 349.9 cases of lost workdays per 10,000 full-time employees compared to 122.2/ 10,000 for all private industry occupations. The statistic shows a nearly threefold increase in injury rates among EMTs and paramedics when compared to the rest of the private sector.

However, the authors weren’t able to attain data on EMS workers employed in fire departments, which could mean EMS-related injuries and fatalities may actually be a greater problem than initial numbers report. We strongly suggest reading these two papers as this column can’t do justice to the volume of information they contain.

Discussion: So, what does this all mean? Simple: It’s time to take action. The American College of Emergency Physicians recently released a recommendation, available online at, for a culture of safety among EMS workers, and efforts to track dangerous events in real time are paying off through an anonymous reporting site at Readers are encouraged to report near-misses and safety-related events to better document and hopefully improve EMS safety.

Conclusion: From what we can see in this available research, EMS remains among the most dangerous professions in the world. Our industry can’t tolerate the unsafe practices we’ve become accustomed to. Safe workplace habits, lifting, lifestyle and driving improvements must win over cavalier, dangerous and old ways of doing our job. It’s vital providers and their leaders embrace a new culture.

Bottom Line
What we know: EMS ranks among the most dangerous jobs in the U.S.
What these studies add: Unfortunately, Australian EMS workers have a rate of injury that’s comparable to U.S. EMS and is seven times higher than the Australian national average.


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Health and Safety

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Related Topics: Health And Safety, Provider Wellness and Safety, EMS provider injuries, EMS on the job injury data, ems injuries, : line-of-duty deaths, Jems Research Review

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Alexander L. Trembley, NREMT-P

Alexander L. Trembley, NREMT-P, is a paramedic for North Memorial Ambulance in Brooklyn Center, Minn and at Lakeview Hospital in Stillwater, Minn. Contact him at


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David Page, MS, NREMT-PDavid Page, MS, NREMT-P, is an EMS instructor at Inver Hills Community College and field paramedic with Allina EMS in the Minneapolis/St. Paul area. He’s also on the board of advisors for the UCLA Prehospital Care Research Forum. You can bike with him during the next EMS Memorial Bike Ride.


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