Administration and Leadership, Columns

Pro Bono: Legal Considerations in Provider Self-Defense

Issue 8 and Volume 39.

It’s well-known that EMS providers can be exposed to all manner of potential violence. Patients under the influence of drugs or alcohol, patients with psychiatric disturbances, patients involved in assaults or other criminal conduct, or patients involved in highly intense or emotional events, such as domestic abuse cases, are just a few examples. EMS providers have a legal duty to care for their patients, but when does the provider’s right to self-defense kick in, and does that right trump the duty to act for the good of the patient?

First and foremost, EMS providers must protect themselves. Scene safety—including safety of the crew—is paramount. Providers can be of no use to anyone if they’re injured or incapacitated by a violent patient. Put another way, nothing in the applicable standards of care requires providers to sacrifice their lives, health or well-being for the benefit of a patient.

Second, some EMS providers may have particular expertise in self-defense techniques or may have even received police training. Nevertheless, it’s important to keep in mind that, when functioning as an EMS provider, your conduct will be measured by applicable EMS standards of care. In other words, the relevant question in court would become, “How would a reasonably prudent EMT (or paramedic) have acted under similar circumstances?” The standard of care isn’t, “How would a jujitsu-trained EMT have handled the situation?”

EMS standards of care address how to deal with violent patients. These protocols may vary, but they often include techniques such as verbal de-escalation and physical/chemical restraint. Some protocols may require consultation with online medical command in these situations; others may require the involvement of law enforcement. Generally, these standards of care or protocols would call for a clinical and/or operational approach to the management of violent threats—and the use of specialized police or martial arts training would ordinarily not figure in. An EMT might be a skilled former high school wrestler, but that wouldn’t mean the standard of care would permit him to put a violent patient in a head lock when functioning as an EMS provider.

Third, provider self-defense must be accomplished only with the equipment, supplies and medications that are called for in the EMS environment. Your state likely has a list of required items that must be carried in an EMS unit, and if those lists don’t include throwing stars and nunchucks, it’s probably not a wise idea to carry them. Most required equipment and supply lists include the necessary tools to permit providers to safely manage violent patients if the need arises.

Fourth, self-defense must be done in strict compliance with applicable state laws and regulations. Some states, for instance, expressly prohibit the carrying of firearms or other weapons by EMS providers on ambulances. Even if your state doesn’t prohibit it, your employer’s policy may prohibit the carrying of weapons on EMS units, and, of course, any weapons carried by EMS providers can end up being used against them by a patient inclined toward violence.

The bottom line: it’s best to check with your EMS agency to know exactly where you stand in terms of self-defense practices in the field. EMS agencies should be sure to instruct their personnel on the use of self-defense techniques that comply with state and local laws, regulations and protocols.

Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth, founding partners of Page, Wolfber & Wirth (PWW), a national EMS industry law firm. Visit the firm’s website at

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