Columns, Operations, Patient Care

Document On-the-Job Assault and Harassment

Issue 2 and Volume 40.

The Research
Bigham BL, Jensen JL, Tavares W, et al. Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: A mixed-methods cross-sectional survey. Prehosp Emerg Care. 2014;18(4):489–494.

The Science

This study was conducted in the Canadian provinces of Ontario and Nova Scotia. During their continuing education day, 1,884 paramedics were asked to complete a survey investigating their exposure to verbal assault, intimidation, physical assault, sexual harassment and sexual assault during the previous 12 months. Of those paramedics, 1,676 (89%) responded. The majority (1,257/75%) of respondents reported experiencing one or more of these violent episodes during the past year.

The most common form of violence was verbal assault, which 1,123 (67%) paramedics reported experiencing, followed by intimidation (687/41%), physical assault (436/26%), sexual harassment (235/14%), and sexual assault (50/3%). Not surprisingly, patients were the most common instigators of violence.

The authors’ conclusion: “The majority of Canadian paramedics surveyed experience violence in the workplace, which can lead to serious personal and professional sequellae. Strategies should be devised and studied to reduce violent events toward paramedics and to mitigate the impact such events have on the wellbeing of paramedics.”

Medic Karen Wesley Comments

Violence in the prehospital setting occurs when the patient or their family turns perpetrator. This study is fairly inclusive and clearly defines the different types of assault. The numbers of assault is staggering, and we know this is happening on a daily basis to EMS providers all over the world. Yet, unless it involves a fatality or some other profession, we don’t hear a whole lot about it.

The National Registry of EMTs estimates that 4 out of 5 providers are injured every year and 52% were the victims of assault. The Center for Leadership, Innovation, and Research in EMS (CLIR), in conjunction with several EMS advocacy groups, has developed a reporting system for EMS workplace violence. In 2013, 51 cases of violence were reported. In 2014, there were only 10.

Only 10 cases? So it really must not be a huge problem. We don’t get assaulted all that often so why worry about it? “It’s just part of the job. Hey, you have to expect to get slapped around and punched once in a while, so why report it and make it a big deal? What are ‘they’ going to do about it anyway?”

How many of you have been assaulted on the job, and how many of you have reported it? It seems like a huge disparity between the two numbers. Were you aware of the CLIR tool for reporting? Did you know it could be submitted anonymously? Go to and find out more.
If we don’t use the tools available for reporting and learn to be our own advocates against violence, we certainly can’t cry foul when administration isn’t on board and protecting us. If we don’t demand that it be given the proper level of attention at state and national EMS conferences, as well as in initial and continuing education, there’s little chance we’ll address and correct this issue.

Seriously people, where’s the outrage? We placate ourselves by saying we live in a culture of violence, so we have to expect it. Violence isn’t a culture. It’s a crime. We need education and we need resources, but first we need to report these crimes.

Will you wait until you’re the victim and seriously injured? Or will you help now to make this recognized as a national crisis for EMS providers?

Doc Keith Wesley Comments

I second Karen’s argument. However, according to the findings of this study, we must address the behavior of our colleagues before we can ever hope to deal with violence from our patients.

According to this study, co-workers were the source of 20% of the episodes of verbal assaults, 44% of intimidation, 3.6% of physical assaults, 42% of sexual harassment, and 13% of sexual assaults. Female providers were more likely to be victims of intimidation from a colleague than a patient or their family. The source of sexual harassment was second only to the patient in frequency.

This is a disgrace. Perhaps, contrary to what Karen said, there’s a culture of violence. Until we stand up and declare this unacceptable and that we won’t take it anymore, we’ll continue to foster a mentality that blames the victim rather than the perpetrator.

Now, to be fair, it’s possible that the experience of these Canadian paramedics isn’t representative of the Unites States EMS workforce. But I doubt it. The Canadian workforce is better organized and professionally represented than many of their fragmented American cohorts. We can only take so many precautions to protect ourselves from patient-initiated violence, but we should never have to be afraid of our co-workers.