Administration and Leadership, Columns

Pro Bono: Self-Defense & the Risk of Liability

Issue 6 and Volume 41.

Recently an EMT was arrested for allegedly assaulting a patient in the back of an ambulance. He was charged with third-degree assault after he was transporting a patient for a psychiatric evaluation and allegedly struck the patient in the head with an iPad after a heated exchange of words. A witness allegedly observed the EMT grab the patient by the throat and push down on it before striking the patient in the head.

Fortunately, that kind of story is rare, but EMS personnel deal with violent and potentially violent patients every day and they need to prepare for it. That involves training on reducing the potential for confrontation and knowing essential self-defense skills to protect yourself and others in the event of a violent outburst by a patient or others. The days of EMS sitting back and law enforcement handling these situations are long gone. We have no choice in many cases but to deal with the situation. We need to be prepared for the unexpected.

There’s minimal risk of liability for conducting self-defense training and we believe this training will actually reduce risk to the EMS agency and individual EMS provider. Most confrontational situations can be de-escalated with proper training of EMS personnel. And yes, knowing how to physically protect oneself against a violent patient is an essential skill in today’s world. We’re not aware of any successful lawsuit in which a patient successfully won monetary damages against an EMS provider for an alleged assault.

Yes, there are potential criminal charges that can be brought against an EMS professional for alleged assault, battery, false imprisonment and other typically misdemeanor or low-grade felony charges. But these charges are very rare and most often dismissed, except in egregious situations like the one described above. Typically, district attorneys are reluctant to bring these types of cases against EMS professionals in light of the very difficult circumstances that they encounter and must deal with.

But there are many ways to avoid potential liability. Here are just a few points:

Get proper training. There are excellent programs that focus on de-escalation of potentially violent situations and the best programs employ the use of effective communication skills over physical skills. But physical self-defense techniques are an important part of this training. Obtain training from a reputable professional with good references and a record of success.

Implement proper policies. Make sure you have effective policies on how to handle potentially violent patients. Safety of the EMS providers should be the overriding theme of all policies and protocols to deal with these situations. Incorporate medical direction, law enforcement, crisis intervention and other community professionals in developing these policies. Research what other agencies are doing and include the best practices from those policies into your own. Educate everyone and train regularly on how to handle these situations in accordance with the established policies.

Keep calm and practice situational awareness. Many difficult and confrontational situations can be avoided if proper initial assessment of the threat risk is made at the onset of the incident. Approach any scene carefully and look around to assess potential threats as you approach. Contact law enforcement in any situation where you feel there’s a potential for violence by a patient or anyone else.

Being prepared is the key to survival and to avoid physical harm to yourself and other responders. We have an obligation to ensure that our people know how to properly handle confrontation and to employ appropriate de-escalation, escape and self-defense techniques when necessary. The key is to act reasonably: What would another similarly situated EMS provider do when lunged at by a violent patient or other person at the scene? We think it could well be reasonable-and unavoidable-in some situations to put your hands on an attacker to prevent that person from seriously injuring you or others on the scene.

Pro Bono was written by the attorneys at Page, Wolfberg & Wirth, The National EMS Industry Law Firm. Visit the firm’s website at or find them on Facebook, Twitter or LinkedIn.