Columns, Operations

Pro Bono: Violence Against EMS Providers

Issue 8 and Volume 42.

The hazards that come from everyday EMS operations are inherent in the job, but then one must confront the added risks of terrorism, biological or chemical attacks, patient assaults or random acts of violence directed against EMS personnel who are merely going about their jobs. Fortunately, the overall incidence of serious or deadly force violence against EMS providers is relatively low.

Assessing Risks

Although EMS agencies can’t guard against every threat of violence their personnel may encounter, they should ensure that their employees have the basic tools they need to address. This starts with an assessment of all reasonably foreseeable risks.

Agencies in some areas make body armor available to their personnel, while other agencies have determined that this precaution is unwarranted. There are no fixed rules as to what an EMS agency’s legal obligations may be in this regard. If your state’s EMS regulatory agency mandates the use of certain protective equipment, then your agency would be obligated to comply. As of this writing, we’re not aware of any state EMS agency that requires body armor be issued to their field personnel.

EMS agencies should ensure that their personnel receive adequate training to address reasonably foreseeable threats of violence they may encounter on the job. This would include basic scene size-up and safety, positioning themselves and their vehicle for maximum protection, situational awareness, coordination with law enforcement agencies and other precautions.

Some agencies participate in tactical teams and provide their personnel with detailed training in tactical EMS operations during violent incidents, but that’s typically in furtherance of the development of a specific tactical EMS team and not training that’s made available to rank-and-file EMS providers.

Self-Defense

EMS agencies should ensure that their personnel also receive basic training in self-defense. It’s important to remember that “self-defense” in the practice of EMS may differ from traditional self-defense techniques of martial arts or weaponry. Specifically, while in our personal lives we have a right to keep a firearm in our homes and, in many cases, use deadly force to protect ourselves from bodily harm, the right of self-defense is different in the context of providing healthcare services.

The conduct of an EMS provider is measured by applicable standards of care. The standard of care is not, “How would a jujitsu-trained EMT have handled the situation?” The relevant question in court would be, “How would a reasonably prudent EMT (or paramedic) have acted under similar circumstances?” EMS standards of care address how to deal with violent patients.

Instead of self-defense with a weapon or martial arts skills, EMS providers would be expected to exercise self-defense techniques consistent with EMS standards of care. This means techniques such as verbal de-escalation, retreat, physical restraint or chemical restraint all might be seen as reasonable conduct. Some protocols may require consultation with online medical command, while others may require the involvement of law enforcement.

Generally, these standards of care or protocols call for a clinical and/or operational approach to the management of violent threats and the use of weapons (which most states prohibit EMS personnel from carrying).

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 that the standard of care permits him or her to put a violent patient in a headlock.

Equipment

Provider self-defense in violent situations must be accomplished only with 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. Most EMS-required equipment and supply lists include the necessary tools to permit providers to safely manage violent patients when the need arises.