Preventing Violence Against EMS

A documented incident pulled from the EMS Voluntary Event Notification Tool (EVENT) states: “Called for chest pain. Performed normal exam and 12-lead on patient in her home. Patient had no desire to go to the hospital and refused transport. The patient (without warning) screamed and grabbed my partner and managed to scratch his face a couple times. He was defending himself from her unarmed strikes with our tablet computer. I dropped the ECG cables and pulled her off of him, and she then attempted to bite my arm. I was able to push her onto the bed and that time her boyfriend ran into the room and restrained the patient. For safety and since the patient had already signed all the forms and didn’t want to be transported, we left the scene and reported the incident to management right away. They weren’t interested in the report since we were no longer on scene. No follow-up was ever performed by the company and we were disciplined for the incident later because the patient called and complained about us.”

A Common Occurrence
We know EMS providers are regularly assaulted or battered in the line of duty because we witness it on a regular basis. At a recent EMS conference, by show of hands, more than 90% of participants acknowledged being assaulted or battered on duty. This isn’t a new problem. A study in Southern California in 1995 revealed an assault or battery occurred in 8.5% of patient encounters.1 Unfortunately, we don’t have a good grasp on frequency, severity, demographics or contributing factors outside of this study.

Management Perspective
I can’t imagine a worse scenario as an administrator than to have one of my staff seriously injured or killed as a result of violence in the workplace. We must prepare for and mitigate situations that may turn violent.

First, we must get a better grasp of the problem. The Center for Leadership, Innovation and Research (CLIR) in EMS launched EVENT in 2010 to collect data on adverse events in EMS. Partnering with the National EMS Management Association and the End Violence Against Paramedics initiative, CLIR expanded EVENT to include violent procedures. Now EMS providers can anonymously report incidents into an international database as they occur.

It will take time to garner enough records for analysis, so I encourage providers to use the tool for all adverse event reporting. According to EVENT’s website, “The data collected will be used to develop policies, procedures and training programs to improve the safe delivery of EMS.”

This data and the accompanying anecdotal narratives can be used to change laws as needed. Assault and/or battery are crimes and should be prosecuted. Although EMS is a dangerous business, it’s not acceptable to condone (through inactivity) violence against our staff. As administrators, we must do all we can to provide a safe working environment. I suggest the following actions:

Be prepared. The best tool to avoid conflict is your brain. One must remain vigilant and avoid complacency on any scene. My most frightening experiences in the field occurred on routine calls (back pain, MVAs, unconscious subjects) when I wouldn’t expect a violent encounter. Law enforcement officers are trained to observe everything around them and not tunnel in on one thing. It’s not easy when chaos is swirling around you, but it’s necessary for your safety. When a provider walks into a back bedroom, don’t initially focus on the patient in the bed–take in the surroundings. Observe the behavior of family members, the medication bottles on the bed stand and, of course, the handgun on the dresser. As taught in the National Association of EMTs safety course, partners should position in an “assessment L” to prevent a potential attacker from focusing on both providers simultaneously.

Develop and enforce policies and procedures that deal with scene safety and violent encounters. This includes staging, use of law enforcement assistance, supervisory response, use of physical and pharmacological restraints, reporting incidents, etc.

Implement training programs to better prepare your staff for potentially violent encounters. This includes scene size-up, deescalating conflict, escape routes, defensive escape tactics, etc.

Use equipment. Purchasing ballistic vests or arming your medics is a local decision. However, I’m not an advocate unless certain caveats are met. If you wear a vest, wear it all the time on duty. Donning a vest for the “bad calls” is like only putting on your seatbelt when you’re going to have an accident. You never know when it will happen, so don’t create a false sense of security with casual use. If your medics are armed, you’ll have a gun on every scene. If carrying, the holder must qualify quarterly and be extensively trained in handgun retention techniques–a huge commitment beyond clinical training.

Support your staff with a zero-tolerance policy. Encourage filing charges against assailants who assault or batter your staff for non-medical reasons. Substance abuse is not a justification. Law enforcement doesn’t tolerate the “they’re just drunk” excuse. Stand by your employees’ side throughout the process. Progressive discipline for employees should only be considered if it’s believed they played an active, intentional role in escalating the circumstance.

As a leader, it’s time we step up and say no more. Everyone goes home after each shift without injury. We owe that to them.


1. Grange JT, Corbett SW. Violence against emergency medical services personnel. Prehosp Emerg Care. 2002;6(2):186—90.

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