FEMA recently posted an article pointing to a report on violence against EMS practitioners. It shows what EMS are up against in the field; yet as a 16-year EMS veteran I can’t help but think no matter how thorough the report is, it only tells half the story.
EMS professionals often don’t report the violence they encounter on the job. Physical abuse can take many forms. Assaults can be minor or may not result in injury to the provider. Some are downright deadly like an incident in Arkansas last year when a volunteer firefighter was fatally shot while on an EMS call. Others are fatal for the assailant, as was the case in 2016 when a Boston Police officer shot and killed a mentally unstable man that was assaulting officers and the EMS workers who were trying to help him. The same day that FEMA posted their article about EMS violence, the district attorney in Boston ruled that the police officers were justified in killing that man.
In my experience riding the ambulance, managing emergency services for large municipalities and as the NFPA liaison responsible for engaging with stakeholders about EMS best practices and health and wellness, I’ve learned that many providers do not report instances of violence for many of the same reasons that I didn’t. During my career, I was assaulted several hundred times by patients but only reported about 15 incidents (because I suffered some form of injury) and only went to court six times when charges were pressed.
It is believed, although it has not been studied yet, that not reporting violence against EMS is widespread throughout the United States. Providers don’t report assaults to law enforcement or supervisors, so oftentimes administrators are unaware of the magnitude of this problem. There are many individual factors why EMS workers don’t report violent incidents. Here are the ones that influenced my decisions:
- I felt sympathetic towards the sick and impaired, and didn’t want to get them in trouble
- I was assaulted by patients who were suspected to be under the influence of some controlled substance, and law enforcement was hesitant to charge them because they wanted them to be medically cleared
- I may have not had a visible injury
- There was no injury
- I felt peer pressure to act like I was tough and that the assault didn’t affect me
- I simply accepted it as “part of the job”
The EMS violence study is a tremendous starting point - although it only focuses on EMS workers employed by large, urban fire departments. This is likely due to lack of data. There are some noteworthy observations from the study including:
- EMS workers are more likely to be assaulted by patients than their firefighter colleagues
- Gender does not determine who gets assaulted
- There is a disconnect between EMS workers in the field and the dispatchers who collect information about the medical emergency
- There is a general lack of knowledge about preventing violent EMS attacks. Free online training opportunities, like this National Institute for Occupational Safety and Health course, can help
- Signage in the back of ambulances stating “it is a felony to assault a first responder” may deter patients from assaulting EMS workers. These are used in Canada and the United Kingdom. They show support for EMS workers
- Computer-aided dispatch (CAD) systems should utilize a flag system so that dispatchers can alert EMS workers about prior patient-initiated violence at the location. Urban departments in Dallas and Montgomery County, Pennsylvania have this feature
- Fire departments can reduce provider stress levels by looking into more personnel to ensure that EMS workers have breaks during their shifts to encourage occupational recovery
- Management should support EMS providers during legal proceedings after an assault occurs
The strength of the data out there clearly demonstrates a need for further and deeper exploration into this subject. Another consideration is encouraging EMS workers to report violent incidents to programs such as the CLIR EMS self-reporting tool so that more robust data can be collected.