Violence Against EMS Providers: What Can We Do About It?

Skip Kirkwood is a featured speaker at EMS World Expo 2012, Oct. 31–Nov. 2, at the Ernest N. Morial Convention Center, New Orleans, LA. For more information, visit EMSWorldExpo.com.

Violence is a complex issue, and responding to it in ways that are appropriate, effective and acceptable is even more complex. It becomes especially challenging when decisions involve business or governmental entities, where issues of employer involvement and liability come into play.

The question raised by some colleagues about arming EMS providers is a deep one. We admit up front that we think firearms are not the solution to our complex problem—few of EMS’ violent encounters involve such application of deadly force that the use of deadly force would be justified in response. But the discussion is a symptom, indeed a significant one, that something is wrong.

Our brothers and sisters in the field are afraid (not the cowardly afraid, but the thoughtful, mature state of mind that recognizes that violence is a possibility for which they are not adequately prepared), but talking about being afraid of violent encounters is not “cool”—so discussion instead leaps to an easy-to-grasp, dramatic and controversial “big” solution that raises more questions than it answers.

At the same time, at the organizational level, in educational institutions and in state EMS offices, this topic is rarely discussed. Managers don’t see the problem because violent encounters are mostly not reported. For a number of reasons, EMS seems to have developed its own “don’t ask, don’t tell” culture—bosses don’t ask, and medics don’t tell. Educators give the topic short shrift because it is poorly addressed (if at all) in textbooks and teaching resources, and most educators are neither well informed nor equipped to address it.

So what’s the deal? Violent encounters are of concern to medics in the field, but not the structures that support them? Why not?

The Problem

Violence against EMS providers takes many forms. Most acts of violence are less than deadly. The risk of non-fatal assault resulting in lost work time among EMS workers is 0.6 cases per 100 workers a year; the national average is about 1.8 per 10,000 workers. Thus the relative risk of non-fatal assault for EMS workers is roughly 30 times higher than the national average. Over a five-year period during which 91 line-of-duty fatalities were identified, 10 (9%) were violence-related.¹ The relative risk of fatal assaults for EMS workers is about three times higher than the national average.

The National Association of Emergency Medical Technicians (NAEMT) found four in five medics have experienced some form of injury as a result of the job. The majority, 52%, claimed to have been injured by assault. More than 20% ranked personal safety as a primary concern.²

Yet this issue is not widely discussed and not considered a priority by EMS executives, researchers, educators or providers. This attitude lies in stark contrast to those of our law enforcement and fire suppression colleagues, whose culture, training, equipment selection and daily activities focus first on survival. “Everybody goes home intact at the end of the shift” is deeply ingrained in the culture of the police and fire communities.

A majority (54%) of respondents to a recent survey of rural EMS providers reported they had not received any employer-sponsored training on dealing with potentially violent situations, although 25% said they had been physically assaulted while performing their duties.³ A study in Australia found that rural ambulance officers reported nearly twice the instances of violent encounters as their urban counterparts.⁴ Recent articles, papers and programs in Canada,⁵ the United Kingdom,⁶ France⁷ and Australia⁸ address this issue in a variety of ways and demonstrate that it’s a universal phenomenon.