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

Most assaults on EMS providers involve unarmed attacks (punches, kicks, grabs, etc.). Most law enforcement trainers will tell you that drawing a firearm in the midst of a grappling-type attack is a poor idea. Historical data indicate that many police officers shot by criminals have been shot with their own weapons, which were taken away and used against them. LEOs rarely find themselves “locked in” with individuals who may assault them—weapons are removed before entering jails or prisoner transport vehicles. EMS personnel in moving ambulances would face extreme difficulty if any “patient” became aware of their weapon and tried to take it from them.

Few EMS agencies have comprehensive, policy-based approaches to issues of violence against staff. These programs should include a statement of policy, training and tools to implement the policy.

Training EMS

Some providers and administrators may erroneously perceive defensive training as a form of offensive conduct or fighting. Some fear that if an EMS agency trains its staff in techniques for dealing with violence, the staff may try out their new skills in a manner that could bring harm to the agency. Regardless of its reasons for not providing training for its staff, it would be difficult for an agency to defend the actions of an employee who used inappropriate and excessive force when the agency had not supplied them with training or an appropriate alternative. Not training field personnel in appropriate response can have devastating consequences.⁹

Some agencies, with good intentions, have introduced training delivered by law enforcement “defensive tactics” instructors to their personnel. These courses are often well received by field EMS providers. However, there is an issue with law enforcement defensive tactics—most of them are not defensive at all! All law enforcement combat activities have a single endpoint in mind: control and custody of the opponent. Thus law enforcement defensive tactics instruction may, if not carefully adapted, lead an EMS provider deeper in to a violent encounter, rather than helping put distance between the attacker and the EMSer. These programs also often fail to differentiate between medical restraint and self-defense, and between uncooperative patients whose actions are medically induced (hypoxia, hypoglycemia, etc.) and those engaging in purposeful violence.

Another dangerous path lies in “self-defense” courses offered by local martial arts studios. Individuals teaching these programs likely have no experience in the healthcare environment or with the unique needs of EMS providers. Moreover, most martial arts training involves some competition, which means teaching participants to “win,” not to escape. Escape should always be the goal of the assaulted EMS practitioner.

One author (Teitsort) teaches EMS-specific techniques and tactics for avoiding and escaping violent encounters. His programs, known as Defensive Tactics for EMS (DT4EMS) and recently retitled Escaping Violent Encounters for EMS and Fire (EVE4EMS/Fire), bring practical skills for defusing, avoiding and escaping purposeful violence while appropriately managing medical patients demonstrating physical manifestations.

One surprising revelation after EVE4EMS courses: The students uniformly ask for more training, while managers of their organizations too often ask, “Isn’t there a way you can get this down to 4 or 8 hours?”

The EVE program provides training in four areas:

Train the mind of the provider—EMS providers need to understand that it’s not just part of the job to be assaulted. EMS agencies, in this same vein, need to learn that employees being assaulted is not acceptable, and that every violent encounter needs to be dealt with appropriately. Providers need to understand and believe that it is acceptable for them to defend themselves when attacked, and that there is an appropriate way to deal with noncooperative patients that is different from defending against and escaping from attack.

Train for the street—EMS providers need to learn and maintain proficiency in a small number of easy-to-learn, easy-to-maintain physical skills that facilitate escape from violent encounters. Maintaining proficiency is a major issue, because like most psychomotor skills, defensive skills are lost if not practiced or used. All but the smallest law enforcement agencies have in-house instructors who periodically refresh members on these skills; EMS agencies should develop and maintain these important capabilities.