Tifphany Hofstetter was terrified as she stood with her co-worker in March and watched their patient drive off with their ambulance in Southeast Portland.
Police had summoned the two paramedics to bring the man to a hospital because he was in an apparent mental health crisis and refused to let officers take him, Hofstetter said.
She and her partner helped the man into the ambulance and drove toward the hospital. But the man became paranoid, freed himself from his seatbelts and yelled within inches of her face, she said. She fled out the side door. Her partner, who was driving, escaped soon after the man crawled through the passageway to the front of the vehicle. He drove off, crashing into several vehicles before being stopped by police.
Although Hofstetter and her partner weren’t injured, colleagues have been in recent months while on duty in Portland. The week before the man drove off with the pair’s ambulance, a different man climbed into an ambulance stopped in downtown Portland and cut, choked and bit a paramedic. In August, two paramedics reported being attacked in North Portland by a woman they were aiding and a man who knew her. One paramedic was punched in the face and the other hit with pepper spray.
“On a regular basis we encounter people that become violent or unpredictable,” said Hofstetter, a lead paramedic who has worked in Multnomah County for 13 years. “It’s becoming more and more of a concern on a daily basis that we get to go home unscathed.”
All of the incidents involved paramedics with American Medical Response, the largest private emergency medical transportation company in the country and the only ambulance provider in Multnomah County. The reports of escalating violence in Portland have prompted the company for the first time to provide mandatory self-defense training to the more than 500 paramedics and emergency medical technicians it employs in Multnomah, Clackamas and Clark counties.
The combative patient management classes consist of about eight hours of physical training and a two-hour online session.
“This isn’t about chokeholds or submission,” Robert McDonald, Multnomah County operations manager for AMR, said about the training. “This is about how do we get away safely so that we can get our law enforcement partners to get more engaged and provide the scene safety that we need to continue that continuity of care with the patient.”
AMR workers don’t carry any weapons because it would go against their primary goal of helping people, McDonald said. Employees are allowed to buy ballistic vests to wear under their uniform. He said he didn’t know how many have done so.
The agency started classes in July and aims to have all its employees complete the training by the end of October.
McDonald estimated the training will cost about $250,000 upfront, and the company plans to add refresher courses and incorporate the classes into its new employee orientations. More than 60 staffers had completed the training as of Sept. 3, said McDonald, who said he also plans to go through the program.
McDonald said he doesn’t know if other AMR branches around the country provide self-defense training. Officials at the company’s national headquarters didn’t respond to several requests for comment.
Assaults on emergency medical services workers are becoming more frequent, federal data shows. The Centers for Disease Control and Prevention estimated 3,500 emergency medical workers were treated in hospitals in 2016 for injuries stemming from violence suffered while on duty. That was up from 3,200 in 2015 and an estimated 2,600 in 2014.
Locally, McDonald attributed the apparent increase of dangerous encounters in part to a Portland police policy change in 2016 that called for officers to more routinely request people in mental crisis be taken to a hospital by ambulance rather than patrol car.
The change came after a 2012 federal investigation found Portland police engaged in a pattern of excessive force against people with mental illness.
As a result, McDonald said, AMR workers’ interactions with behavioral health patients in crisis have increased. Behavioral health-related calls have increased by 3 to 5 percent every year since 2016, and they tend to be the ones with higher cases of verbal or physical assaults against paramedics, he said.
McDonald said his agency doesn’t have an exact tally of Portland-area attacks on its workers because not all incidents are reported. The company is trying to compile data on reported cases.
According to data from the Multnomah County District Attorney’s Office as well as police and media reports, at least eight cases have been prosecuted since 2018 involving people arrested for attacking, threatening, spitting on or otherwise interfering with paramedics on duty. Six of those cases occurred in 2019, including the incident involving Hofstetter.
Joseph Coffin, the 31-year-old man accused of stealing the ambulance, has pleaded not guilty to charges including robbery, unauthorized use of a vehicle, reckless driving and assault.
Jeremiah Ray, the man who cut and choked the paramedic in downtown Portland, was sentenced in April to two weeks in jail and three years of probation.
“Our behavioral health population has exploded and their predisposition toward violence has increased,” McDonald said. “We needed to come up with novel solutions, and this is one of those.”
During the first week of September, Hofstetter and nine other paramedics gathered in a conference room at AMR’s Clackamas headquarters for the daylong training session. Rubber tiles covered the carpeted floors.
Hofstetter and her colleagues dodged foam batons masquerading as knives, blocked punches from colleagues holding boxing pads and maneuvered out of headlocks.
Instructors tell the group to never turn their back on a patient or cross their feet while standing—they could easily be knocked to the ground if pushed. They’re told to be aware of exits at all times, stand about 10 feet away when approaching a patient and to stand at an angle so the person doesn’t feel trapped.
“We want to give them a choice,” Jeff Birrer, an AMR lead paramedic in Multnomah County and one of three lead instructors, told the group. “And we want one of the choices to be leaving without interacting with us, if that’s what they want to do.”
Birrer said he tells his co-workers that hitting an attacker should be a last resort and to remember that not everyone is lashing out in anger.
“Our whole goal is to get our people to leave when there is a problem so that everyone stays uninjured,” said Birrer, who has worked in the field for nearly 35 years, mostly with AMR in Portland.
Nicole Chaves, another training lead instructor and AMR paramedic in Clackamas County, said she’s received positive feedback from co-workers who’ve told her the training is a step in the right direction, she said.
“I think it’s really important for us to know how to defend ourselves in life in general,” she said.
“We’re in a very vulnerable position being care providers and dealing with people from all walks of life. It’s unfortunate that it’s gotten to the point where this training is necessary, but this is something that keeps us in a position to save lives, whether it’s a patient or our own.”