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How to reduce risk of violence to EMS providers

Take a mental "stand down" to review essential safety practices that can reduce the risk of injury from violence


The last few weeks have served as a sobering reminder on how violent it can be for EMS providers attempting to provide field care. In the past few weeks, an FDNY EMT was run over and killed by her ambulance after it was stolen, while a Dallas paramedic was critically wounded by a gunman. This is in addition to untold number of assaults EMTs and paramedics experience daily across the country.

Violent acts against EMS providers are not new, but it feels like it's becoming more frequent. It's possible that the public's suspicion of other public safety providers such as law enforcement is crossing over to EMS. It may be that the invisible line of respect for authority has seriously degraded, making it very easy for someone to lash out.

To a certain extent, it doesn't matter what the reason is. Our jobs have inherent risks, physically and emotionally.

Dallas Police walk a neighborhood a block away from a shooting in Dallas. (AP Photo/LM Otero)
Dallas Police walk a neighborhood a block away from a shooting in Dallas. (AP Photo/LM Otero)

It's a good time to do a mental "stand down" to remember essential safety practices that can reduce the risk of injury from violence. There are a variety of ways to gain additional information about violence harm reduction; the National Association of EMTs offers an EMS Safety Course, while DT4EMS provides valuable information related to provider safety from violence and the Escaping Violent Encounters video series is always available for individual, company or department training.

Here are five tips to consider before going out on your next run:

1. Violence can happen at any time.

No joke. No matter the situation, the chance of it going sideways exists. EMS providers should simply assume that is the case and remain quietly alert throughout an EMS incident.

2. Slow down.

It's easy to become complacent about safety issues when nothing happens call after call. After a while, we forget about situational awareness and simply focus on the issues directly in front of us. Taking a few extra fractions of a second might give you the opportunity to notice the semi-hidden weapon, the defensive position of the patient or the silently upset family member standing off to one side.

3. Take stock of yourself.

What are you doing that could precipitate or aggravate a violent response? While EMS providers need to be assertive in order to create calm out of chaos, bystanders might interpret the assertiveness for aggression. Check your voice and body language to make sure you aren't part of the problem.

4. Don't unnecessarily put yourself in harm's way.

A dash cam video showing an EMS provider stopping his ambulance to scold a tailgating driver provoked a lively discussion among EMS professionals. I admit that I've done this once (well, maybe twice). I'll also admit that afterwards I felt like I took an unnecessary risk doing this.

I could have contacted my friendly local law enforcement officers and provided the necessary information to cite the driver (which I've also done). There have been several other situations during my career that I should've known better.

5. Train like we practice.

Finally, we need to train like we practice, so that we practice like how we trained. For decades, EMS students have been taught the scene safety dance, saying "BSI, scene safe" while waving their hands in the air as they began a scenario. That has to stop.

EMS educators must embed realistic information into their teaching so that newcomers are better prepared to identify and respond to threats. Critical thinking for scene assessments begins at the emergency medical responder level and reinforced throughout all other levels of provider. Until that happens, we will be challenged on how to keep ourselves safe.

A death of any EMS provider is simply one too many.

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