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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


Dallas Police walk a neighborhood a block away from a shooting in Dallas.

AP Photo/LM Otero

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.

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.

Here are five EMS safety 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.

This article, originally published in May 2017, has been updated.

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.