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Insult to injury: Assaults on EMS clinicians on the rise

A Maryland paramedic recounts a patient assault, and the emergency services director and police chief detail legal options

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“The optimal scenario is to be able to prevent the violence against EMS professionals by identifying scenes early,” writes Bowman.

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The laws in Maryland regarding assaulting an EMS clinician or other public safety professional make it difficult to immediately charge and have an offender arrested on the scene unless there are significant criteria that is met.

One Maryland paramedic plans to press charges after being assaulted in the back of an ambulance during a transport because she believes the offender will strike again.

Video: Gordon Graham on violence prevention

An unprovoked attack

Just before 7 p.m., the in-station alert at Hagerstown’s Community Rescue Service activated for a reported man down. The paramedic crew responded, and found local city police already on the scene. The call presented like many routine calls handled by CRS, the busiest EMS operation in Washington County, Maryland. CRS handles over 20,000 calls for assistance from four stations annually.

During the transport, the call quickly turned violent.

I spoke with the paramedic involved. “I was precepting a new hire EMT and we were following standard patient care protocols,” she told me. The transport from Hagerstown’s downtown district to Meritus Medical Center is relatively short. “The patient suddenly began yelling. I had the new hire move to the captain’s seat ... a safer location,” she said.

“The patient stopped yelling, looked me right in the eye and he threw a punch,” the paramedic said. “I said, ‘he is hitting me’ and dropped the mic.”

The patient reportedly struck the paramedic in the hand.

“I have never been afraid. But I was fearful,” the paramedic said. She moved to a safer location as the patient continued to be aggressive. The crew was met in the ambulance bay by security.

After care was transferred to the emergency department personnel, the paramedic notified her duty officer and the local police. She requested to file a report. Officers told her that they wouldn’t be able to press charges because they didn’t witness the assault, she had no marks on her body and there wasn’t significant bodily injury.

“I just broke down. I was crying,” she recalled. “I couldn’t believe that there was nothing that could be done. The patient will get discharged and do this again to another clinician one day. People that assault EMS professionals need to be held accountable for their actions.”

“He wanted to intentionally hurt me,” she added. “This wasn’t a combative patient, and someone got caught by a flailing extremity.”

Increasing assaults

The trend for increasing assaults on public safety, specifically EMS professionals was identified over 20 years ago.

A 2002 report, “Occupational fatalities in emergency medical services: A hidden crisis,” outlines that on average, an EMS professional is violently killed on duty in the U.S. each year.

A 2017 CDC report, “Emergency Medical Services Workers: How Employers Can Prevent Injuries and Exposures,” noted 2,000 EMS professionals are injured each year in a violence-related incident. This rate of violence-related injuries results in lost workdays for EMS professionals (22 times higher for EMS providers compared to the national average). More than half of EMS professionals assault injuries result in lost work time.

“EMS personnel’s risk of violence while serving the community,” also published in 2017, reports female EMS professionals may have a disproportionately greater risk of violence-related injury.

The law regarding EMS assaults

“Under Maryland law, for a person who commits an assault against a first responder in the performance of their duties, the grading would be a felony second-degree assault,” Frederick Police Department Chief of Police Jason Lando told me. “However, there is a caveat. There must be a physical injury beyond that which would be considered minor. If a paramedic gets punched and there is no significant injury as a result, it would be classified as a misdemeanor second-degree assault.”

Lando added that this does not mean charges cannot be filed, but a misdemeanor assault would not result in an on-scene/physical arrest ... unless the officer was there to witness it happen.

“Rather, the case could be brought to court by way of a summons to appear. The victim could file charges if the suspect was identified or the investigating officer could file the charges on the victim’s behalf,” Lando said.

Chief Lando emphasized that people may confuse the lack of a physical arrest on scene with charges not being filed. In both cases (summons versus physical arrest), the case goes to court. More and more, however, states are steering away from taking people to jail in many cases and opting to file charges by way of a summons.

The CRS paramedic intends to file charges in Washington County District Court because she believes the act was intentional.

“He will continue to be an offender until someone gets shot, stabbed or killed,” she said, adding, that the next victim could be a police officer, firefighter, EMT, paramedic or hospital professional.

“At times, the laws that address assaulting a first responder can be broad and not clearly defined,” Washington County Division of Emergency Services Director R. David Hays said. “The Division of Emergency Services will fully support any first responder that is assaulted, using all means possible within the judicial process.”

Preventing assaults against EMTs, paramedics

“Assaulting a firefighter, EMT or paramedic is not taken lightly, and we strive to make incident scenes and transports as safe as possible utilizing the most appropriate resources at our disposal,” Hays said.

The optimal scenario is to be able to prevent the violence against EMS professionals by identifying scenes early.

“When an emergency communications specialist interrogates a 911 caller, there are a series of questions built into the script that ask questions related to ‘are there any weapons?,’ ‘is the patient violent?’ If the call is an assault as example, the question would involve asking if the assailant is still on scene,” Hays continued.

In Washington County, after a call is dispatched where the scene is not secure – meaning a weapon may be present, the patient or family member may be violent, or there are too many concerns for EMS to enter safety – law enforcement is dispatched first. Additionally, dispatchers add “scene is not secure” to the end of the dispatch.

“This announcement creates an awareness of circumstances that are potentially harmful to the patient and, most importantly, the responders. Hearing this phrase institutes a standing protocol for responders’ actions related to response,” Hays said.

Hays added that in some situations, the scene can deteriorate after EMS and fire units arrive. He says that crews should first try to remove themselves from the immediate area and request law enforcement. If crews cannot self-extricate or are involved in protecting themselves, they should activate their EAB on their portable radio and state their unit, location and situation if possible. By doing this, it will alert the communication center that there is a problem on the scene so law enforcement can be started.

After action

According to Hays, Washington County offers several resources to clinicians that may have been assaulted including:

  • CISM available through the Department of Emergency Services
  • A chaplain group through the Washington County Volunteer Fire and Rescue Association

“Anytime a clinician is assaulted, whether it be by a patient or another individual involved in the incident, law enforcement should immediately be notified, and a report filed,” Hays said.

“With the ever-changing dynamics of society, we must remain vigilant and always maintain situational awareness, not only for our safety, but for the safety of our patient and others around us,” Hays said.

This article was originally posted June 14, 2023. It has been updated.

Todd Bowman is a nationally registered and flight paramedic with more than 18 years of prehospital experience in Maryland. He attended Hagerstown Community College for his paramedic education and later obtained his bachelor’s degree in journalism from Shepherd University in Shepherdstown, West Virginia. His experience ranges from rural, metro and aviation-based EMS. He is an experienced EMS manager, public information officer and instructor. Follow him on social media at @_toddbowman.