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Rapid response: Risk of senseless violence is constantly looming

Unprovoked killing of Lt. Alison Russo-Elling is a tragic reminder that EMS providers are putting their lives at risk for choosing to serve their community


Russo-Elling, 61, was a 25-year veteran of the department and was a World Trade Center first responder who assisted in rescue and recovery efforts, according to an FDNY statement.


Lt. Alison Russo-Elling, FDNY EMS, was killed in the line of duty on September 29, 2022. It was initially reported that she had been rendering aid to a patient when an unprovoked assailant stabbed Russo-Elling multiple times. It was later reported that she was walking to get some food when she was attacked. Regardless, the unprovoked, violent attack severely injured Russo-Elling. She was transported to a nearby hospital, where she died of her injuries.

Russo-Elling, 61, was a 25-year veteran of the department and was a World Trade Center first responder who assisted in rescue and recovery efforts, according to an FDNY statement. Russo-Elling began her career as an EMT before becoming a paramedic in 2002. She was promoted to Lieutenant in 2016.

Persistent risk of violence

The tragic death of a member of the service is another reminder of the persistent risk of violence to EMS providers everywhere. The danger of violence directed at EMS can come from patients, the patients’ friends or family and bystanders.

In the days ahead, we will learn more about the incident, the assailant and the life and accomplishments of Lt. Russo-Elling. Meanwhile, the dangers EMS providers face from violent attackers are not unique to New York. As you go in service, please keep these things in mind.

  • You might be a target. At this time, there isn’t a motive for the attack or a known relationship between Russo-Elling and the attacker. But attacks on first responders, simply for wearing the uniform and being in public to serve their community, happen. Police officers are ambushed while sitting in their patrol cars. Firefighters are shot at while responding to a fire or caring for an injured person. A paramedic was killed walking on the sidewalk. Either through intent or mental illness, first responders are under attack.

  • Learn and practice defensive tactics. Russo-Elling was stalked and attacked without warning. Please don’t think I am questioning her preparedness or response to the attack. Instead, find cause from this senseless tragedy to seek out training in defensive tactics to fight off an attack.

Emergency scenes are dynamic

Here are a few additional things to keep in mind when you are caring for a patient and there is potential for or actual violence at the scene.

  • The scene is never safe. Emergency incidents are always dynamic, regardless of the location, people present, the patient’s complaint and the number of responders. As you assess and reassess the patient, also assess and reassess the environment.

  • Monitor your surroundings. The patient, rightfully so, gets a lot of focus from responders. Monitors and equipment can also take up a lot attention. At least one member of the team should be scanning the room, road or location for changing hazards and then alerting the team of changing conditions and specific actions to mitigate new or worsening risks.

  • Create distance and shielding. If the patient’s condition and resources allow, move to a more secure location to continue assessment and care. The ambulance is not totally secure, but it is more secure than sitting on the street. Otherwise, look for ways to move away from an assailant, use cover and concealment, and involve law enforcement early.

Remember and honor

FDNY EMT Yadira Arroyo was killed in 2017. The man charged with killing her continues to evade consequences for taking her life, with a trial not scheduled until January 2023. Unfortunately, we can expect similar delays and legal posturing from the killer of Russo-Elling. Justice can be frustratingly slow, but that should not keep us from remembering and honoring Arroyo, Russo-Elling and far too many other EMTs and paramedics who have died in the line of duty. Never forget these dedicated and humble community servants.


Read more:

How to make scene safety a core part of every EMS response

Attacks on EMS providers by the very people we are trying to help are becoming all too common: Review your safety practices and training

Editor’s note: The Center for Firefighter Injury Research and Safety Trends (FIRST) shared a fact sheet about violence against fire-based EMS responders.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.