Why EMS providers should never tolerate being attacked

It took 10 years for one paramedic to realize being assaulted by a patient, bystander or co-worker is not part of the job

By Sean Hulsman

"He bit my hand. It's my own fault. I got too close to his mouth."

I spoke those exasperated words over 10 years ago. I said them to a somewhat amused police officer who had just watched the intoxicated male on our stretcher attempt to eat my thumb.

Firefighter Eric Karcher escapes an arm grab from EMT Nick Egloff.
Firefighter Eric Karcher escapes an arm grab from EMT Nick Egloff. (Photo by Sean Hulsman)

All he offered in response was, "Break the skin?"

When I said no, he just went about his business at the station.

We'd been called to the cellblock to pick up a violent, intoxicated prisoner. The police had decided to put him on mental health commitment papers and summoned us to transport the individual to the hospital. When we arrived, the prisoner was screaming profanities and smashing his head against the bars of his cell.

We rolled our stretcher in, opened our packages of soft restraints and watched as four officers opened the man's cell and wrestled him out and onto our stretcher. He was flailing wildly, yelling and spitting. As the police worked to secure him to the stretcher, I began to perceive that my partner and I should be doing more to help control the violent subject. I mean, we couldn't just stand there, right?

So I put my knee on the prisoner's shoulder and grabbed a non-rebreather mask. As I went to put the mask on his face to prevent him from spitting on us, he curled forward, got his teeth on my thumb and locked in a nasty bite.

I struck out at the man in blind rage and was able to free my hand and assess the damage. There were teeth marks, a tear in my glove and some decent bruising, but the skin had not been broken.

When we finally got the man restrained, we transported him to the hospital. That was it.

There was no assault report and no treatment at the hospital for my injury. I just went back to work. I was tough and I believed it was my own fault for not being more careful.

Worsening violence towards EMS providers
We've seen the news and we know the score. People are ambushing law enforcement officers. A man ambushed and killed volunteer firefighters in West Webster, N.Y. A disturbed individual attempted to copy the West Webster attack in the area where I work shortly thereafter. Emergency services, it seems, is becoming a more dangerous occupation.

We have gotten better at sharing reports of attacks to local media. In turn, there is more frequent media coverage of violence toward EMS providers. Paramedics slashed and stabbed in Detroit, a paramedic assaulted in Massachusetts and an EMT attacked by a patient's family member on Christmas morning are just a few of the recent headlines.

Yet, this is not really news. EMS has been getting assaulted for years.

Being assaulted should never be part of the EMS job
It is extraordinarily difficult to explain violent human behavior, especially when that violence is directed at people whose purpose is to help others. Such explanations are the purview of learned mental health professionals. However, explaining violent behavior is not my job as an EMS educator and, as it turns out, neither is being subjected to violence.

Our company CEO, several managers and myself recently completed the "Escaping Violent Encounters" instructor course taught by Kip Tietsort, a veteran paramedic, police officer and EMS1 columnist. We reviewed deceptively simple concepts like:

  • Don't be on an unsafe scene.
  • Use your awareness to detect potentially unsafe scenes.
  • Maintain a safe distance from questionable patients or bystanders.

We talked a great deal about verbal skills and customer service. Yet, the most useful thing that I learned during our training was this: It is not part of our work as EMS providers to be assaulted.

I've been a paramedic for 22 years, but had never considered that I really shouldn’t be assaulted at work. In retrospect I’m embarrassed at how long it took me to learn that. Baristas at coffee shops don't take it in stride when a customer shoves them. Mail carriers do not accept a punch to the face as they place a package in a mailbox.

Why, then, should anyone who is summoned to deliver medical care receive and accept physical violence? It seems to be a question of industry culture.

EMS is slowly recovering from a chronic identity crisis, but in the past we've come to see ourselves more like police and less like physicians and nurses. We're on the streets in rough neighborhoods dealing with unstable people. We're supposed to be tough mentally and physically.

When that patient storms over and shoves us against the wall or surprises us with a punch from the stretcher, EMS culture says "Suck it up! It's just part of the job."

Personal bravado makes things worse. In some places co-workers and even administrators treat reports of violence against EMS as petty — as if we were whining about being physically attacked.

I am nearly seven feet tall and weigh 285 pounds. Should a guy my size really be carrying on about an injured thumb? Filing a police report? Seeking medical care? The answer is a resounding "Yes!"

The best way to prep field staff for the eventual call that goes bad is to provide training which focuses on scene safety, pre-attack indicators and how to escape when a physical threat manifests. We should also collectively remember that assaults are not part of our job, and work to be sure that anyone who assaults us faces charges. In New York and some other states assault on an EMS provider is now a felony, so we can change the culture incident by incident.

Many people know who and what they are, but perhaps true wisdom is knowing who and what we are not. Paramedics and EMTs are not police. We are not MMA fighters or professional wrestlers. We are not trained or equipped to apprehend criminals or tackle and restrain violent subjects.

We provide medical care. While on duty, being knocked down, pushed, kicked, slapped, bitten or punched is unacceptable. We all must continue to deliver this message: Violence against an EMS provider is assault and it's a criminal offense.

About the author
Sean Hulsman, MEd, EMT-P is Director of Education at Twin City Ambulance Corporation in Western New York. He began his EMS career in 1992 and continues to teach and work in the field. You can contact Sean via his blog: Coarse Asystole.

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