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Special Report: It’s time to stop the violence

NEMSMA launches initiative to end violence against paramedics

Editor’s Note: Recognizing that EMS personnel are at high risk of suffering violence on the job, the National EMS Management Association (NEMSMA) has launched an initiative, called End Violence Against Paramedics, to address the issue. Skip Kirkwood, NEMSMA’s past president, outlines what’s involved.

If today’s EMS leader receives Internet news feeds, reads the online versions of our leading trade publications or occasionally visits EMS-oriented social media sites, two things are readily evident. First, paramedics (regardless of certification level) are subject to violent attacks on a regular, if not daily, basis. Second, the street-level paramedic community is concerned about the issue. Less evident, but visible if you read between the lines, is the fact that the EMS community is looking for leadership on this issue. We’re the leaders, so let’s lead.

To underscore this issue, consider the following excerpts from news stories nationwide, all of which took place within the past four years:

Centralia, Wash., Jan. 28, 2013: “Two AMR paramedics getting gas for their ambulance Saturday found themselves fighting a stranger.”
Oklahoma City, Okla., Jan. 25, 2013: “Pregnant medic loses baby after patient assault.”
New York, N.Y., Nov. 4, 2012: “EMT says Brooklyn prosecutor attacked her in ambulance.”
Jersey City, N.J., July 1, 2010: “Jersey City EMTs attacked by man suspected to be high on PCP.”
Middletown, Ky., May 29, 2009: “Police searching for leads in stabbing of EMS paramedic.”
Cape Vincent, N.Y., Jan. 31, 2009: “Cape Vincent EMT shot and killed by patient.”

These are not single, isolated incidents that make headlines because of their rarity. In the 2005 NAEMT Experiences with Emergency Medical Services Survey, more than one in two respondents (52 percent) reported that they had been assaulted by a patient. In one study in a large California EMS system, EMS personnel encountered some sort of violence in 8.5 percent of patient encounters and were subjected to violence directed at them in 4.5 percent of patient encounters. Of encounters where violence was directed at EMS personnel, 21 percent involved nonphysical (verbal) violence only, while 79 percent involved physical violence.

Personnel constitute the core of our service

Our people—the paramedics who deliver the patient care that constitutes our core service—are concerned about this issue, as discussions about arming themselves with concealed firearms for personal defense attest. Not that this idea is necessarily the right solution, but it should be taken seriously as a legitimate concern and a plea for help. When our people feel like nobody is listening to their concerns, perhaps drastic measures are in order—or so they might reasonably conclude.

Some states have taken the step of placing assault on a paramedic on legal par with assaulting a law enforcement officer—as it should be. In other states, it remains a simple assault, with no enhanced penalty attached. We should work on that. Our people are, one way or the other, public servants, who often have no choice about where they go or to whom they provide care. As agencies or through our state associations, we should lobby our legislature for par legal status with our law enforcement colleagues. And since decisions to prosecute or to plea bargain are made at the local level, every EMS director, chief and CEO should develop a relationship with the local prosecutor to make sure EMS cases are not reduced, or plea bargained, in a manner that is inconsistent with the way assaults on law enforcement officers are handled.

Culture of acceptance is wrong

Many agencies have cultures that accept, and teach new members, that paramedics are punching bags. This is wrong. It happens through a combination of peer interaction, policy and practice that teaches paramedics that it is better for them to “absorb the hit” and carry on, regardless of injury or indignity, than it is to report the violence and encourage prosecution. Here are examples of how that happens:

More-tenured staff teach younger paramedics that being assaulted is part of the job. They tease, harass and belittle colleagues who “make a fuss” about being kicked, punched or spit on.

There is much ignorance up and down the ranks. Many think of attackers as patients and that they therefore should be allowed greater latitude in their actions. Yet voluntary intoxication—getting drunk, stoned or dusted on PCP—is not a defense to a criminal act. Most paramedics are able to differentiate between the blind, purposeless resistance of the diabetic, the hypoxic or the demented, vs. the violent attacks of drunk, drugged, or just plain mean and ugly people they often must deal with. When the latter lash out, they should be prosecuted.

Supervisors and managers don’t want to hear about it, demonstrating more concern for “meat in the seat” and “trucks on the road” than for the physical and mental well-being of their employees. Paramedics describe being “grilled” and “harassed” by bosses who are more interested in the paramedic’s contribution to the event than in the paramedic’s well-being, when that boss was nowhere to be found during the excitement. Medics who are attacked should not be presumed guilty during an investigation.

Organizational policies, procedures and practices encourage employees to stay in service and in fact punish them financially for taking care of violence-related issues. Employees injured through violence will often hide their injuries, because employers haven’t addressed the limitations of their workers’ compensation coverage, which (if not modified) is geared to a 40-hour-a-week employee who rarely works overtime. Going on workers’ comp can often seriously impact the take-home check of paramedics who are already poorly compensated.

Yet this is not an issue of national importance, or even an issue commonly discussed by EMS leaders. I’m not sure why—but it’s time for that to change. Violence against paramedics is not acceptable and should not be tolerated.

NEMSMA End Violence Against Paramedics initiative

NEMSMA wants to change this state of affairs. The NEMSMA End Violence Against Paramedics initiative, adopted by the board of directors in 2012, is an effort to change the culture of the EMS community, from top to bottom, with regard to assaults, batteries and other violence against our people. This effort, which will be a multi-focal and multi-year project, will involve a number of efforts:

We will make a concerted effort to document instances of violence against paramedics. To that end, we have partnered with our colleagues at EVENT (EMS Voluntary Event Notification Tool) to produce an anonymous reporting database. EVENT is a program of the Center for Leadership, Innovation, and Research in EMS with sponsorship provided by the North Central EMS Institute, the Emergency Medical Services Chiefs of Canada, the National Association of Emergency Medical Technicians, the National Association of State EMS Officials and NEMSMA. The EVENT Violence Reporting Tool will be made available nationwide and will be promoted by all partner organizations.

We will work with our partners that represent EMS practitioners to carry the message that violence against paramedics is unacceptable and that offenders must be prosecuted. We will increase the understanding of paramedics and those they work with, including medical directors, that voluntary intoxication is not a defense to assault or battery.

We will build a partnership with EMS educators, both pre-service and in-service, to educate paramedics that violence against them is not a part of the job that they must endure. We will work with these partners to ensure that effective, appropriate training is provided with sufficient frequency that essential skills are maintained.

We will make a concerted effort to educate EMS executives and senior leadership on the importance of building a proper, supportive environment for their personnel, where violence against paramedics is not tolerated, where reporting and prosecution of attackers are supported, and where effective, appropriate training in preventing and dealing with violence is provided.

We will assist EMS agencies in developing this environment by providing model policies, templates for assessing an organization’s culture with regard to violence and educational materials for use within the agency.

We invite leaders who share our concerns to involve themselves in our effort. Let’s make sure everybody knows that paramedics are not punching bags, and violence against paramedics is not just “part of the job.”

Skip Kirkwood has been involved in EMS since 1973, as an EMT, paramedic, supervisor, educator, manager, consultant, state EMS director, and chief EMS officer. He is a past president of the National EMS Management Association, is a vigorous advocate for the advancement of the EMS profession, and a frequent speaker at regional and national EMS conferences.