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Preventing violence against EMS personnel

Violence prevention training and situational awareness can help keep EMS providers safe on scene

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EMS personnel can take it upon themselves to learn basic self-defense techniques, build strong relationships with other groups such as police, and, before every shift, prepare themselves and their partners for a potentially violent event.

Photo/Brian Maguire

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By Brian J Maguire, Dr.PH, MSA, EMT-P; Peter O’Meara, PhD, MPP, BHA; and Barbara J O’Neill, PhD, RN

The regularly reported cases of violence against EMS personnel reinforce the dangers of the job and are reminders that every EMS professional should be prepared for a violent encounter.

Sadly, assaults against EMS personnel is not a new problem – a 2002 article in Annals of Emergency Medicine found that there was on average, a fatal assault a year among EMS professionals in the U.S. alone [1]. More recent research shows that there are, on average, over 400 serious violence-related injuries among EMS personnel every year in the U.S. [2].

Although anecdotal evidence suggests that many EMS agencies worldwide have made good-faith efforts to reduce the risks of violence for their personnel, a 2017 systematic review found that none of the results of those efforts have been published [3]. As a result, our profession has no lessons-learned, no best practices and no reliable interventions to reduce the risks of violence or violence-related injuries.

How to prepare for a potentially violent incident

A recent journal article highlighted suggestions that might reduce the risks of violence against EMS personnel. In the paper “Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics,” the authors describe the responses from 633 EMS personnel who had been the victims of on-duty violence. They asked the assaulted personnel what they thought could have been done to prevent the incident [4]. Their valuable insights have been compiled to help EMS personnel focus on ways to reduce their own risks.

1. Training on violence prevention

One of the most cited themes in their recommendations was the need for better training. The respondents noted that they had received little to no violence-prevention training as part of their basic or refresher classes. In order to address this, they suggested that EMS personnel should work with EMS managers and educators to either find or to develop training programs that focus on topics such as dealing with specific populations, self-defense, de-escalation techniques and, developing improved situational awareness.

2. Take a self-defense course

While those discussions are taking place, EMS personnel can take it upon themselves to find and attend classes in self-defense. No one is suggesting that all EMS personnel become martial arts experts, but periodic training in some basic self-defense skills might make all the difference in an unavoidable violent situation.

3. Create better interprofessional relationships

Communications was noted as lacking in many of the assault incidents. Respondents felt that the dispatchers and communications personnel could have done a better job of collecting and sharing information about the potential risks so that the crew could have been better prepared upon arrival. Some respondents felt that police could have prevented the assault had they come fast enough or had not left the scene before the assault took place. These stories highlight the importance of EMS personnel taking it upon themselves to develop good relationships with other groups such as communications center personnel and local law enforcement officers.

4. Maintain situational awareness

When asked about who could have prevented the assault, many of the respondents replied that they themselves could have prevented it. They noted that they should have seen the danger earlier had they not been so focused on patent care and let their situational awareness diminish. This is a very important point. It can be easy for us to become complacent or too caught up in what we are doing, or simply be over-confident that no one would want to hurt us and then fail to see a growing threat.

What did respondents say about body armor and firearms?

It was noteworthy that “none of the respondents suggested that a bullet- or stab-proof vest would have prevented the incident” and “none of our respondents claimed that having a gun would have helped prevent the violent incident [5].” This suggests that the onus falls heavily on EMS personnel to rely on their own self-preparedness to protect themselves in a violent situation.

Work with EMS leaders to make the job as safe as possible

Ideally, EMS personnel should be faced with no risks of on-duty violence. Unfortunately, the risks are very real and occur with significant frequency. We know from this report and others that the most likely perpetrator of violence against EMS personnel are patients, but assaults have also been perpetrated by patient family members, on-scene bystanders and even coworkers and former friends.

To create conditions that make the job as safe as possible, EMS personnel need to work with managers and educators to create agency-wide safety systems that include tailored training programs and new organizational policies and procedures focused on scene safety techniques. Those teams should also accept the responsibility of publishing the results of their interventions so that other EMS professionals can learn from their experiences.

EMS personnel can also take it upon themselves to learn basic self-defense techniques, build strong relationships with other groups such as police, and, before every shift, prepare themselves and their partners for a potentially violent event.

While the risks are real, each person can improve safety for themselves and their partners. As a profession, we must work on sharing the results of our safety initiatives so that we can all learn from each other and work together to reduce risks and improve safety for all EMS professionals.

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About the authors

Dr. Brian Maguire began his career as a New York City paramedic. He has a doctoral degree in public health and was a 2009 Senior Fulbright Scholar. An adjunct professor at Central Queensland University in Australia, Brian has been one of the most published paramedics in the world in the area of paramedic safety. He is a 7th degree black belt in Tae Kwon Do. Dr. Maguire is an epidemiologist for Leidos where he works on occupational safety for the military.

Dr. Peter O’Meara is an adjunct professor in the Department of Community Emergency Health & Paramedic Practice at Monash University, Australia. In addition, he is the acting chief executive officer of MobileCE and a director of the Global Higher Paramedic Education Council, both based in the United States. He is a councillor and recently elected Board member the National Rural Health Alliance (Australia).

Dr. Barbara J. O’Neill is an associate clinical professor in the School of Nursing at the University of Connecticut and an Adjunct Lecturer at Central Queensland University in Australia. She has been working on paramedic safety research for over five years.


1. Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: A hidden crisis. Ann. Emerg. Med. 2002;40(6):625-632.

2. Maguire BJ, O’Neill BJ. EMS personnel’s risk of violence while serving the community. Am. J. Public Health. 2017;107(11):1770-1775.

3. Maguire BJ, O’Meara P, O’Neill BJ, Brightwell R. Violence against emergency medical services personnel: A systematic review of the literature. Am. J. Ind. Med. 2017:1-14.

4. Maguire BJ, O’Neill BJ, O’Meara P, Browne M, Dealy MT. Preventing EMS Workplace Violence: A mixed-methods analysis of insights from assaulted medics. Injury. 2018;49:1258-1265.

5. Maguire BJ, Browne M, O’Neill BJ, Dealy M, Clare D, O’Meara P. International survey of violence against EMS personnel: physical violence report. Prehosp. Disaster Med. 2018;33(5):526-531.

This article, originally published in 2019, has been updated.