September 4, 2019 | View as webpage
Dear Leaders,

Safety is one of the core principles for the future of EMS outlined in the 2050 EMS Agenda. In this newsletter, learn how Austin-Travis County EMS implemented a study to dig into the frequency of assaults against its personnel, and how your agency can contribute to the body of research on violence against providers.

Also in this briefing, Paramedic Brent Tracey, recent recipient of the Tim Hynes Foundation 2019 SMTA Scholarship, breaks down how safety management systems mitigate risk in EMS and pave the way to a Just Culture.

Another risk inherent in EMS is physical injury. Be sure to check out our EMS1 Special Coverage series, "Bridging the gap in bariatric patient care: Pathophysiology, assessment and transport solutions," with solutions for patient and provider safety.

Greg Friese, MS, NRP
Editor-in-Chief, EMS1

A research-based approach to understanding assaults on EMS
By Chief Ernesto Rodriguez

The EMS Agenda 2050 is calling for the EMS of the future to focus on a people-centered vision. To become “inherently safe and effective” is among the six key principles that support achieving that vision. While this principle seems straightforward, we know that safety is a major challenge in the EMS industry. As we consider factors that present a frequent risk to providers, some of the first things that come to mind include driving, exposures, assaults, wellbeing, and strains and sprains.

At Austin-Travis County EMS, we have implemented measures to provide protection from disease, improve vehicle design, provide protective equipment, increase mental health support, encourage fitness and good health, monitor workload levels, evaluate rest opportunities, improve driver training, provide self defense training, and ensure our emergency alert systems remain highly reliable. Yet, as I was writing this article, I received another text alert of an assault against one of our clinicians resulting in injuries and the arrest of a patient turned assailant. 

When discussing various safety-related challenges, many fellow EMS chiefs and directors from across the nation agree that assaults involving our personnel seem to be occurring more frequently. We agree that we need to report to a national database to gather information about assaults and injuries, and we agree that we need to address assaults against our EMS clinicians. The question is, how can EMS organizations prevent assaults? What steps should we take? What do we need to know?

In a systematic review of research on violence against EMS personnel, Brian J. Maguire, et al, in the American Journal of Industrial Medicine in 2017, concluded that there is a “lack of peer reviewed research of interventions” which means that the interventions many of us are implementing have no base of evidence to support them. Our goal in Austin is to share our lessons to begin to change the problem identified by Dr. Maguire and his team of researchers. This is the beginning of our journey. We share it in hopes of encouraging others to do the same.

EMS personnel perspective on assaults

After reviewing research about violence against EMS personnel, we developed a survey to learn more about assaults, what leads to them, factors that increase their likelihood, early warning signs and how our culture might need to change. 

Here’s what we learned about our personnel’s experiences with assaults:

  • Most assaults are not reported when they happen
  • Assaults are most commonly reported when an injury occurs 
  • Most assaults happen while providing direct patient care in the ambulance
  • 63% of our field medics say they were assaulted in the past two years
  • 86% of our communications medics say they were verbally assaulted in the same period
  • More than 69% of field personnel agreed with a statement that said assaults are an unavoidable risk of an EMS career
  • 94% of communications personnel said that verbal assaults while on duty in the communication center are an unavoidable risk

There is much more to learn and unpack from our survey, but these findings will help to set us on course to begin our journey.

Our next steps involve using the Institute of Healthcare Improvement Model for Improvement to bring agency leaders, personnel, law enforcement and others together to improve awareness, training and reporting. We plan to share our lessons and engage researchers who are interested in the topic to help study violence against EMS personnel and the interventions we implement. 

It’s important for EMS agencies to conduct surveys or research to learn more about what kinds of assaults are most prevalent, what signals might help us recognize the risk for an assault, what actions can be taken to avoid assaults, what support people want when they are assaulted and other important questions. We would love to hear from others interested in studying and reducing assaults on EMS clinicians. We look forward to sharing our experiences and hope to learn from others who want to reduce violence against EMS personnel.

About the author

Ernesto M. Rodriguez, MA, LP, is EMS chief, Austin-Travis County EMS. He can be reached at

Additional resources:
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How EMS can improve operational safety through SMS and risk mitigation
By Brent Tracy, BA, FP-C

I recently attended the Association of Air Medical Services (AAMS) sponsored Safety Management Training Academy in Pittsburgh, Pennsylvania, as a year one student. I learned that implementing a successful safety management system (SMS) into an air or ground EMS transport system takes vision, discipline and patience. To be successful, it requires a commitment from the very top of an organization and must extend to the entire team.

SMS offers an organized and measurable format to grow your sustainable safety program with deep roots. Here’s a brief overview of the four pillars of SMS:

  1. Safety policy. Work with senior management to write a strong safety vision statement which becomes your organization’s guiding light. Establish senior management’s commitment to increased safety practices utilizing clear, unambiguous language (the least certified person in your organization should be able to understand it).
  2. Safety risk management. Implement new systems and revise existing systems. Develop operational procedures (e.g., scoring a daily risk assessment) and identify hazards or ineffective risk controls.
  3. Safety assurance. Evaluate the application of your SMS and determine whether expected progress toward effective risk management and improved safety performance is being achieved.
  4. Safety promotion. Build out safety culture through safety training and encouraging employees to share information. Identify “weak signals,” which occur when common practice drifts from policy and precipitates near misses. It’s been identified that the No. 1 cause of accidents is deviation of policy.

Evaluate your organization’s risk mitigation

Here are three questions you should ask yourself about your organization to increase your operational safety through SMS and risk mitigation:

  1. Is your safety committee diversified and educated? Form a safety committee with a task force approach. Select members with different backgrounds – for example, a paramedic, nurse, pilot, mechanic and a logistics officer. The variety will lend itself to unique safety perspectives. Send as many safety committee members as your budget will allow to formal SMS training. The structured learning and networking opportunities they gain will pay huge dividends to your safety culture. Hopefully, your organization understands that SMS and risk mitigation is a sound financial investment. Funding a robust SMS will significantly contribute to your organization’s bottom line with accident and incident reduction.
  2. Does your organization promote a punitive culture or just culture? Employees who comfortably self-report incidents are the secret sauce of safety promotion. This practice provides the fuel for data collection, which drives safety assurance. But it’s also the most difficult to capture. We are asking that employees self-report incidents and near misses that would potentially fly under the radar. A great question most employees will ask themselves is, “What incentive do I have to make myself look potentially incompetent in front of my peers?” The answer is to grow your organization’s just culture to allow employees to feel safe and accountable in sharing this extremely valuable information, which often leads to system improvements.
  3. How do you grow your just culture? We must all understand that perfection is unachievable. We will make mistakes, but will be held accountable. We will share and learn from our mistakes. And we will critically evaluate and design the systems which support our team before errors become critical. Create a learning culture by investing in your employees’ education. Be fair and just in the treatment of employees. Identify and create safety champions within your organization. Managers need to take steps to retain their best and brightest (be on the lookout to identify employees who grow excited when the subject of checklist utilization is broached).

At the SMTA, I was surprised to learn that, on average, it takes a mid-sized organization 7-10 years to effectively implement a safety culture. The key is utilizing a phased approach of the four pillars of SMS.

But for now, in the spirit of raising our risk reduction profile, let’s all ask ourselves, “what can I do today to make myself and my crews safer?” This information, gleaned from the top tier safety professionals who presented at the recent SMT, is just the tip of the iceberg. It’s my hope that sharing their perspectives may compel you to re-examine and seek improvement opportunities within your SMS. 

About the author

Brent Tracy, BA, FP-C, is a flight paramedic with Humboldt General Hospital in Winnemucca, Nevada. He was recently awarded the Tim Hynes Foundation 2019 Safety Management Training Academy (SMTA) Scholarship.

Additional resources:
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3. Regional systems of care. The Montgomery County Hospital District EMS paired a novel stroke assessment endovascular pathway with specialized training with marked success.

2. Updating national EMS education standards. In an NHTSA EMS Focus webinar, EMS education standard revision panel leaders detailed what will be included, as well as a revision timeline.

1. Community preparedness. Help your community be disaster-ready with this emergency Public Information Kit from Gov1.
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