Trending Topics

Research Analysis: Preventing downstream consequences of EMS assaults

NAEMT’s National Survey of Violence Against EMS Practitioners identifies training gaps in EMS safety


The U.S. Department of Labor defines workplace violence as “an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property.

AP Photo/John Minchillo

The National Association of EMTs (NAEMT) recently published a survey on member experiences with violence in the prehospital setting. They received nearly 2,200 responses from mostly paramedics and EMTs detailing not only their exposure to violence, but also the role violence plays on their perceptions of safety, provider knowledge of reporting systems, agency policies and procedures, as well as the types of education and training respondents were interested in.

Ninety-one percent of respondents reported having been verbally harassed, while two-thirds reported being physically assaulted while practicing EMS, mirroring rates previously published. There was no difference across genders, however, women were slightly less likely to feel safe on duty versus their male counterparts (57% vs. 64%).

NAEMT’s decision to ask about uniforms was unsurprising given the debate that often forms around the importance of distinguishing EMS from other first responders. Two-thirds of respondents felt their uniform was unique enough to delineate their role as a healthcare provider, however, across different types of agencies, fire-based providers were the least likely to feel this way.

Although scene safety has long been a required part of any simulated patient encounter, actively incorporating the construct into an organization’s practices is harder than simply stating “scene is safe” at the beginning of a drill. While 99% of respondents felt they personally made safety a priority, only three-quarters could say the same about their coworkers and their agencies. The discordance between these two could be expected, but closing this gap should also be a priority, as it is a representation of an organization’s culture and potentially the trust between partners.

Only one in three respondents knew of their agency’s written policy on violence against EMS providers. Of these agencies, nearly 50% reviewed their organization’s policy each year, 68% had policies specific to verbal confrontations, and 81% required all acts of violence to be reported. NAEMT specifically asked if the policies contained information on firearms, and 32% had a body armor policy and an equal number had policies related to carrying a firearm while on duty.

Just over half of the respondents felt they had received adequate training, and when training was received, it focused on EMS safety, excited delirium, altered mental status, and violent and unruly patients. In comparison, respondents felt they wanted more training on violent and unruly patients, verbal de-escalation, altered mental status, and self-defense.

As NAEMT is also a lobbying organization, they finished the report by focusing on various legislative efforts relating to violence in EMS. Of course this varies by state, but interestingly, only two-thirds of respondents even knew their rights under the law. Specifically, NAEMT has been supporting the Workplace Violence Prevention for Health Care and Social Service Workers Act, passed by the House of Representatives in November, 2019.

The U.S. Department of Labor defines workplace violence as “an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property. Workplace violence includes abusive behavior toward authority, intimidating or harassing behavior, and threats.”

Memorable quotes from the National Survey of Violence Against EMS Practitioners

Following are some of the more memorable quotes from respondents to the NAEMT National Survey of Violence Against EMS Practitioners:

  • “If the violence was unintentional – altered mental status due to hypoglycemia – and no harm or insignificant harm is inflicted, I likely will not report.”
  • “Default assumption is that providers are at fault until proven otherwise.”
  • “I’d kill a small forest if I reported every incidence of violence. I just report when an injury occurs.”
  • “We need more active training for providers on how to de-escalate, restrain and manage all patients before they get violent.”

Key takeaways from the National Survey of Violence Against EMS Practitioners

Here are 3 takeaways from the NAEMT survey of Violence Against EMS Practitioners.

1. Violence is underreported

The need to report assaults against first responders is a double-edged sword which must be appropriately balanced, something that was well supported by many of the comments from survey respondents. As violence occurs on spectrums – from verbal to physical, from no harm to severe injury/death, and from uncontrolled to intentional – so should the spectrum of reporting.

If a provider is injured by a patient or bystander, the need to appropriately document what happened is likely obvious to most involved. But asking providers to report every incidence of verbal harassment without providing them a reporting tool that doesn’t take more than a few minutes to complete is asking for incomplete data.

2. Violence likely has downstream consequences

When I think about all of the ways a violent encounter, or even the threat of violence can negatively impact the future, the following things come to mind:

Little is known about the direct link between experiencing violence while performing EMS duties and the list above, but the indirect links are growing stronger with each evaluation on the topic.

3. Change is going to need to occur at all levels

NAEMT, along with other groups, is working on advocacy at the state and national level to ensure there are legislative frameworks that support enticing organizations to put systems in place protecting their employees. Similarly, organizations, and the leadership within, must ensure that all providers are comfortable reporting moments in which risk actually existed or even the threat of risk existed.

Additional resources on protecting EMS providers from violence

Learn more about how to protect providers from violence with these resources:

Catherine R. Counts, PHD, MHA, is a health services researcher with Seattle Medic One in the Division of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.

Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and pre-hospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine.

Connect with her on Twitter, Facebook, or her website, or reach out via email at