A research-based approach to understanding assaults against EMS personnel

EMS Chief Ernesto M. Rodriguez shares insights from the City of Austin EMS Department Assault Survey


This article originally appeared in the Sept. 5, 2019, issue of the Paramedic Chief Leadership Briefing, Understanding EMS assaults | Risk mitigation | Hurricane Dorian assistance. Have you subscribed to the Paramedic Chief eNewsletter? Manage your subscriptions today.

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?

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. (Photo/Courtesy of ACTEMS Chief Ernesto Rodriguez)
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. (Photo/Courtesy of ACTEMS Chief Ernesto Rodriguez)

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 ernesto.rodriguez@austintexas.gov.

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