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Paramedic and EMT protection: How to avoid violent attacks

Know the signs of escalation and how to diffuse dangerous encounters


Violence prevention is a non-negotiable skill for EMT and paramedic safety.

Photo/Audrain Ambulance District

By Zack Zarrilli

As a medical professional, your goal is to help your patients. However, sometimes, your patients are resistant to care. Situations can escalate quickly when a patient is upset or angry. Do you know what to do if a patient becomes violent?

Violence prevention is a non-negotiable skill for EMT and paramedic safety, and yet it’s not always taught in their primary job training. Management of Assaultive Behavior (MAB) training on violence towards EMS providers can help. This training focuses on situation assessment and non-physical de-escalation. It gives professionals the know-how to help keep everyone safe during a potentially violent encounter in the field.

Why first responders need MAB skills

While it’s just another day at work for first responders, it could very well be the worst day of a patient’s life. In emergency situations, people tend to be unpredictable. As such, it’s important for paramedics and EMTs to have situational awareness and prevent escalation if a patient becomes upset.

Unfortunately, violence against first responders is a reality. From verbal threats to physical altercations such as biting, kicking, or punching, EMTs and paramedics face potential hazards every time they clock into work.

A study from 2020, spanning over 104 scientific articles, found that between 57-93% of EMS responders experience at least one instance of verbal and/or physical violence during their careers.

There are many potential reasons for this. First responders encounter a higher volume of new patients. And, unlike primary care doctors or other medical professionals, you aren’t able to build a relationship with your patients over time. You’re meeting a higher volume of people, so statistically, there is a higher chance of dangerous encounters.

Also, as an emergency responder, you are typically the first person to interact with the patient following a traumatic incident. Victims are often stressed and overwhelmed, and this could manifest into violence.

As a first responder, you might even arrive at an already violent situation. There are a few common violent scenarios that EMTs and paramedics are called to, from domestic violence and fights, to large-scale emergencies.

Substance abuse and mental health emergencies can also play a role in a patient’s likelihood of violence. Patients may not be emotionally or physically well, increasing the likelihood for them to lash out against the people trying to help.

Tension in any of these stressful situations could lead to threats of violence against first responders. Identifying and mitigating these potentially violent situations will help you keep your patients, your coworkers and yourself safe.

We can’t predict when EMS assaults will occur, but we can prepare. Learning how to prevent escalation and knowing EMS self-defense is essential. Here are a few violence prevention tips to keep in mind:

Know the signs of escalation

It’s always important to practice EMS scene safety. Maintain awareness of your environment at all times and keep an eye (and ear) out for potentially dangerous situations. Emergency scenes can be sensory overload. With lots of sights, sounds and stressed-out people, it can be difficult to remain focused. No matter how much training you have or how many years you’ve been in the industry, there can still be surprises.

More than likely, there will be a warning sign before a situation becomes violent. Know what to look out for so that you can intervene.

  • Verbal hostility or threats. Verbal escalation often precipitates physical escalation. The patient might start with hostile language or threats as they become upset.
  • Yelling. If a patient begins to yell or raise their voice, this is a clear indicator that they are frustrated.
  • Physical aggression. Patients might hit or throw objects before they direct that anger towards a person.
  • Suspicious body language. Watch for sudden movements, staring and other concerning body language. Patients might also look around the room or area for potential weapons.

Steps to de-escalate and prevent violence

If you’ve identified a potentially violent situation, it’s time to use de-escalation MAB techniques. The idea is to calm the patient down and mitigate the risk of violence.

The following steps can help you do so:

  • Clear, active listening. Sometimes, patients resort to violence if they are feeling unheard or misunderstood. Show the patient you are actively listening and stay engaged during the conversation.
  • Call for backup. If more professionals are around, the patient may become intimidated and less likely to respond violently. If the patient becomes aggressive anyway, there are more people on the scene to intervene.
  • Communicate effectively. Ask the patient questions and try to facilitate a conversation rather than making demands. Don’t just tell the patient to “calm down” or make threats.
  • Consider the environment. Things like loud rooms or big crowds can be triggering for patients. If it seems like the setting could be a factor in their anger, move to a quieter corner.
  • Calm body language. As upsetting as the situation may be, try to maintain your own composure. An angry response could cause a bad chain reaction. Stay at eye level, speak with an even tone, and maintain a non-threatening stance. Responding calmly sets the tone of the interaction and can diffuse a situation before it becomes violent.

Remember that every patient and each situation is unique. Use your judgment to determine which technique is right at the moment.

What to do if a situation becomes violent

If de-escalation attempts are unsuccessful, you have to prioritize your own safety and the safety of your crew. Do your best not to freeze up – instead, know when to use fight-versus-flight strategies. If the patient needs to be restrained, make sure to follow the proper protocols.

Get MAB certified

The best way to prepare yourself for assaultive behavior is by taking a training course. Management of Assaultive Behavior (MAB) certification classes will teach you valuable violence-prevention skills and de-escalation techniques.

Unlike a traditional self-defense course, these courses are specially targeted for medical professionals with information based on the healthcare setting. MAB teaches non-physical strategies for violence de-escalation and conflict management.

Managing Assaultive Behavior training courses cover critical topics such as:

  • Identifying and preventing potentially violent situations
  • De-escalation techniques
  • Intervention and negotiation strategies
  • How to handle a violent emergency

Ready to get certified? Look for a reputable provider with an accredited program. Many courses can also count for continuing education credits, a great benefit for your career.
Whether or not you choose to get certified, learning and internalizing MAB skills is essential. In a dangerous situation where you have to make quick decisions, understanding these techniques will make all the difference.

About the author

Zack Zarrilli, Founder of SureFire CPR, spent 15 years as a firefighter and paramedic. Too often, Zack would arrive on the scene of someone unconscious, surrounded by friends and family members of the victim who felt simply helpless. Sometimes, these bystanders were CPR-certified but lacked the confidence and experience to act. This is why Zack started SureFire CPR. The classes are practical and engaging, teaching crucial skills a person would need to have in order to confidently administer CPR. SureFire CPR teaches its students what to do and how to feel empowered enough to take action.