Kicked & Spit On: What's A Medic To Do?

I still have fond memories of an incident that happened in the early 1980s, when I was a captain/paramedic working in St. Louis. I responded with a paramedic company to a report of three people shot near the riverfront area of the Gateway Arch. As I parked my duty car and got out, I could see the scene was chaotic with lots of people engulfing the ambulance from all sides, as the medics had already loaded two critically injured patients into the rear and closed all the doors. The crowd was so overwhelming and anarchic that the two police officers who had arrived were unable to gain control.

As I approached the side door of the ambulance, I was suddenly grabbed on the upper arm by an out-of-control woman who was screaming irrationally. Her grip, with her fingernails imbedded into my upper arm, with all her adrenaline flowing, was excruciating and she had a death-hold that I could not break. This lasted about a minute, but it seemed like an eternity. Finally, I had to use a self-defense tactic to free myself from her grasp. For about a week, I had deep bruises on my upper arm that resembled the tips of her fingers.

Work in this profession long enough and eventually you will be assaulted by a patient, family member or bystander. Could you forget the first time you responded to a call and instead of being greeted with gratitude and appreciation when you showed up, you were attacked by a violent patient?

Violent patients will attack you for a variety of reasons. Sometimes, they are psychiatric patients or have metabolic imbalances, such as hypoglycemia; other times, they think you are a police officer because of the way you are dressed. Have you ever gone into a business to do an inspection or been buying groceries when a civilian came up to you with that quizzical look at your uniform and badge, trying to decide whether or not you are a police officer. Usually, they are looking for a police officer to have a question answered or they are trying to report something they saw. The reasons why patients attack are as varied as the attacks themselves.

Each year, countless medics and firefighters are assaulted by patients they are there to help. Recently in Connecticut, a paramedic/firefighter was kicked in the shoulder suddenly as the patient lay on the stretcher. The patient then began to spit on the paramedic, claiming he had AIDS. In Texas, as paramedic/firefighters and police officers were climbing a staircase to a third floor for the report of a person down, a man standing on the third floor landing suddenly yelled a profanity and dove down the stairs, knocking the firefighters and police officers over and down the stairs. In Kentucky, two paramedics were attempting to treat the patient of a stab wound when he resisted. One paramedic was bit on the finger and the other was kicked in the ribs.

Although there are no known statistics that are kept on assaults against emergency responders, Don Walsh, an assistant chief paramedic with the Chicago Fire Department, examined assaults against medics in the 25 most populous cities as part of his 1993 master’s thesis. His study found that 92% of paramedics surveyed said they were victims of assault; 64% of paramedics reported having been injured during assaults; and 96% of those paramedics reported receiving treatment for their injuries. His study clearly showed a high number of assaults against emergency responders in urban environments.

Whether you work in the big city with lots of violence or in the quiet suburbs, violence against medics and firefighters can occur anywhere. The biggest enemy of responders is complacency or lack of attention as they approach the scene or while they are at the scene.

The goal at the beginning of every shift should be to complete your shift and return home to your family in the same physical and mental way you reported for work. That means all limbs attached, no holes in your body, no scratches on your face or arms, and with all your mental faculties. Unfortunately, this is easier said than done sometimes – especially in high-volume urban environments.

Your first goal on the job should be to avoid any possibility of violence or assaults against yourself. If possible, don’t put yourself in a position where you have to defend yourself. This is especially true if the person has a knife or a gun. Remember – the person with the loaded pointed gun is always the incident commander! There is no dishonor in backing out of a situation where your safety is in jeopardy. You can always regroup with law enforcement to make a second entry into the scene or have law enforcement secure the scene, then you can make a second entry.

Another rule of thumb is if the person who greets you at the door of a building is confrontational, you are not duty-bound to go inside. Back away, call for law enforcement and wait for them to arrive. Remember what was drummed into you in EMT class: scene safety, then your ABCs.

Many departments are now issuing body armor to their personnel. If body armor is available to you, do not hesitate to don it on potentially violent scenes.

Taking away opportunities from those who would harm you should also be a goal. Never let a pen or pencil stick out of your uniform shirt pocket. Someone could easily grab it and use it as a blunt object. The same can be said of scissors, clamps and knives, which we all carry, that can become weapons. Stethoscopes around your neck can be used to choke you. If you wear a tie, never wear one that must be knotted; instead, wear a clip-on tie. If a violent patient grabs your clip-on tie, if will come off. With a knotted tie, a person can pull you around.

It is important to watch the patient’s eyes and facial expressions. Typically, a person who attacks you will show some form of rage on his or her face and the eyes will dart from one spot in the room to another, sizing up the situation, plus planning the attack. An experienced emergency responder can calm a situation with voice control, before it escalates out of control. You must know what words to use and not use. Any comments that are references to a person in an inflammatory manner can elicit an attack.

Your voice intonations will also determine whether a call deteriorates or is successful. The tone of your voice, pacing, rhythm, pitch and audio level will either turn a patient or family member defensive, or get them to cooperate with you.

The emergency responder is the most valuable asset the fire service possesses. Only through training, by having the proper resources and taking the right approach can responders minimize the chances of attacks that they face on a daily basis.

Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master’s degree in management and business and a bachelor’s degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636-789-5660 or via