EMS: Assaults: A Major Stressor

May 1, 2019
Richard Bossert shares tips for avoiding and dealing with assaults on the job.

First responders sometimes encounter combative and violent patients, family members or bystanders. Thankfully, most responders aren’t seriously injured or sustain a permanent injury that can cause a line-of-duty death. The issue is a common one, so it’s important that EMS personnel do whatever possible to avoid these situations but also learn how best to manage the stress if they do experience an attack on the job.

A common problem

Based on my research, approximately 80 percent of first responders say they have been attacked, but fewer than 5 percent report the attacks. I find that many courts share a philosophy that complicates matters: If the assailant is under the influence of drugs or alcohol, the courts deem them not responsible for their actions. In one case, a New York EMT was attacked and needed eight surgeries; in another, a Philadelphia medic was attacked and required antibiotics. In both cases, police reports were filed, but no criminal charges or jail time served. 

Fortunately, over the past several years, many states have made attacking EMS personnel a crime, ranging from simple to aggravated assault, including felony charges. In Pennsylvania, it’s under Chapter 27 Assault – Title 18 Crimes and Offenses.

Dr. Jennifer Taylor from Drexel University’s Dornsife School of Public Health states that EMS personnel are 14 times more likely to be violently injured than firefighters. Further, females are over six times more likely to be victims of violent acts.

Preparation and avoidance

Being aware of potential risks and maintaining a safe distance isn’t always enough to prevent an attack. You must also be mindful of medical issues like diabetes, strokes or even a head injury that can turn an ordinarily passive patient into a raging physical or verbally abusive person. Adding drugs and alcohol can rapidly deteriorate an incident. In teaching scene safety, I educate all colleagues that there are three things to remember: Everyone is crazy, everyone is under the influence, and everyone is packing a weapon.

So, what can you do? Remain alert to your surroundings and be prepared for the situation to change rapidly. One provider should concentrate on the patient and the other on the environment. If something looks, feels or sounds suspicious, stay out of harm’s way.

Other tips for avoiding dangerous situations:

·      Share information with crews related to known violent locations

·       Send backup on drug overdoses, violent crimes, domestic disputes

·       Train on how to handle combative patients and learn self-defense

Managing stress

The prevalence of on-the-job attacks raises the question: How are EMS and fire personnel being affected mentally and emotionally by these events? I believe more than most realize. 

Stress is a response characterized by physical and psychological arousal as a direct or indirect result of exposure to any demand or pressure. Everyone deals with stress, but EMS and fire personnel must manage a higher level due to their job and environments. And if you are attacked on the job, your stress response will be heightened.

Dr. Paul Diken, a licensed psychologist, says anxiety and depression are common among first responders who have been assaulted, and being unable to work through stress can develop into post-traumatic stress disorder (PTSD). Diken adds that anxiety can build because our brains make associations to events. A threat-sensitive incident produces a parasympathetic stimulation that can lead to harmful physical and psychological effects. Further, there can be a dosing effect where a single event may not trigger a PTSD experience, but many events can build up until it becomes a knockout punch.

Taylor also underscores the mental impact of an assault: “You go back the next day expecting to perform as usual, but every time someone does something to you, you’re different.” You become so focused on the assault that it can be hard to concentrate on the job, even patient care.

What to do

Do your personnel know their jurisdictional laws and rights? An assault doesn’t have to be physical; it can be verbal or even a threat. Do you have a procedure for members to follow if assaulted? Learn your regulations and rights in dealing with a violent act. 

It’s important that EMS personnel who have been attacked report and document every assault. Notify the police and your immediate supervisor at the incident scene or contact them as soon as possible. Having witness statements, along with any video is always a good backup.

It’s also important to focus on improving psychological therapy and employee assistance programs to help victims seek help.

Watch out for each other and stay safe out there.

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