EMS: Violence Against EMS Providers: Understanding and Mitigating the Risks

EMS practitioners often are the first responders who are on location in critical situations in hostile environments. They can face violence from the individuals to whom they try to render care, those individuals’ family members and/or bystanders. Violent behavior can include physical attacks, verbal abuse and threats.

Several factors contribute to the risk of violence against EMS providers. These include:

Mental health crises. Many calls to which EMS providers respond involve individuals who are experiencing a mental health crisis who might exhibit unpredictable or violent behavior.

Substance abuse. The judgment of individuals who are under the influence of drugs or alcohol can be impaired. Undoubtedly, this can increase untoward behavior, particularly when the two substances are mixed. Such individuals can become violent without notice.

High-stress environments. Emotions run high at domestic disputes, crime scenes and other volatile settings, which increases the risk of providers encountering violence. 

Lack of awareness. Sometimes, the public might be uneducated about the role of EMS providers. This lack of knowledge can lead to misunderstandings and aggressive behaviors.

To mitigate these risks, EMS providers must employ street smarts—in other words, a combination of awareness, training and practical strategies—to help to ensure their safety.

Situational awareness
This involves constantly being aware of one’s surroundings and identifying potential threats. EMS providers must assess the scene before they enter and remain vigilant throughout the incident. Consider one provider caring for the patient while the other maintains awareness of the surroundings and changes in conditions.

De-escalation techniques
De-escalating potentially violent situations is crucial. EMS providers must learn how to mitigate such situations, including using calm, nonthreatening body language and verbal communication skills to diffuse tensions. Language or cultural barriers can make this difficult.

Self-defense training
Although the primary goal of an EMS provider is to avoid physical confrontations, basic self-defense training can be invaluable when there’s no other option but to protect oneself. Remember, if the scene is unsafe, relocate, regroup and get assistance before returning.

Use of technology
Wearable alarms or panic buttons that discreetly alert dispatchers or law enforcement can be lifesaving in emergencies. Ensure that you have a radio protocol: If dispatch doesn’t hear from you in a specific time frame, they must contact you to ensure that everything is going well; if there isn’t a response, immediately dispatch police for an assist.

Communicate with law enforcement
Establishing a good rapport, working relationships and communication protocols with local law enforcement agencies can ensure faster response times when a situation escalates. Training and understanding the response and capabilities of local or state law enforcement is paramount.

Post-incident support
Access to counseling and support after a violent incident can help EMS providers to cope with trauma and prevent long-term psychological effects. This service must be available 24/7.

Policy changes
Addressing violence against EMS providers also requires changes at the policy level. These include:

Comprehensive violence prevention and de-escalation training. Police departments, social workers and psychologists are excellent resources for incorporating this training into the EMS curriculum initially and through a continuing education program.

Reporting and tracking. All incidents of violence against EMS should be reported. A database should be maintained to track and analyze these incidents for preventive measures. Review every incident. If there’s a systemwide trend, educate all providers to be more aware and better able to handle it.

Legislative action. Penalties for violence against EMS workers has improved over the past several years, but judges still let violators off after they deem the event to be unusual. These decisions can send the message to the public that they can get away with EMS violence.

Community education. Public awareness about the work of EMS providers—we are there to help and the importance of respecting and supporting their efforts must be increased.

Safe on scene
By linking situational awareness, effective communication and self-defense policy enhancements, EMS providers can better protect themselves. EMS organizations must be held responsible for ensuring that first responders can perform their duties safely and effectively.