Author(s): John Montes. Published on July 2, 2018.

The 400 Blows

Work-related violence is a major problem facing an array of first responders. Why is so much of it going unreported?

As an 18-year emergency medical services veteran, I can tell you that work-related violence directed at EMS workers is a vastly underreported problem.

A recent study provides a bit of insight. “Expecting the Unexpected: A Mixed Methods Study of Violence to EMS Responders in an Urban Fire Department,” published in the American Journal of Industrial Medicine, includes some eye-opening factoids from several previous studies. In 2012, for example, an estimated 2,400 EMS workers were sent to the hospital with injuries received from work-related violence. Unfortunately, this trend continues to be the most common cause of injury for EMS workers nationwide.

While these statistics may be revelatory to some, I can’t help but think that they only tell half the story of what emergency responders face in the field.

In my experience, first responders seldom report the violence they encounter on the job. During my career, I was assaulted several hundred times but only reported about 15 incidents—mostly because I suffered some form of injury—and only went to court six times when charges were pressed.

There were many factors that contributed to my reluctance to report violent incidents: I felt sympathetic toward the sick and impaired and didn’t want to get them in trouble; I was assaulted by patients suspected of being under the influence of an illegal substance, and law enforcement was hesitant to charge them for an assault because they wanted them to be medically cleared; I was not injured, at least not visibly; I felt peer pressure to act tough and as though the assault didn’t affect me; and I simply accepted it as “part of the job.”

Though it hasn’t been formally studied, many believe that this lack of reporting violence against responders is widespread. Many responders don’t even report assaults to their supervisors, meaning that even department leaders may be unaware of the magnitude of the problem. One can only wonder how much this issue wears on responders’ mental health and to what extent.

Although the aforementioned study only focuses on EMS workers employed by large urban fire departments, I think it provides a starting point for a broader discussion about violence against all responders. Researchers analyzed data from the Firefighter Injury Research and Safety Trends project, and interviewed multiple paramedics and EMS to gain a deeper understanding of the problem.

Among the noteworthy observations from the study are: EMS responders are more likely to be assaulted by patients than their firefighter colleagues, and gender does not determine who gets assaulted; there is a general lack of knowledge about how to prevent violent attacks; signage in the back of ambulances stating “It is a felony to assault a first responder” might deter patients from assaulting EMS workers; and computer-aided dispatch (CAD) systems should utilize a flag system so that dispatchers can alert all responders about prior patient-initiated violence at the location, a feature already used by at least two departments.

Other observations were that departments can reduce responder stress levels by adding personnel so that workers have opportunities for breaks during their shifts to encourage occupational recovery; and department management should support personnel during legal proceedings after assaults occur.

I would add to this that supervisors should encourage responders to report violent incidents, or at least to enter the incident into a self-reporting computer tool so that more robust data can be collected. The strength of the available data clearly shows a need for further exploration into this subject, and more data will help draw more attention to this underreported problem.

JOHN MONTES is specialist, Emergency Services Public Fire Protection, at NFPA. Top Illustration: Michael Hoeweler