A Real Problem

We responded to a house for the dreaded “unknown medical.” As we arrived, dispatch told us that the caller thought there was something wrong with her sixteen year old son because he was hallucinating. When I opened the door, I saw a teen male who was covered in sweat and acting quite agitated. His mother told us that she had taken him in for his methadone injection when he started acting funny. She also tells us that he has been with her all day and he has not had any other drugs. As she was explaining this, the teen kicked me in the groin without warning or windup, and that is how the fight began.

Any fight that begins with a kick to the groin is going to be a nasty one with no rules. He hit me several more times and kicked my knee fairly hard. I closed the distance, managed to get a grip on his arm, and got him in a headlock. Since I outweighed him by about 100 pounds, I took us to the ground. While on the ground, he tried throwing elbows back into my face, but couldn’t reach due to the angle. He fought pretty hard, and wasn’t really responding very well to pressure points or other pain compliance techniques.

When the police showed up, the responding officer helped me get him in handcuffs, and we were able to move him to the stretcher, where he received some much needed Haldol and a pair of restraints. Once we got to the Emergency Room, they did a drug screen and it showed that he had cocaine, methamphetamine, and methadone in his blood stream. He wound up having one ruptured ear drum, some bruises, and two broken ribs.

Wirecutter posts about a Paramedic who was caught on camera punching a patient because the patient was attacking him. Attacks on medical personnel are a real problem. Years ago, when taking a course called “Advanced EMS Administration” I had to write a paper on this exact problem. The entire report came in at over 2,000 words, but I will give you an excerpt:

Fifty two percent of all EMS responders report having been physically attacked on the job at some time within the previous twelve months. According to the University of Maryland, the risk of nonfatal assault resulting in lost work time among EMS workers is 57 cases per 10,000 workers per year. The national average for all professions is about 1.8 cases per 10,000 workers per year, making the relative risk for EMS workers about 30 times higher than the national average. This isn’t just EMS getting hurt: in 1999, the Bureau of Labor Statistics estimated that 2,637 nonfatal assaults occurred to hospital workers–a rate of 8.3 assaults per 10,000 workers. Healthcare providers are twice as likely, and EMS workers 15 times as likely, to be assaulted on the job as are police officers or prison guards. Some locations and cities are obviously seeing injury rates that are far above the average.

The Occupational Safety and Health Administration (OSHA) has identified violence in the medical setting as a potential hazard, and has found the training of medical staff to identify and deal with potential violence ineffective. It is the third leading cause of on the job injuries in EMS (only lifting patients and vehicle collisions injure more EMS workers) and the second leading cause of on the job fatalities (behind vehicle accidents), yet the only training medical workers get is “don’t go over there unless it is safe.” This approach is obviously not working. There remains a reluctance on the part of EMS agencies and hospital administrators to provide training to effectively address workplace violence.

This begs the question: Why are EMS agencies so reluctant to face this issue? In most agencies, there is no policy for dealing with violent encounters and training for dealing with such encounters is rare, yet the problem seems endemic. There appears to be a variety of reasons, some may not recognize the extent of the problem and thus don’t perceive the need for training personnel in basic defensive measures, while others erroneously perceive using defensive tactics as fighting, or a form of aggression. Still other agencies feel that the liability that defensive uses of force would bring upon the agency is greater than the costs of treating injured employees. Whatever the reason, allowing the situation to continue as it is now is resulting in seriously injured workers, and the problem is not going to get any better until we as a profession find a way to deal with this issue. There are a number of possible solutions to this problem, but none of them are ideal, and none of them can guarantee that there will be no injuries to patients or medical workers.

I wrote that paper in 2010, over 13 years ago. I haven’t looked at the numbers lately, but I am fairly certain that the problem has gotten worse. Recently in Florida:

• At South Seminole hospital, a patient attacked a pregnant nurse and caused the death of her unborn child
• A nurse was attacked in Escambia County by a patient just last month
• A man in a Leesburg emergency room attacked a nurse
• A naked man attacked a nurse in the Villages
• I was suspended for nine days when a patient attacked me and then claimed that I had used too much force in subduing him. The police cleared me, but the hospital didn’t seem to care about that.
• There isn’t a week that goes by that I am not the target of a violent patient’s attack, or at least threatened with violent action by a patient.

It isn’t just nurses. Paramedics, too.

• A patient attacks an ambulance crew in Florida
• A UK paramedic has his jaw broken by a patient
• An EMT in Boston was stabbed by a patient, who was then ruled too insane to stand trial. The EMT is now incapable of working, the woman is free to go
• A man who stabbed a Cleveland paramedic gets probation

Why is this happening? The fact here is that many in health care, including administrators, feel just like the nurse who filmed that paramedic’s punch:

It infuriated me. It made me really angry, cause I mean, it wasn’t just a tap; I saw a full-blown punch. I’ve been a nurse for 16 plus years, and I’ve endured a lot of physical abuse, emotional abuse, verbal abuse, kicked on, spit on, called names, and I’ve never physically put my hands on my patients.

What this stupid cow is saying is that she is willing to let someone beat her, injure her, and do whatever they want, and she will not respond. I say fuck that. I am not letting some asshole who thinks that it is OK to hit people to injure me, possibly causing permanent injury or death, and not respond. No one should have to put up with that just so they can claim that they have “never put their hands on a patient.”

Read the facts again: these attacks are resulting in severe injury and death at an alarming rate. Since workers can’t sue employers if they are injured as a result of being attacked in the workplace, the only liability that an employer faces for these attacks is Workers’ Compensation. This means that employers are willing to allow their employees to be injured because the cost of paying Workers’ Comp claims are less than the cost to PR and liability for workers using force in self defense. This is the same philosophy that causes places like Pizza Hut to not care when their delivery drivers are attacked and shot during robberies.

I don’t care. I will lose my job and hire a lawyer to defend myself in front of the nursing board before I see myself get disabled or killed by some asshole who wants to use me as a punching bag. I get paid to treat you for your illness, not for you to attack me.