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 than
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 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 we get is “don’t enter the scene 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.
Why are EMS agencies so reluctant
to face this issue? In most agencies, there is no policy for dealing with
violent encounters, training for dealing with such encounters is rare, yet the
problem seems endemic. There appears to be a variety of reasons for this: 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.

Some changes are desperately needed if we are to see an
improvement in the number of injuries that are inflicted upon EMS workers by
their violent patients. It is obvious that the current policy of “scene
safety” is not working. There is a definite need for research into this
area that impacts the safety of our medical workers, so that a solution can be
found for preventing and dealing with this epidemic of violence.


 Maguire BL. Hunting KL.
Smith GS. Levick NR. Occupational
fatalities in EMS: A hidden Crisis. Annals of Emergency Medicine. 2002;
40(6): 625-632.

Maguire BL. Hunting KL.
Smith GS. Levick NR.
Occupational Injuries Among Emergency Medical Services Personnel. Prehospital Emergency
Care. 2005, 9:405-411

Maguire BJ. Walz BJ.
Current Emergency Medical Services Workforce Issues in the United States. Journal
of Emergency Management. 2004; 2(3): 17-26.

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