A 2010 report by the U.S. Bureau of Labor Statistics found that a health care or social assistance worker is nearly five times more likely to be the victim of a nonfatal assault or violent act than the average worker in all industries combined. Nearly 60 percent of all nonfatal workplace assaults and violent acts by persons occur in the health care and social assistance industry, and close to three-quarters of those assaults are committed by health care patients or residents of a healthcare facility.
In 2009 Brian Maguire, clinical associate professor of emergency health studies at University of Maryland, Baltimore County, presented research at the National Association of State EMS Officials midyear meeting showing an assault fatality rate seven times higher for EMS personnel than for other health care workers. The research also demonstrated a non-fatal assault rate 22 times higher for EMS providers than the national average for all occupations.
A 2002 study by Maguire, et al. conservatively estimated, from available data, 114 EMS worker fatalities in the United States during a six year sample period, finding ten of them to be from homicide, with most of the ten being shootings. It concluded: “This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.” Maguire reviewed the available data for a five year sample period again in 2013, and found 8% of EMS worker fatalities were caused by assault. Assaults accounted for 530 out of 21,749 non-fatal injuries during the five year sample period, 45% of them against women despite constituting only 27% of the EMS workforce. The 2013 study concluded: “Data from the DOL show that EMTs and paramedics have a rate of injury that is about three times the national average for all occupations. The vast majority of fatalities are secondary to transportation related-incidents. Assaults are also identified as a significant cause of fatality. The findings also indicate that females in this occupational group may have a disproportionately larger number of injuries.”
A search of the www.EMSclosecalls.com Secret List publication, which chronicles deaths, injuries and near injuries in the EMS and fire service, returns 1,860 results when the keyword “shot” is queried, 1,650 results for the word “assault,” 359 for the word “shoot,” 83 for the word “stab,” and 43 results for the words “dog attack.”
Several high profile attacks against EMS providers and firefighters have occurred in the past several years. In April of 2013 a man in Georgia lured five Gwinnett County firefighters into his home after calling 911 for chest pains. The firefighters responded believing it to be a routine call. Upon arrival at bedside, the patient pulled out a gun and held the firefighters hostage for nearly four hours before ultimately being killed by law enforcement. While the firefighters were in captivity, the offender admitted to them he had planned the kidnapping for several weeks, and intentionally targeted them because he knew they would be unarmed.
In December of 2012 another man lured firefighters to his home in Webster, New York by setting fire to his house and car, then gunned them down with a rifle from behind a berm. Two firefighters were injured and two were murdered before the assailant killed himself. The dead included 19 year old volunteer firefighter Tomasz Kaczowka. It was later found that the assailant was a convicted felon who beat his grandmother to death with a hammer in 1980, and had been released from probation in 2006.
In January of 2013 a California EMT was stabbed in the back by a patient’s son while on a routine medical call, leading to a five hour stand-off with deputies before the assailant was taken into custody. Two Detroit paramedics were attacked by a violent mob in October of 2014 after their dispatch center failed to inform them that people at the scene were engaged in a physical fight. A Missouri Paramedic was shot twice in the torso by a sniper in 2004 while fighting a nearby house fire. In 2011 another two EMTs were shot by snipers, one in a hospital parking lot, and the other on a residential call. EMS providers are documented as being targeted for assault in numerous other news stories. Additionally, EMS providers’ response vehicles are targeted for theft of controlled substances, as was the case in 2013, when a man was arrested and charged with burglarizing medications from a Jacksonville, Fla. ambulance.
During the creation of this document, several accounts of graphic workplace violence in other industries were reported by the media, including the gruesome beheading of a 54 year old grandmother by a radical Islamic terrorist at a food distribution center in Oklahoma, and the abduction and murder of a female real estate agent in Arkansas...
...These. . . numbers are undoubtedly underreported due to. . . an industrywide culture that discourages the reporting of assaults. Paramedic Skip Kirkwood, director of Durham County EMS and editorial advisory board member for the EMS World periodical, describes this culture in the following way:
“Classroom discussions reveal that one of the major reasons EMS providers tolerate violence against them is organizational cultures that mock them (particularly senior personnel) if they make a fuss about being assaulted. Do LEOs mock other cops who are assaulted? No, they help ‘cuff and stuff’ attackers and take them to jail. Do firefighters mock other firefighters who fall through floors or get hurt fighting fires? Nope – they rescue them and use the lessons learned to improve safety at the next fire. EMS folks need to support and help our brothers and sisters who are assaulted on duty – and assist the perpetrators in receiving their just rewards via the criminal justice system.”
It is clear that staging for police is only one, though important, tactic for protecting yourself and your crew. It is not an all-encompassing safety plan. Neither is relying on some sort of perceived neutrality of EMS providers. The evidence we have shows that an intoxicated, mentally ill, recidivist felon who somehow plead out of beating his own grandmother to death with a hammer does not care where your paycheck comes from or what type of uniform you wear. You still work with police, respond with police, drive similar cars as police, and call the police on your radios when you see someone breaking the law. You are not a neutral party. If you talk to anyone who has been in this business for a while, nearly all of them have been been assaulted, shot at, stabbed, or have been otherwise threatened on multiple occasions throughout their career. In my career so far I can recall off the top of my head being cleared for entry into a dozen or so dangerous scenes by police who hadn't even arrived on scene yet; I've had my ambulance carjacked; race rioters in front of a bar threatened me and my crew, causing us to retreat; I've been threatened with one firearm; a older male patient grabbed my dick; I've been punched by more patients than I can remember, although admittedly none were that bad. I have found myself in countless dangerous situations without warning, because that's just the nature of the business. Sure, you can stage for law enforcement, if your dispatchers were informed by the caller that the scene was dangerous, if your dispatchers relay that information to you in time, if you have 24 hour law enforcement in your service area, and if they aren't engaged in jurisdictional battles with other departments. That's a lot of what-ifs.
My service area, though safer than most, is 350 miles from the nearest level I trauma center, 75 miles from the nearest level II, and about 50 miles from the nearest level III. Air transport is an option sometimes when the weather is good. What are my chances of surviving a thoracic GSW? There are a lot of what-ifs there too.