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Provider Violence: A Real Threat

No call is routine anymore!! We know that health care workers are facing threats, intimidation, and in some horrific circumstances, actual violence, and we know that it is happening more and more. So, I pose the question, how confident are you in your ability to recognize red flags? - because things can change in an instant. Nurses, law enforcement, and EMS are all at high risk -- it's likely you or someone you know has been directly affected by workplace related violence. Let's face it, you arrive because someone has called 911 so stressful circumstances and fear can make folks do some crazy and spontaneous things. Most of the time, it is the patient who acts out, but you have to keep your eye on the patient's immediate family members as well. It's no surprise, but the influence of drugs and alcohol are very prevalent as contributing factors.

In early 2019, the NAEMT published a comprehensive national survey on violence against EMS practitioners. Some takeaways are provided below:

+ 2/3 have been physically assaulted while practicing

+ 9/10 have been verbally assaulted while practicing

+ 1/3 feel that their uniforms don't clearly differentiate them as "EMS"

+ Nearly 65% didn't have OR were unsure if they had policies around workplace violence

+ Nearly 80% stated they wanted additional training on verbal de-escalation practices

+ Properly reporting violence is a huge problem

+ Many states have laws to protect EMS & deter violence through tougher penalties

Research has shown that violence against healthcare workers is “an underreported, ubiquitous and persistent problem that has been tolerated and largely ignored.” In the NAEMT survey, the majority of EMS practitioners (84%) said they report any act of violence to their EMS agency. (Only 16% said they don’t report all acts of violence.) If you take anything from this blog post - remember this:

Violence should NEVER be acceptable as just another part of the job

Some steps you could consider implementing at your agency to prevent or reduce workplace violence (WPV). Failure to prepare could impact your career longevity. It only takes one unfortunate event to abruptly end your time at the best job in the world.

+ Clearly define what workplace violence is:

(The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty).

+ Develop strong SOP's around this relevant topic

+ Carry your radio and ensure your local comm center provides real time updates

+ Encourage timely reporting of incidents without fear of punitive action

+ Train all personnel in both verbal de-escalation and self-defense techniques

+ Collaborate and train more with your local law enforcement partners

+ Secure potential projectiles that reside in the back of your ambulance

+ Purposefully pre-plan events where large crowds will be gathered

+ Mitigate risks (they are different based on the phase of the call)

+ Recognize that it's the joint responsibility of (you) the individual first responder and to your entire organization (leadership included).

In summary, acts of violence experienced by EMS responders can vary and have been described as relatively benign and quite traumatic “struck by patient,” “punched in the face by a drunkard,” “tackled by a large man,” and “assaulted by a combative patient” just to name a few. Formal recognition of the problem is increasing, however, compared to other health care settings, such as hospitals, WPV in the prehospital setting is inadequately described and requires further consideration/research. Never lose sight of the fact that EMS serves a crucial role in meeting persistent and emerging community health needs. Due to this, you are often providing patient care in unpredictable and increasingly hostile environments.

Let's do better together and report these incidents and adequately prepare for them to happen - a long and healthy career depends on it!!

November 27, 2023

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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