It’s Time to Stop the Violence

Skip Kirkwood is a featured speaker at EMS World Expo 2013, September 8–12, in Las Vegas, NV, and will be presenting a preconference class on "Managing and Mitigating Violence Against EMS Providers." For more information, visit EMSWorldExpo.com.

Recognizing that EMS personnel are at high risk of suffering violence on the job, the National EMS Management Association (NEMSMA) has launched an initiative, called End Violence Against Paramedics, to address the issue. Skip Kirkwood, NEMSMA’s past president, outlines what’s involved. The following excerpted article can be found in its entirety on the Best Practices in Emergency Services website at emergencybestpractices.com.

If today’s EMS leader receives Internet news feeds, reads the online versions of our leading trade publications or occasionally visits EMS-oriented social media sites, two things are readily evident. First, paramedics (regardless of certification level) are subject to violent attacks on a regular, if not daily, basis. Second, the street-level paramedic community is concerned about the issue. Less evident, but visible if you read between the lines, is the fact that the EMS community is looking for leadership on this issue. We’re the leaders, so let’s lead.

In the 2005 NAEMT Experiences with Emergency Medical Services Survey, more than one in two respondents (52%) reported that they had been assaulted by a patient. In one study in a large California EMS system, EMS personnel encountered some sort of violence in 8.5% of patient encounters and were subjected to violence directed at them in 4.5% of patient encounters. Of encounters where violence was directed at EMS personnel, 21% involved nonphysical (verbal) violence only, while 79% involved physical violence.

Some states have taken the step of placing assault on a paramedic on legal par with assaulting a law enforcement officer—as it should be. In other states, it remains a simple assault, with no enhanced penalty attached. We should work on that. As agencies or through our state associations, we should lobby our legislature for par legal status with our law enforcement colleagues.

Many agencies have cultures that accept, and teach new members, that paramedics are punching bags. This is wrong. It happens through a combination of peer interaction, policy and practice that teaches paramedics that it is better for them to “absorb the hit” and carry on, regardless of injury or indignity, than it is to report the violence and encourage prosecution.

Organizational policies, procedures and practices encourage employees to stay in service and in fact punish them financially for taking care of violence-related issues. Employees injured through violence will often hide their injuries, because employers haven’t addressed the limitations of their workers’ compensation coverage, which (if not modified) is geared to a 40-hour-a-week employee who rarely works overtime. Going on workers’ comp can often seriously impact the take-home check of paramedics who are already poorly compensated.

The NEMSMA End Violence Against Paramedics initiative, adopted by the board of directors in 2012, is an effort to change the culture of the EMS community, from top to bottom, with regard to assaults, batteries and other violence against our people.

We will make a concerted effort to document instances of violence against paramedics. To that end, we have partnered with our colleagues at EVENT (EMS Voluntary Event Notification Tool) to produce an anonymous reporting database. EVENT is a program of the Center for Leadership, Innovation, and Research in EMS with sponsorship provided by the North Central EMS Institute, the EMS Chiefs of Canada, NAEMT, NASEMSO and NEMSMA. The EVENT Violence Reporting Tool will be made available nationwide.

We will work with our partners who represent EMS practitioners to carry the message that violence against paramedics is unacceptable and that offenders must be prosecuted.

We will build a partnership with EMS educator to educate paramedics that violence against them is not a part of the job that they must endure. We will work with these partners to ensure that effective, appropriate training is provided with sufficient frequency that essential skills are maintained.
We will make a concerted effort to educate EMS executives and senior leadership on the importance of building a supportive environment for their personnel, where violence against paramedics is not tolerated, where reporting and prosecution of attackers are supported, and where effective, appropriate training in preventing and dealing with violence is provided.

We will assist EMS agencies in developing this environment by providing model policies, templates for assessing an organization’s culture with regard to violence and educational materials for use within the agency.

We invite leaders who share our concerns to involve themselves in our effort. Let’s make sure everybody knows that paramedics are not punching bags, and violence against paramedics is not just “part of the job.”

Skip Kirkwood, MS, JD, EMT-P, EFO, CMO, is chief of the Wake County (NC) EMS Division and past president of the National EMS Management Association.