Understanding Assaults on EMS Personnel: City of Austin EMS Department Assault Survey Results

Ernesto M. Rodriguez, LP, MA, Eric Gordon, LP, BS, Patricia Bourenane, BA, Keith Simpson

Background: At least one national research study indicates that approximately 60% of EMS personnel have experienced physical violence in the workplace and somewhere between 21-78% have experienced verbal abuse.1 Internet searches reveal that communities across the United States are reporting increased violence against EMS providers. Even so, it is likely that assaults on EMS personnel are largely under-reported in the industry as clearinghouses for gathering EMS personnel assault data in the United States are under-used.

Objectives: To improve our understanding of assaults on ATCEMS personnel: Identify the number of personnel experiencing assaults in the workplace; assess the effectiveness of training provided by the department; evaluate reporting practices; assess the support provided to personnel who have been assaulted; and better understand the beliefs, attitudes, perceptions about assaults held by our personnel.

Methods: Two broad surveys were developed using Survey Monkey and distributed to two groups in the department for participation: Field personnel (445) and Communications personnel (50). Each survey was customized for each group; therefore, the surveys were not exact duplicates. Personnel were asked to answer the surveys on a voluntary and anonymous basis. Although some personnel skipped several questions, many answered most of the questions.  Microsoft Excel was used to tabulate the results and the results were placed into tables in this report.

Results: Surveys were distributed via email to 445 Field personnel and 50 Comm personnel. The overall response rate was 47.19% (210) of field personnel and 52% (26) of communications personnel. In the field personnel group (Field) 79.52% were male and 19.52% were female while in the communication personnel group (Comm) 37.5% were male and 58.33% were female.  In the Field group the largest age group of respondents was 30 to 39 (39.52%) and 40 to 49 (37.5%) in the Comm group. The majority of respondents in the Field group had 0 to 14 years of tenure (166 or 79.4%). In the Comm group, two tenure groups represented the majority of responses with 41.67% indicating a tenure between 0 to 4 years and 29.17% with tenure from 15 to 20 years. Most of the respondents in both groups were Clinical Specialists with 53.59% in the Field group and 37.50% in the Comm group.

Responses to Multiple Choice Questions:

I have received training at ATCEMS to recognize individuals exhibiting aggressive behavior.

Field

Comm

Strongly Agree

8.61% (18)

25.00% (6)

Agree

51.67% (108)

37.50% (9)

Disagree

26.79% (56)

33.33% (8)

Strongly Disagree

12.92% (27)

4.17% (1)

I have received training at ATCEMS to recognize individuals that might exhibit aggressive behavior.

Field

Comm

Strongly Agree

7.18% (15)

12.00% (3)

Agree

47.37% (99)

52.00% (13)

Disagree

34.45% (72)

32.00% (8)

Strongly Disagree

11.00% (23)

4.00% (1)

I have received training at ATCEMS to help me initiate escape options when encountering individuals with aggressive behavior.

Field

Comm

Strongly Agree

5.29% (11)

NA

Agree

30.29% (63)

NA

Disagree

46.63% (97)

NA

Strongly Disagree

17.79% (37)

NA

I have received training at ATCEMS on how to deescalate a situation with an aggressive individual.

Field

Comm

Strongly Agree

3.85% (8)

13.04% (3)

Agree

33.17% (69)

47.83% (11)

Disagree

45.19% (94)

34.78% (8)

Strongly Disagree

17.79% (37)

4.35% (1)

Are you aware that ATCEMS has PEER Support and other counseling services available for employees involved in workplace assault.violence?

Field

Comm

Yes

90.95% (191)

100% (24)

No

9.05% (19)

0% (0)

Provider assaults are an unavoidable risk of working in EMS as an industry.

Field

Comm

Strongly Agree

21.05% (44)

NA

Agree

48.80% (102)

NA

Disagree

23.92% (50)

NA

Strongly Disagree

6.22% (13)

NA

Verbal assaults are an unavoidable risk of working in EMS as an industry.

Field

Comm

Strongly Agree

NA

47.06% (8)

Agree

NA

47.06% (8)

Disagree

NA

5.88% (1)

Strongly Disagree

NA

0% (0)

Have you ever been assaulted during your EMS career?

Field

Comm

Yes

92.38% (194)

70.83% (17)

No

7.62% (16)

29.17% (7)

Have you ever been verbally assaulted at ATCEMS within the last 2 years?

Field

Comm

Once

NA

13.33% (2)

More than once

NA

86.67% (13)

Have you ever been verbally assaulted while on duty with any EMS provider?

Field

Comm

Once

NA

6.25% (1)

More than once

NA

93.75% (16)

Have you ever been assaulted while on duty with any EMS provider?

Field

Comm

Once

19.34% (35)

NA

More than once

80.66% (146)

NA

How often have you been assaulted at ATCEMS within the last 2 years?

Field

Comm

Once

36.87% (66)

NA

More than once

63.13% (113)

NA

If you have been assaulted, did you report the incident to your supervisor?

Field

Comm

Yes

54.95% (100)

25.00% (4)

No

45.05% (82)

75.00% (12)

If you have ever reported an assault to your supervisor at ATCEMS, did you supervisor follow up with you?

Field

Comm

Yes

56.05% (88)

18.18% (2)

No

43.95% (69)

81.82% (9)

My supervisor encourages me to report assaults if they occur.

Field

Comm

Strongly Agree

30.00% (54)

13.33% (2)

Agree

46.11% (83)

26.67% (4)

Disagree

18.89% (34)

46.67% (7)

Strongly Disagree

5.00% (9)

13.33% (2)

My supervisor has discussed with me the importance of reporting assault incidents when they occur.

Field

Comm

Yes

41.11% (74)

26.67% (4)

No

58.89% (106)

73.33% (11)

If you have been assaulted at ATCEMS, did you file charges with law enforcement?

Field

Comm

Yes

43.59% (78)

NA

No

56.42% (101)

NA

When assaulted, I feel ATCEMS provided adequate support for me

Field

Comm

Strongly Agree

8.00% (14)

0% (0)

Agree

43.43% (76)

46.67% (7)

Disagree

35.43% (62)

33.33% (5)

Strongly Disagree

13.14% (23)

20.00% (3)

Other Findings

Most Field personnel said they were providing direct patient care (91.8%) when they were assaulted and that most assaults occurred in the back of the unit (92.9%). The top three conditions that field personnel thought contributed to violence included an attacker showing signs of impairment, exhibiting aggressive behavior,  or possibly experiencing a mental or behavioral health condition. In the communications center, personnel identified people exhibiting aggressive behavior, experiencing a highly emotional environment, or possibly experiencing a mental or behavior health condition as contributing factors to verbal assaults.

Conclusions and Discussion

Personnel at ATCEMS are experiencing high numbers of assaults. Over 86% of Communication staff report having been verbally assaulted more than once in the last two years and 63% of Field personnel report being assaulted more than once in the same time period. It is estimated that even these high numbers do not reflect the true magnitude of assaults on ATCEMS personnel because assaults are likely under-reported and only cases involving injuries are reported most commonly.

Although 100% of ATCEMS personnel receive situational awareness and self-defense training, additional training in recognition of the potential for aggressive behavior, escape planning, threat avoidance, and de-escalation may be needed. Collaborative training with law enforcement officers and members of the legal system could improve reporting and prosecution of persons who assault EMS personnel. Equipping EMS Commanders with better training and tools for responding to personnel who report assaults could improve agency responsiveness, follow-up, engagement, and support when assaults happen. Personnel who are assaulted seem to be divided as to whether the department’s support mechanisms are adequate and effort needs to be aimed at learning what kind of support is needed, when it should be delivered, and what personnel need and expect.

Finally, an important finding of this survey is how EMS personnel perceive the workplace violence that they are experiencing. More than 69% of Field personnel agreed with a statement that said assaults are an unavoidable risk of an EMS career and 94% of Comm personnel said that verbal assaults while on duty in the communication center are an unavoidable risk. There needs to be further study about this cultural element, its drivers, and how it connects to industry ideals such as the “EMS Culture of Safety” and the EMS Agenda 2050 vision of being People Centered and its principle of becoming “Inherently Safe and Effective.” 2,3 Ultimately, assaults on a public servant should never be tolerated, even by those who believe the risk to be inherent in this industry.

Next Steps

The department recently trained a group of Improvement Leaders in improvement science. The training was based on the Model for Improvement established by the Institute of Healthcare Improvement (IHI). An improvement team will be assembled to continue work to reduce assaults on ATCEMS personnel and to begin to address the findings of this survey report. The team will focus on better reporting, enriched training, and work with law enforcement to learn more about recognition of potentially dangerous situations, de-escalation techniques, and other important strategies. Ultimately the team’s aim will be to reduce the number of assaults on ATCEMS personnel.

References

  1. Boyle, M., Koritsas, S., Coles, J., Stanley, J. A pilot study of workplace violence towards paramedics. Emerg Med J; 2007 Nov; 24(11): 760-3
  2. “Strategy for a National EMS Culture of Safety,” NHTSA Office of EMS, accessed July 2019, https://www.ems.gov/pdf/safety/Strategy-for-a-National-EMS-Culture-of-Safety-10-03-13.pdf.
  3. “EMS Agenda 2050: A people-centered vision for the future of emergency medical services,” NHTSA Office of EMS, accessed July 2019, https://www.ems.gov/pdf/EMS-Agenda-2050.pdf.