FACTS ONLY: violence and death by violence in EMS

[mycrofft]

OK, prelim peek a IAems's article:

EMS deaths per ACES article
http://www.paramedicduquebec.org/documents/EMS_Fatalities.pdf
In a five year period (1992-1997) nation-wide:

91 probable EMS worker on the job deaths; includes Physician assistants, nurses, aides/orderlies/attendants, and technologists/technicians.

67 were MVA's
14 were "other" , including suicide (?)
10 were "assaults", of which 7 were GSW; most were female.

So, average of 2 assaultive deaths a year, versus 18.2 average on the job deaths a year including assaultive deaths.

NOTE: does not differentiate between assaults by patients, co-workers, or others.

 

[Aidey]

1997 is the newest data they have?

 

[mycrofft]

ADDENDUM to ACES article

http://www.paramedicduquebec.org/doc...Fatalities.pdf
This sample would not include persons fulfilling an EMS role without the official job descriptor (firefighters, law enforcement) or volunteers/good samaritans. It does include workers in hospitals.

 

[Melclin]

Interesting thread

http://emj.bmj.com/content/24/11/760.full

I know the guy who did that study and I reckon his feet were the biggest threat to workplace safety going around, forget drug affected psych patients.

Incidentally, my googling turned up a few press articles about New Zealand and Australia. No homicides cited, but they are citing a growing trend towards ambulance personnel being slapped or otherwise manhandled.

Whenever I read or hear about "the skyrocketing problem of ____", I usually find there is an equal or faster increase in the type of folks who will fall prey to that sort of thing, so the per capita rate is same or lower.

There is a fair bit of talk about the rise in assaults on our service. My understanding is that they are mostly minor in a physical sense, like being slapped or threatened, but they tend to cause people to go off on stress leave.

Its an issue I'm interested in because I did a bit of work with aggression management techniques in regards to mental health emergency management. Early on in my education, a paramedic told me that not a single paramedic in the entire service has been punched who didn't deserve it. That's a bit extreme, but there is some validity to the idea. I would submit that a lot (not all) of assaults happen due to poor aggression management. We learned a bit about it at uni, and Ambulance Victoria put us through some excellent assault prevention training before we went on road, but I don't know that the message has been heeded.

When I get back to work, I'll see if I can find some actual stats that are allowed to be public.

 

[mycrofft]

Melclin thanks ("good on you"?)

The "They deserved it" comment is going to bother some folks, since it's "everyone's right" to work in a safe working envirojnment (tell that to bomb disposal and law enforcement officers), I think they meant some folks don't use common sense or they treat patients/otherts in a manner that will likely precipitate some sort of retaliation.
Yeah, let's see those figures.

 

[mikeward]

From a lecture I delivered

One of the challenges Brian Maguire had in doing his doctorial research into EMS workplace fatalities was the lack of a central database.


Occupational fatalities in emergency medical services: a hidden crisis.
Ann Emerg Med. 2002 Dec;40(6):625-32.

Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. CONCLUSION: 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.


Subsequent study by Maguire shows that the INJURY rate of ems personnel TWICE as high as firefighters.


Occupational Injuries Among EMS Personnel

PREHOSPITAL EMERGENCY CARE 2005;9:405–411

Four hundred eighty nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5–37.6). “Sprains, strains, and tears” was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3–21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35–1.72) compared with firefighters, 5.8 (95% CI 5.12–6.49) compared with health services personnel, and 7.0 (95% CI 6.22–7.87) compared with the national average.

INJURIES FROM ASSAULTS ON PARAMEDICS AND FIREFIGHTERS IN AN URBAN EMERGENCY MEDICAL SERVICES SYSTEM

PREHOSPITAL EMERGENCY CARE 2002;6:396–401

Objective. To determine the nature and frequency of injuries resulting from assaults on paramedics and firefighters in a large, fire department-based emergency medical services (EMS) system. Methods. This was a descriptive study involving retrospective analysis of an occupational injury database. All injury reports involving assaults from 1996 to 1998 were reviewed. Results.

There were 1,100 injury reports submitted during the study period, of which 44 (4.0%, 95% CI 0-10.9%) involved an assault. Paramedics were assaulted in 35 (79.5%) of these incidents and firefighters in nine (20.5%).

Forty-one assaults (93.2%) occurred during patient care activities. Medical attention was sought in 36 incidents (81.8%), and in 14 (31.8%) the employee lost time from work.

Twenty-six assaults (59.1%) were classified as intentional and 17 (38.6%) as unintentional. One (2.3%) could not be classified.

Conclusions. In this EMS system, injuries resulting from assaults were uncommon. However, due to their potential impact on the victims and the EMS system as a whole, policies and procedures should be developed to minimize these incidents.

 

[mycrofft]

mikeward, good bunch of data

The first article was identical in wording to the American College of Emergency Surgeons article I cited above in the prelim review. Citations are gold, thanks. I'll see if I can take them with me when I'm gone for the next two weeks (starting the 31st).

Every article so far ends with a note to the effect that, while this is not a common occurance, it is potentially serious and deserves better tracking and that procedures need to be thought out to make the workplace safer.

My feeling is that the following questions are lurking under the surface:

• How many of these are unavoidable as long as we make contact with, or ride alone with, patients in the back of an ambulance?
  
• What setting did they occur in; ambulance, on scene, or at ER/etc.?
  
• How many of these are going to be apporpriately addressed with threat or application of "lethal force", "less lethal force", "manual resistance" (i.e., martial arts), or just need procedural changes (i.e., no moving resistant patients without law enforcement performing the physical control, no response to reported assaults or batteries or scenes of those or homicides without the perp or suspect being in custody)?
  
• How many of these would be helped by wearing of protective equipment (Kevlar)?
  
• How many of these were "ad hoc" attacks, neither by concealed weapons or by taking a weapon from someone authorized to carry it (security guard, responder), versus weapons on the person of the patient?
  
• How many involved an assaultive bystander, or at-large perp or suspect on the scene?
  

Many of these are going to remain unanswered in the big picture due to the type of recordskeeping that is done. PD's will have this sort of raw data, but it's not really in our purvey to get it, or is it? ALso, maybe unions will when they cover the EMS workers (IAFF for fire EMS, I have no idea who is covering non-fire EMS workers).

PS: NREMT says they don't do business over email, period.

 

[Luno]

Well, you're on quite a tear, aren't ya

The first article was identical in wording to the American College of Emergency Surgeons article I cited above in the prelim review. Citations are gold, thanks. I'll see if I can take them with me when I'm gone for the next two weeks (starting the 31st).

Every article so far ends with a note to the effect that, while this is not a common occurance, it is potentially serious and deserves better tracking and that procedures need to be thought out to make the workplace safer.

My feeling is that the following questions are lurking under the surface:

• How many of these are unavoidable as long as we make contact with, or ride alone with, patients in the back of an ambulance?
  
• What setting did they occur in; ambulance, on scene, or at ER/etc.?
  
• How many of these are going to be apporpriately addressed with threat or application of "lethal force", "less lethal force", "manual resistance" (i.e., martial arts), or just need procedural changes (i.e., no moving resistant patients without law enforcement performing the physical control, no response to reported assaults or batteries or scenes of those or homicides without the perp or suspect being in custody)?
  
• How many of these would be helped by wearing of protective equipment (Kevlar)?
  
• How many of these were "ad hoc" attacks, neither by concealed weapons or by taking a weapon from someone authorized to carry it (security guard, responder), versus weapons on the person of the patient?
  
• How many involved an assaultive bystander, or at-large perp or suspect on the scene?
  

Many of these are going to remain unanswered in the big picture due to the type of recordskeeping that is done. PD's will have this sort of raw data, but it's not really in our purvey to get it, or is it? ALso, maybe unions will when they cover the EMS workers (IAFF for fire EMS, I have no idea who is covering non-fire EMS workers).

PS: NREMT says they don't do business over email, period.

Unfortunately, I think that you've misunderstood the field that you're attempting to get "facts" from... As a good MD friend of mine says, "EMS? That's an evidence free zone..." The problem is that there is a lack of adequate research and documentation for the majority of what we do, and how we do it.

I see a large issue with your demand for "facts" and studies within the field for assaults on providers. It's kind of like researching wife aggressor/husband victim domestic violence, the majority of the cases simply are not reported. Whether it's a delusion that we are here to "save people" or the simple shock when we are assaulted, the majority of incidents do not get reported, much less tracked. I believe that a good place to start with statistics would of been with DT4EMS, since it was kinda his niche... (Kip, you still out there?) We can stand on a soap box, moan and conjecture, but unless we change the mindset, and start to realize that it is an issue and provide safe avenues for reporting and assistance, this will just be another dirty EMS secret pushed under the rug. I've been assaulted numerous times, and they're documented in the run report, but there is no current way to document or track those assaults. I will just add this to the growing list of poorly documented and researched EMS procedures and issues...

 

[mycrofft]

Apologize for the delay, I'm away from computers.

Yeah, I'm on a tear. Yeah stuff is underreported, that's why I'm trying to focus on job related homicides, they are harder to sweep under the carpet. The Philadelphia study, while not up to the minute, seems to have some rigor.
Not seeing more or newer data here.

 

[mycrofft]

OK, to sum it up (no more data received)

As a field ems worker you are probably more likely to die in a "civil dispute" (someone you know or love) than on the job due to patient or bystander violence. Certainly more likely to die in a traffic or other accident.

I was talking with an aquaintance who was in law enforcement and does carry a concealed weapon, and he pointed out some facts/opinions he had, to whit:

1. When you are carrying a gun lawfully, now you not only have to protect yourself, but the firearm.
2. If you produce a firearm, even during the threat or comission of a crime, the person you point it at can claim self defense if they shoot first. This defense has worked against law enforcement on duty. Not that you will think about this in a real life or death situation, but it could make people bent on violence more likely to try to defend themselves than let you shoot them.
3. You do not wear your sidearm without intent of using it, you do not produce it to wave around and discourage people; the only time you might "cover" someone is when that person is immediately about to be handcuffed and booked, and you must be prepared to shoot that person. No such thing as a "warning shot", and in fact discharging a firearm in such a manner is probably illegal in and of itself. (When you go out the door, you tell yourself "I'm going to kill someone today"; when you come home and lock your gun away, you say "Good, I didn't shoot anyone today").
4. There are many rules about discharging your weapon. You must be proveably convinced life is on the line. You must not discharge the weapon if the "background" (what is also in the line of fire behind the target) is unknown or may place others in danger. You must not fire at or from moving vehicles. You must not fire if the distance is such that the target is unlikely to be reliably hit.
5. Even if you fire justifiably, that does not protect you against civil actions including lawsuit or dismissal from your job.

So, personally, I am more convinced than ever that I would never want to carry a concealed firearm, and that the scenarios for it being appropriate and beneficial in a field EMS sense are vanishingly minisucle.