It’s a story I have heard, face to face, all across the country in DT4EMS’ EVE classes. The locations may differ from pre-hospital to in-hospital, male or female, in a uniform or scrubs…but the story is the same. 
The healthcare provider comes in contact with a person labeled a patient, usually there is some form of perceived intoxication or lack of mental faculties, and within moments what started out as a supposed routine patient/provider interaction turns into an explosive situation where someone is criminally assaulted.
The anatomy of an assault in healthcare is unlike any other assault. In this short article, I would like to share what the better part of two decades of researching the subject has revealed to me.
What makes an assault in healthcare different from other criminal assaults is many go undocumented in both directions. Meaning, although the majority of criminal assaults are directed at the healthcare provider, many are done by a provider upon a true patient.
For the context of this article, the generalized term of healthcare provider encompasses EMT/Paramedic, nurse, firefighter on the medical call etc.
Basic Anatomy of an Assault in Healthcare
- Head
- Body
- Extremities (Extensions)
- Heart/Soul
The Head– There is an industry wide problem with training, the mental preparation for a violent encounter. When medical staff are trained at their initial level, there is no distinction between a person who should be considered a patient and who not during a use-of-force encounter. Basically, everyone is to be considered a patient. When the provider is unaware, so then is their dispatch for pre-hospital or their triage in-hospital. Every study shows violence in medicine is real. When there is no differentiation in the mind of the healthcare provider between patient or aggressor the attitude of the provider and the perceived “control” of the situation leads us to-
Body– Body language and the perception of control. With the head telling the provider by policy and training they are supposed to be in control of a scene or situation, the body language starts to speak louder than any spoken word. Countless studies have stated a majority of human communication is via body language.
Heart and Soul– There is an attempt at verbal control of the situation. When that fails, the attempt of physical control (restraint) is where we find an overwhelming majority of criminal assaults taking place. Usually by a drunk or drugged individual toward staff or staff upon a true medical/trauma patient. You can see for yourself here: Pre-Hospital and for those in-hospital.
Extremities– When the culture in medicine allows for the belief criminal assaults are “part of the job” (thanks to the Head), the extremities (extensions) of the problem as follows:
- Administration- With the belief that everyone staff contacts are in fact a patient, there is a lack of support for victimized staff.
- Police- Since they are rarely contacted, there is a lack of recognition of how deeply rooted the violence is. I have personally been told by officers who had witnessed a criminal act ask the staff member if they wished to pursue charges only to have the staff member decline. (The staff member is the victim, not the hospital or agency. It is not up to the agency to pursue charges of the assault)
- Courts- With a lack of police reports the courts are not as aware the problem is of epidemic proportion. However, it needs to be noted that many states have providers on the same law as assaulting a police officer. (Penalty is not protection, but it proves there is a problem)
- Media- With a lack of reporting the criminal assaults, the media does not think the assault is news worthy when the provider is assaulted, but let the provider assault a person…Without proper training, staff will resort to what they “feel” is right at the moment.
- Peers- Thanks to the HEAD, peers and senior staff have had a history of mocking those victimized. Fear of ridicule has kept numerous providers from pursuing criminal charges. Jaded, is that was it expected now in emergency medicine?
This Anatomy of the Assault in Healthcare lends itself to a cyclic process.
