Violence in Emergency Medical Service and the Need for Training

Below is an unedited paper written by Stephen Beauter, EMT-B for an effective essay writing class. I liked it and thought it would make a great blog post. Enjoy. Oh, BTW, he got an “A”.

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Violence in Emergency Medical Service and the Need for Training

Walking to the door of a strangers’ house on your first call as an Emergency Medical Technician (EMT) will make one nervous. When an EMT approaches the door or a scene where there is the high probability of violence is even more unsettling. Current formal education and initial training for an EMT does not include violence awareness, or how to react and possibly defend themselves if a violent encounter arises. This is startling considering that the risk for non-fatal assaults on Emergency Medical Service (EMS) workers is approximately thirty times higher than the national average. The risk that the EMS provider will face for fatal assaults is three times higher than the national average (Kirkwood & Teitsort, 2012). Emergency Medical Technicians are trained to treat the sick and injured, but with the threat of violence on every call, awareness and defense training needs to be included in initial training.

In careers where workers interact with the general public there is always the risk for violence. Assault and battery are common types of violence experienced by Emergency Medical Service personnel. Other types of violence include ambushes where EMS personnel are targeted and domestic violence.  Assault is defined by Merriam-Webster dictionary as “the crime of trying or threatening to hurt someone physically; a violent attack” (Merriam-Webster, 2013). Emergency Medical Service providers are generally at more risk of violence because of their interaction with the general public outside of the hospital and in the presence of extenuating circumstances where emotions are running high (like domestic violence situations). The majority of calls do take place without the presence of law enforcement on scene; however, for various reasons, scenes can turn violent during the course of the call. Patients (those who have been provided services by Emergency Medical Service) can have a medical reason for being violent such as hypoxia (lack of oxygen) or recovering from a seizure for example. There are those patients who are violent because of drugs or alcohol, or that do not wish to be treated and turn violent against the Emergency Medical Service providers as a result. In a study by the National Association of Emergency Medical Technicians (NAEMT) found that 52% of respondents to the survey have been claimed to have been injured as a result of an assault (Kirkwood & Teitsort, 2012).

Violence can occur to EMS providers out of a situation that seemingly does not have violent beginnings. In one instance an ambulance was called to a house where Emergency Medical Service was to help a woman whose boyfriend was performing CPR on her when police arrived. During the course of the treatment providers were asking questions of the boyfriend, and he became aggressive and combative and was consequently arrested  (WWAY, 2013).  While in this instance police was reported to be on scene with Emergency Medical Service, that is not always the case. In another instance a patient who was intoxicated willingly went with Emergency Medical Service workers in the ambulance to the hospital. During transport to the hospital, the patient decided to unclasp the restraints that were used to secure him to the stretcher. When the Emergency Medical Technician that was caring for him attempted to re-secure the patient, the Emergency Medical Technician was struck multiple times and choked by the patient. The patient had to be restrained by another Emergency Medical Service member until police could arrive (Moynihan, 2012). While these two cases are at two perceived ends of the severity scale, they illustrate how violence can occur when least expected.

Members of emergency first response personnel are trained and equipped to do their jobs with the proper protection. Police officers will start the day with all the equipment necessary to do their job, and stay safe. This will include various personal safety items that will include a firearm and a bullet proof vest among various other safety items. Fire fighters will go to a house fire, and they will be in their safety equipment so they will not get burned. Emergency Medical Technicians will have the tools they need to save lives, but they are not taught how to protect themselves. During formal education and training, Emergency Medical Technicians are instructed to wait for law enforcement personnel to arrive and secure the scene before entering the scene when possible.

All medical professionals that have direct care of patients face the possibility of violence on the part of the patient. Nurses, doctors, or nurses’ aides are some that can face violence by patients; but the difference is that if violence erupts they have the added assistance of co-workers nearby and hospital security. In the field (outside of the hospital) EMT’s and paramedics do rely heavily on being able to control the scene that they are on to offer assistance in an effective and efficient manor, much like their law enforcement counterparts. When a violent situation does occur it may give off the impression that the EMT or paramedic has lost control of the scene. This may be a contributing factor as why in some ambulance agencies, cultures exist that accepts and teaches new members that Emergency Medical Service personnel are punching bags, and it is better to carry on than it is to report the violence and encourage prosecution (Kirkwood, 2013). Medical personnel either in the hospital or in EMS may view such instances as a hazard of the job. That is not the case. When these instances arise, the offenders must be prosecuted for change to start to happen.

Kip Teitsort; founder of DT4EMS, a program that teaches techniques and tactics for escaping violent encounters for Emergency Medical Service, contends that the mindset of Emergency Medical Service personnel has to change. Emergency Medical Technicians and paramedics have to understand that it is not acceptable to be assaulted while on-the-job (Teitsort, 2013). To start to change this culture, every assault has to be reported and prosecuted. It would not be considered acceptable in any other line of work for a person to assault another and expect not to be punished for it. Just as all people are held accountable to the law, those who assault EMS workers have to be held accountable as well.  The change in the culture will have to start at the national level if the mindset of workers to be that it is not acceptable to be assaulted on the job. To facilitate the changes, providers must file reports and pursue criminal charges against their attackers in each and every instance; and the agencies that the EMT’s and paramedics work for have to encourage their employees to file these reports and charges.

Emergency Medical Service workers need awareness training in two areas. First is scene awareness. EMS personnel need to know their surrounding area when on scene and their positioning on scene. Scene and positioning awareness is critical that in the event that the EMS workers need to evacuate the scene quickly, they will know the fastest route out. Having an awareness of the scene will also make visible any hazards like guns or knives before it is too late. Another area that EMS workers need training in is violence awareness. Scenes can start off as non-violent but if the EMT can recognize the escalation of violent tendencies there is a possibility that violence can be avoided. Having the ability and training to de-escalate the violent situation could save the EMS workers from harm.

With the inherent risks of working in EMS, education is in need of a mandatory course in awareness and self-defense. Revisions and updates to medical protocols occur constantly, and continuing education is required for an EMT or Paramedic to renew their license. But, no training is provided for their protection. Emergency Medical Service workers have the possibility of a form of violence on every call that they are dispatched to. Careers have been shortened and lives have been ended because of violence against EMS personnel. On January 31, 2009 three EMT’s with the Cape Vincent Volunteer Fire Department responded to a call for chest pain. According to police reports while on scene Christopher Burke became agitated. After retrieving a rifle Burke fired a total of three rounds from the rifle. One of those rounds struck and killed EMT Mark Davis (Madsen, 2009). Tom Ryan president of Firefighters Local #2 in Chicago Illinois said: “I want everyone to know around the entire country to keep your hands off our paramedics, our firefighters and our police officers because they are there to help you. They are called to assist you, not to be your personal punching bag.” (Goudie, 2013)

Not all calls that EMS will respond to will be violent. But for the protection of those who save other lives; local, state, and national agencies need to make awareness and defense training included in the initial training of EMT and paramedics. Times have changed, and in some areas EMS workers are being targeted for violence and being assaulted. It is time that the licensing bodies give the proper tools so that EMS personnel have the best chance to go home safely at the end of their shift.


Goudie, C. (2013). DePaul student Erik Kawar charged with assaulting paramedic. Retrieved from

Kirkwood, S. (2013, May). It’s Time to Stop the Violence. EMSWorld. Retrieved from Medical Technicians-paramedics

Kirkwood, S., & Teitsort, K. (August, 2012). Violence against Emergency Medical Service providers: what can we do about It? EMSWorld. Retrieved from Medical Service-providers-what-can-we-do-about-it

Madsen, N. (2009) EMT’s death a “senseless act” Watertown Daily Times. Retrieved from

Merriam-Webster. (2013). Assault Definition. Retrieved from

Moynihan, C. (2012, November 10) Brooklyn Prosecutor Arrested in Assault of Emergency Medical Technician. New York Times. Retrieved from

Teitsort, K. (2013). DT4EMS. Retrieved from

WWAY, (2013, August 12) Man Charged with Assaulting Emergency Medical Service Worker. WWAY. Retrieved from

About Stephen: I live in Republic, Missouri have been married for 7 years to my wife Sarah and we have a 2 year old daughter. I have been an EMT-B for 5 years working in both city and rural services with my current position with Ozark County Ambulance District working PRN.


This paper was written for an effective essay writing class and I chose the topic after talking with Kip one shift we were working together and started to realize then what an “epidemic” violence is in EMS. And I wanted to write the paper from a position that real changes needed to be made to not only the mindset or culture, but also in the training that is given to new EMT’s and medics.


You can contact Stephen via email :

Stephen Beauter