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January 30, 2016

Drexel study: Paramedics face higher risk of assault than firefighters

Researchers at Dornsife School of Public Health assess options to improve conditions for ambulance workers

Ambulance workers and firefighters make up two of the most admirable professions that serve the daily and spontaneous needs of the public. In addition to the inherent dangers of their jobs, however, there are also related crime risks that often go overlooked and underreported in discussions about their service to the community. 

In a new study led by Drexel University's Dornsife School of Public Health, researchers attempted to quantify and evaluate the dangers paramedics and firefighters face on a regular basis. After reviewing statistics gathered by the FEMA-funded Firefighter Injury Research and Safety Trends (FIRST) project and conducting a series of interviews with paramedics injured by their patients while on duty, the Drexel team determined that paramedics are 14 times more likely to be victims of a violent attack than their firefighting peers.

Lead investigator Jennifer Taylor, an associate professor at the School of Public Health, began her research by examining whether there is a gender discrepancy in the rate of violent assaults on male and female firefighters. While she found that female firefighters were six times more likely to be assaulted than their male counterparts in the group she studied, she ultimately concluded that profession, not gender, was likely a better indicator of risk.

“As an epidemiologist, I started describing the risk factors that public health researchers usually use: age, race, sex, etc. But we had some members of the responder community tell us to look at the paramedics because women are more likely to be paramedics than firefighters," Taylor said. "This is why stakeholder engagement is so important in all phases of scientific research. By having a group of advisers who could look at preliminary data, they prevented me from making an incomplete conclusion.”

Since women in the group studied were 15 times more likely to be paramedics than firefighters, a comparison across the two professions suggested that the gender gap in violence was statistically insignificant.

In her one-on-one interviews with paramedics, Taylor found several common threads that help explain the source of violent encounters. Multiple paramedics said they had troubled relationships with dispatchers, who often neglect to warn them about the scenes they're entering and are untimely about sending backup once a situation is deemed unsafe. Others said that felt they had inadequate training to handle combative patients.

The department in question typically fields more than 700 calls per day, often when the ambulance request isn't even for true medical emergencies. The cumulative stress of that response rate, which requires the same mentality for each call, can contribute to poor work environments that produce high burnout levels.

“You go back the next day and [you’re] expected to be the same person. You’re not,” one paramedic in the study said. “Every time someone does something to you, you’re different than you were the day before.”

Several suggestions came out of the study that may serve as effective remedies for the occupational hazards of ambulance workers. Giving dispatchers a resource to flag locations that previously produced violent outcomes could help responders better prepare for high-risk calls, while attaching a felony assault warning on vehicles might discourage attacks and symbolize support from management.

Another option would be to expand community paramedicine training so that crews have multiple competencies that can prioritized for emergency assignments.

Overall, the researchers believe that improving work conditions for paramedics and EMT workers will have broader public health benefits.

“No one has looked at what the implication is for patient and public safety if we beat our medics into the ground,” Taylor said. “For cities that are large and have a huge issue of poverty, we’re exhausting our workers. We don’t have standards for how many medics we should have per 100,000 people. I’m very worried about exhaustion, burnout, and possible emotional detachment by the responders."

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