Verbal attacks, including graphic threats, racial slurs, and other language aimed to frighten or offend, are a regular occurrence in the field for EMS workers. Now, a year-long comprehensive study shows how common they are among first responders in Dallas, Philadelphia, and San Diego.

During a one-year pilot of the EMERG violence reporting system, 126 incidence were reported, with more than eight out of every 10 reports describing verbal violence and seven out of every 10 reports citing emotional stress resulting from those attacks. Nineteen percent of the reports also cited physical violence.

The findings, 'EMERG-ing data: Multi-city surveillance of workplace violence against EMS responders,' were published in a special issue of the Journal of Safety Research, sponsored by the National Safety Council and dedicated to work presented at the 2022 National Occupational Injury Research Symposium.

Researchers at the Center for Firefighter Injury Research and Safety Trends (FIRST) at Drexel University's Dornsife School of Public Health have studied workplace violence against EMS responders for over ten years. This pilot was part of the Stress and Violence to fire-based EMS Responders (SAVER) study from the Federal Emergency Management Agency's Assistant to Firefighters Research & Development program.

The EMERG aim of the SAVER study was union-led and department-supported. Unions spearheaded recruitment and retention efforts because previous FIRST Center research found that department members were more comfortable reporting injuries to their unions than to their departments.

The partners included the International Association of Fire Fighters (IAFF) Local 58 and Dallas Fire-Rescue Department, IAFF Local 22 and the Philadelphia Fire Department, and IAFF Local 45, the San Diego Association of Prehospital Professionals, Teamsters 911, American Medical Response, and San Diego Fire-Rescue Department.

Partnering with the Center for Leadership, Innovation, and Research in EMS (CLIR), modifications were made to an existing data system, EMERG, to capture confidential incidents of violence. Participants were encouraged to report any and all instances of workplace violence - including verbal violence - to EMERG from December 2019 to November 2020.

Agitated or intoxicated patients were the most common assailant, causing first responders both physical and mental harm. Of the first responders who experienced a physical injury, one-fourth experienced a subsequent negative effect on their emotional health. Ultimately, across all injury types, first responders' emotional stress injury was rated as being more severe than their physical injuries.

Eighty percent of incidents happened on scene. Unions, along with the research team, unearthed significant data that would not be shared otherwise - more than half (52%) of all events went unreported to the fire department. Forty-one percent of events did not have police notification. Sixteen percent of assailants were arrested.

Researchers note that, although the true total number of reports may be higher due to under-reporting or lower due to no restrictions on how many people could report the same event, this is estimated to account for less than 10% of the responses. Additionally, the data from this study is one of the industry's larger samples of real-time verbal violence reports to date.

An example story reads:

"As we attempted to assess our patient, the patient became verbally aggressive and swung his arm at us as he yelled 'Don't f***ing touch me!' We backed off and requested cover from police. Patient eventually eloped without further incident as we awaited police. We have a past history with this patient. Two months prior he threatened to kill us and we ended up in a physical altercation with him that included [him] punching, kicking, and spitting."

All narratives were reported in an online supplement for the scientific community and public to delve more deeply into the experiences of those who reported 9-1-1 calls. By reading them, the researchers aim to clarify the dangerous nature of EMS work and the support first responders need to maintain their own health and safety as the work to save lives.

Violence against firefighters, paramedics, and EMTs is something the industry has been discussing for decades. According to the National Institute for Occupational Safety and Health (NIOSH), violence is the second-most frequent cause of nonfatal injuries for EMS responders as of 2020. This exposure to violence affects EMS providers' well-being and compounds other known stressors of the job, such as high call volume and long hours, leading to burnout and other health concerns.

This pervasive issue burdens a 9-1-1 system that is already strained. The FIRST Center has been closely measuring the issue and has developed two interventions that can help first responders protect themselves and help fire and rescue department unions and leaders protect their members from on-the-job violence.

First, a WPV Prevention Course for First Responders is in the final stages of development through funding from the IAFF. This course, geared toward the individual first responder, provides skills and knowledge needed to recognize a potentially violent event, diffuse a violent situation, and protect themselves when a scenario spirals dangerously out of control.

Second, through FEMA AFG Fire Prevention & Safety funding, the FIRST Center developed the SAVER Systems-Level Checklist and Model Policies in partnership with the fire and rescue service. These policies, available now for all fire and rescue departments to implement, provide a policy framework that shifts the onus of safety and health from that of the individual responder back onto their department leadership. By implement the Model Policies, fire department leaders can ensure their rank-and-file have the necessary resources and support to avoid violent events or recover from physical and mental injuries received from experiencing workplace violence.

This research was conducted by Jennifer Taylor, PhD, MPH, CPPS, Andrea Davis, MPH, CPH, and Victoria Gallogly, MPH, of the FIRST Center in collaboration with Regan Murray, MPH, from the University of Arkansas Fayetteville, Margaret Binzer, JD, from the Alliance fro Quality Improvement and Patient Safety, Rozhan Ghanbari, MPH, from the California Department of Public Health, Lieutenant Diane McKinsey from the Philadelphia Fire Department, Battalion Chief David Picone from San Diego Fire-Rescue, and Paramedic Gary Wingrove from the Paramedic Foundation.

The FIRST Center is a research, education, and practice enterprise organized to support the United States fire and rescue service through objective data collection and analysis.

For more information, please contact Victoria Gallogly, FIRST Center Outreach & Communication Coordinator vhg25@drexel.edu. For reporters seeking information or an interview, please contact Greg Richter, Drexel University Assistant Director of Media Relations gdr33@drexel.edu.