V IOLENCE A GAINST E MERGENCY M EDICAL S ERVICES P ERSONNEL

Background. Emergency medical services (EMS) providers may be exposed to violent behavior while performing their routine duties. Objectives. To determine the prevalence of violence against EMS providers in the prehospital setting and to determine factors associated with such violence. Methods. Consecutive medical calls for EMS agencies in a southern California metropolitan area were prospectively analyzed for one month. Following each call, prehospital personnel recorded information about any episodes of violence (verbal or physical) during the run as well as variables felt to be associated with these behaviors. Results. There were 4,102 cases available for analysis. Overall, some sort of violence occurred in 8.5% (349 4,102) of patient encounters. Of this reported violence, 52.7% (184 349) was directed against prehospital care providers, while 47.3% (165 349) was directed against others. The prevalence of violence directed against prehospital care personnel was therefore 4.5% (184 4,102). Patients accounted for most (89.7%; 165 184) of this violent behavior. The type of violence varied, with 20.7% (38 184) being verbal only, 48.9% (90 184) being physical, and 30.4% (56 184) constituting both verbal and physical attacks. Male sex, patient age, and hour of the day were significantly associated with episodes of violence. Logistic regression analysis provided odds ratios (ORs) with confidence intervals (CIs) for factors that were predictive of violent behavior. These included police presence (OR 2.8; 95% CI 1.8-4.4), apparent presence of gang members (OR 2.9; 95% CI 1.6-5.3), perceived psychiatric disorder (OR 5.9; 95% CI 3.5-9.9), and perceived presence of alcohol or drug use (OR 7.0; 95% CI 4.4-11.2). Conclusion. Emergency medical services providers in some areas are at substantial risk for encountering violence in the prehospital setting. Certain situational factors may be used to predict the risk of encountering violence. Training, protocols, and protective gear for dealing with violent situations should be encouraged for all prehospital personnel.