Exposure of prehospital providers to violence and abuse.

Introduction: Before 1994, violence toward EMS personnel was informally recognized but was the subject of only limited scientific investigation. Confrontations with EMS personnel in the out-of-hospital workplace appear to involve verbal and physical assaults, injuries, disabilities, and mental stresses and often seem to go unreported. Without formal recognition of violent encounters, EMS agencies are unlikely to implement appropriate policies, procedures, or training to deal with this issue. This article focuses on quantifying the current existence of violence toward EMS personnel, as well as violence-related policies and appropriate training at EMS agencies.

Methods: A survey was administered to a convenience sample from the Albuquerque Fire Department. Surveys were completed by 331 respondents. Validity was measured per question response. Descriptive statistics analyzed question responses.

Results: Ninety percent of the 331 EMS personnel who responded stated that an assault or violent action had been directed toward them during their EMS work career. In a forced choice ranking of the 13 most stressful parts of their EMS job, abusive and violent situations were listed as the number 1 stressor. According to 71% of respondents, no clear protocols existed to handle abusive situations. Seventy-one percent of respondents reported that abusive situations were considered a "part of their job" and that they lacked the training to learn how to protect themselves. After experiencing an assault, 80% of respondents felt angry and 69% felt irritable.

Discussion: Prehospital providers will encounter violent and abusive situations while on the job. Violence-related policies, associated training, and reporting systems were not in place for the Albuquerque Fire Department in 1995. With a 90% exposure to violence, combined with the lack of training or policies about violence, the potential for work-related injuries and liabilities is evident. Management personnel need violence education to understand the scope of the problem. Violence reporting should be consistent and be encouraged, according to "Guidelines for Preventing Workplace Violence for Health Care and Social Workers" from the Occupational Safety and Health Administration.