Tactics used to protect paramedics from assault are not based on evidence

Published:08 October 2019

Many paramedic services and individual paramedics are using or considering a variety of solutions to protect themselves in the field.

Self-defence training, body cameras, weapons, tasers, ballistic vests and chemical restraints have all been touted to prevent assaults on paramedics but none are based on evidence.

That's according to CQUniversity adjunct academics Professor Brian Maguire and Dr Barbara O'Neill, both based in the USA, who have co-authored an article in the latest Journal of Emergency Medical Services, with Monash Adjunct Professor Peter O'Meara.

The authors say that many paramedic services and individual paramedics are using or considering a variety of solutions, amid reports of high rates of assault-related injuries among emergency medical services.

They say that thousands of paramedics are injured every year in the US alone, and female personnel may have a disproportionately greater risk of violence-related injury.

In Australia, about 10 paramedics a year suffer serious injury secondary to an assault and the rate of assaults tripled between 2001 and 2014.

"Some managers may think it is better to do something rather than nothing and so just pick an intervention and implement it. The problem is that such a course of action may result in increased risks for the EMS personnel through unintended consequences," the authors say.

"Ballistic vests may increase exposure to dangerous situations because vested personnel may go into a dangerous situation that they would not have entered without the vest.

"Body cams may likewise provide personnel with a false sense of security leading to an increase in injuries. An unintended consequence may be that patients may be reluctant to confide in their providers when they know the information is recorded.

"Weapons pose a host of potential problems.  The issuance of handguns may also increase the risks of suicide and injuries among EMS family members and may lead to increased legal costs for personnel and agencies. Handguns also raise the need for a secure weapons lockbox in the ambulance for when the crew responds to an airport or other secure site."

The authors asked 600 paramedics from 13 countries who had been assaulted what they thought, in hindsight, might have prevented their assault.

None suggested that having a gun would have prevented their assault and none suggested that having a ballistic vest would have prevented the assault.

They did, however, note factors that might have prevented the incident, including better situational awareness, better access to and knowledge of the use of restraints, self-defence and violence prevention/de-escalation training, and better relationships with police (who sometimes arrived late or left the scene too soon) and dispatchers (who could have collected and relayed additional information about the risks on the scene).

The authors urge ambulance agencies to work with university-based researchers so that potential interventions will be designed and implemented in such a way that they can be reliably evaluated and published, so that all agencies can benefit from the lessons learned.

"As a profession we must ensure that the same rigour that is used to demonstrate the safety and efficacy of every medication we administer to our patients is used to demonstrate the safety and efficacy of every intervention that we use to protect our personnel," they conclude.