By Ariel Jenkins, Director – Risk Control, Safety National and Brian Fass, President & Founder, Fit Responder
When risk managers with emergency service personnel (firefighters and emergency medical technicians) on the payroll read through descriptions of their losses, they may find phrases such as “employee struck by patient on head, employee was hit on the arm during a struggle with patient, or employee was punched in the face by a drunkard.” A risk manager could also see loss descriptions such as “employee was tackled by a large man in chest area, or while patient was in transport, became combative and pushed employee down resulting in contusion”.
Injury through assault remains a widely recognized, but little acknowledged, problem threatening emergency service personnel. Many EMS personnel admit to being attacked by a violent patient, an angry bystander or upset family member. The frequency of assault on our EMS providers is alarming and while most attacks are not life threatening, the risk of serious injury is evident and unpredictable. Responders require a reasonable, liability-conscious, effective means of preventing and avoiding assault, before it occurs, and defending themselves once attacked.
According to a February 2016 study published by the American Journal of Industrial Medicine, participants reported that no part of their EMS training made them knowledgeable about the risks related to combative patients or familiar with protocols for self-protection during patient care. Participants in the survey also generally believed that the overriding message of training to approach violent/combative patients is to simply “suck it up”.
Whether EMS providers fear for their personal safety or not, they will respond when assaulted. How they respond will be a matter of training – or lack of it. When not properly trained, the risk of personnel over-responding to an assault exists. The cost of skepticism and ineffectively educating first responders on violent patient encounters can be very high. In October, 2014, firefighters in Glendale, Arizona, were accused of using excessive force in response to a patient who had assaulted them. The completion of an internal investigation (March, 2015) found that two of the firefighters had used excessive force and violated city and department policies when they repeatedly punched a patient. Shortly after the findings were released, the family of the victim filed an $11 million dollar claim against the Fire Department (March, 2015).
Within the firefighter and EMS communities, there is growing interest in Escaping Violent Encounters training (EVE). (EVE) training for EMS/Fire is a liability-conscious, risk management best practice approach to patient and visitor assault prevention and response. The EVE training will assist in reducing the risk of assaults on staff, minimizes injuries to staff and patients, aid in controlling overall liability, while reducing FF/EMS fear of personal safety. It will also help to prevent negligence lawsuits and follows established national safety standards or your state equivalent. Trainees of this program have reported it to be empowering and that the training supports a culture of resilience to performing their jobs in a pre-hospital environment.
Risk managers and safety professionals can no longer afford to assume that effectively controlling the risk of encountering combative patients is common sense amongst the firefighter and EMS communities. While encountering violent and combative patients is an inherent part of first responders’ jobs, efforts to control the risks must be made beyond simply “sucking it up”. Stakeholders of this issue would demonstrate leadership within their organizations by conducting an objective assessment of their training, wellness, and safe patient handling practices. If an objective assessment is not possible using internal expertise, then making the use of external expertise is prescribed. Investing in the best safe patient handling practices and violent encounters training will certainly enhance the efforts of firefighters and EMS professionals to avoid injury, and sustain a long healthy career.
Ariel Jenkins, CSP, ARM, MBA, ARM-E
Ariel Jenkins is a Director of Risk Control with over 20 years of experience. He is responsible for technical direction of risk control at Safety National. This includes technical development of the risk control team and the content of deliverables. He also leads the public entity risk control practice at Safety National. Ariel has a broad base of knowledge and experience in the areas of workers’ compensation, fleet safety, auto liability, general liability and safety culture and is regularly called upon to speak and write on these subjects by industry associations and publications.
About Safety National
Safety National is a leading provider of alternative risk funding products such as excess workers’ compensation, deductible casualty, loss portfolio transfers and reinsurance. Safety National is a member of the Tokio Marine Group and is rated “A+” (Superior), FSC XIV by A.M. Best. Learn more at www.safetynational.com.
About Bryan Fass, ATC, LAT, CSCS, EMT-P(ret)
Bryan Fass is president and founder of Fit Responder, where he works nationally with departments, corporations, state and local governments to design and run scientifically valid injury prevention and wellness programs. He is frequently contacted for expert opinion and content contribution for all aspects of public safety fitness, ergonomics and wellness. Bryan authored the Fit Responder book used by departments and schools plus writes for numerous web and peer-reviewed journals including the National Strength & Conditioning Associations Tactical Strength & Conditioning journal, officer.com, ems-1.com, firerescue1.com & JEMS.
About Fit Responder
Fit Responder’s Injury Free training is a liability conscious, risk management best practice approach to preventing training, patient & equipment handling injuries in EMS, fire-rescue and law enforcement departments. This program introduces a complete system of pain management, job specific mobility, wellness, tactical fitness and patient handling that will reduce the rate and severity of injury. Learn more at http://www.fitresponder.com.
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