Mid-Atlantic Rescue Systems, Inc.

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If you are a member of an Emergency Medical Response crew, at what point is your safety more important than your duty to act? According to many protocols around the country, your safety never overrides your duty to act.


Throughout the country, the instances of violent assaults on EMS personnel. In July 2022, the Journal of Emergency Medical Services reported that “EMTs and paramedics have a rate of workplace violence that is six times higher than the rate for all workers in the United States”. In NYS, since 2016, assaults against on-duty EMS personnel can be considered felonies.


So how do you react to an aggressive patient? How should you respond, provide patient care, and still be able to continue serving others? Years ago, one EMT instructor held a session for each class that was full of role-playing and often so realistic that students remembered their lessons so well that one student called the instructor at home one evening to thank him. The crew entered a scene with an erratic patient, but the true danger was not the patient, it was another person on the scene who pulled a weapon.


Every scene and every transport must include situational awareness – if a crew has a member who is not responsible for administering aid to the patient, then he or she should take a step back and view the scene, watching for anything “out of the ordinary” or dangerous. Always act within your scope of practice. EMTs and Paramedics should be trained in watching for potential dangers.


If you are treating a patient, and the patient, or surrounding individuals become a threat to your safety, call for law enforcement. While you are waiting, if you MUST retreat, do not fail to observe your patient, and assess his/her condition even from a distance; if you can administer any aid to the victim SAFELY, continue to do so. Use self-defense ONLY if there are no other options. Always report verbal/physical assaults, and your actions taken, to the appropriate authorities.


Sometimes a patient’s aggressive actions are the result of physical illness (i.e.: diabetic reactions), mental illness and delusions, drugs, or intoxication, and sometimes even just fear. Try to use non-aggressive language to attempt to diffuse the situation. Never forget that trained EMS personnel ALWAYS have a duty to act. Sometimes all that you can do is observe from a distance – your aggressive patient may collapse, or even stop breathing. By observing, you can move back in when the potential threat is gone even if law enforcement has not yet arrived.


Even if it comes to a matter of a lawsuit, you or your lawyer must be able to show that you provided reasonable care to your patient. However, if a lawyer presents that you abandoned the patient and did not attempt any patient care even when you would have been able, and this action caused harm, then you could be charged with negligence and dereliction of duty. (This is NOT a professional legal interpretation).

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