EMS workers — paramedics and emergency medical technicians — often face violence from the very people that they are trying to help. Though it usually goes unreported, one Canadian study found over 25% of paramedics said they were physically assaulted in the previous year, mainly by patients.

That study and a handful of others merely sought to gain a rough estimate of how extensive the problem is. A new study of EMS workers from one urban United States fire department takes a much closer look, conducting interviews and focus groups with EMS workers to gain a better understanding of the workers' perspective on the violence they face.

A stressed workforce responding to a stressed community during a stressful event can lead to violence.

Outsiders might not expect that EMS workers are subject to much violence. But they are. “I have been kicked, punched, bitten, spit on, verbally abused. You name it, I’ve had it all,” said one of the paramedics interviewed for the study. And she's not alone.

Why would anyone assault an emergency worker? Part of the answer seems to be stress. Emergencies are stressful situations — a person has had a heart attack, a fall, a child has been burned or injured. And the job itself is stressful. The paramedics in the fire department in the study respond to about 750 calls a day.

The community these paramedics serve is also experiencing increased stress from poverty, violence, lack of access to healthcare and other factors. A stressed workforce responding to a stressed community during a stressful event can lead to violence, as the events in Ferguson, Missouri show all too clearly.

Stress can't explain all the violence. The person-to-person nature of the work may be an issue. The study found that EMS workers were 14 times more likely than their firefighter co-workers to be the victim of an assault while on the job. EMS workers find this demoralizing. As one paramedic says, “I don’t think I should be that worried about being assaulted [by] a person that I’m supposed to be helping. I mean, I really don’t think it’s fair.”

The problem is bad enough that at a focus group, when asked how to stop the violence, one worker suggested carrying a taser. And she was enthusiastically seconded.

EMS workers in the study constantly complained about the lack of support they receive. It starts when the dispatcher offers too little information about the situation awaiting the emergency team. As one emergency medical technician describes it: “We’re dispatched in way too many incidents that we have no idea what we’re walking into.”

Too often, the legal system lets responders down as well. In the state where the study was conducted, assaulting a first responder is a felony. Yet people are rarely punished for these attacks. Charges may be reduced or dropped due to a defendant's mental illness or medical problems. And EMS workers feel a decided lack of support from their department. One paramedic explains: "…[I]f you assault a paramedic, firefighter, police…you’re supposed to be charged with a felony. That rarely ever happens. You know, most of the time, you go in there alone. ...And [the assailant] will explain how sorry they are and what they did to you. And the judge says, ‘okay’...And that’s all you get.”

Trained to offer emergency medical assistance, workers receive little or no training on the risks of combative patients or on how to protect themselves, despite the fact that such training is available.

All this doesn't just make an EMS worker's job harder; it also affects how they care for patients. One paramedic explained that ever since she was assaulted, she's very careful about getting too close to patients. That's not good for care. Yet who can blame her?

For now, the study suggests that EMS workers may have to watch their own back because no one else is doing it for them. One idea to help protect them is to have locations where violent interactions have occurred flagged in the system so dispatchers and paramedics know better what to expect if a call comes in from that location again.

The study appears in the American Journal of Industrial Medicine and is freely available.