Violence in the Fire EMS Workplace:

Are You Ready for the Next Call?

By Donald W. Walsh, Ph.D., EMT-P

The recent violent line-of-duty deaths of two paramedics were tragic, but were neither surprising nor unforeseeable. Research shows that fire and EMS first responders may need to look into law enforcement training just to respond to calls. If your department or agency has not started "street smart" training programs and looked at purchasing body armor for its employees, you will want to read this article closely.

In February 2004, a Lexington, Kentucky, man who told a reporter he was battling "alien clones" during a six-hour standoff at his home was charged with the shooting deaths of his wife and Lieutenant Brenda Cowan (of the Lexington Fire Department), who was responding to a domestic dispute call. Cowan had been just promoted to lieutenant one month prior to her death. Another firefighter and a police officer were also shot.

In the same month in Kansas City, Missouri, Mary Seymour, a paramedic in the Kansas City Metropolitan Ambulance Service Trust (MAST), was shot twice in the chest while at the scene of an incident involving a house explosion. Seymour's ambulance and the police department had arrived at a reported house explosion when a suspect began firing at them from across the street.

Seymour was wounded and fell near her ambulance. A fire department official decided to retrieve her, and the police laid down cover fire as six firefighters ran over and dragged her back behind a fire truck. The firefighters put Seymour on a backboard, placed her in a fire truck, and raced her down the street to another ambulance. The fire apparatus and ambulance on the scene had bullet holes on the side of the vehicles, and bystanders and public safety officials at the scene said the shooting was non-stop during the rescue operation and after.

We Saw This Coming


In mid-1990s, I researched years of data related to EMS-encountered violence in the workplace at National-Louis University as part of a doctoral dissertation work. The study's numbers and trends were alarming. In a 12-year career in an urban EMS service, a typical responder will be assaulted in the line of duty 9.6 times. The assaults could range from being kicked or punched; hit with fists, sticks, bats, or blunt objects; shot with guns; or stabbed with knives or sharp weapons. In that same time period, an assault will be attempted 17 times. Attempted assaults were incidents in which people tried to hit or batter the first responder; either the person missed or the responder was able to avoid the threat by a quick diversionary action.

The study found that in 24 percent of the top 25 most populated cities served by EMS, EMS personnel were shot at while responding to emergency calls or while at the scene. Ninety-two percent of those agencies reported that they had EMS employees assaulted in the line of duty, with 95 percent of the agencies saying their personnel received hospital treatment for their injuries. EMTs and paramedics were shot, stabbed, burned, cut, beaten up, and jumped on by gangs.

It's Not Just a Big City Issue


In the late 1990s, that same National-Louis University research team, in conjunction with Emergency Medicine Researchers International of Chicago, Illinois, used the same research methodologies in a rural American setting. Their findings were again alarming. During an EMS state conference in the Midwest, 284 EMS workers, mostly from rural communities, participated in the study. Seventy percent were volunteer EMS personnel and served populations under 5,000. Forty percent of the rural EMTs and paramedics reported being assaulted during their EMS career of 10 years. Seven responders reported being shot at; two were actually hit. One of the EMTs was shot by his wife in the station house after a domestic dispute; the other was shot by an intoxicated person with a deer hunting rifle.

The study found that rural America was not just small towns with farmlands but vast geographical areas with high rates of unemployment and drug and alcohol abuse—perfect places for clandestine drug lab operations. Combined with increasing levels of domestic abuse, responders were placed in very dangerous situations. One particular issue noted in the study was that many of the EMS responders knew the victims or abusers when they responded to the scene. This created difficult situations for responders when it came to having someone arrested.




Steps to Counter the Anticipated Violence


Many departments and agencies are addressing occupational encountered violence with additional training. The most current form of training is "street smart" education, which offers tactical operational approaches to emergency scenes using intelligence and basic response skills. One example of good "street smarts" is approaching a known drug house without lights and sirens. Another is sharing crime intelligence information you collect in your geographic areas with law enforcement agencies and personnel on other shifts.

Your 911 public safety answering points (PSAP) centers, which operate police, fire, and EMS communications, should share intelligence with each agency, especially "hot zones" or problem areas, based on prearrival information and screening. How many times have you responded to the scene of an injured person only to find that the patient was the victim of domestic abuse, there are no police on the scene, and the hostile spouse is telling you to get out of there or else? How many times have you arrived on the scene prior to the police? Communication and coordination of accurate 911 information are key components in the "street smart" response.

In addition, EMTs and paramedics must have excellent communication and social skills in their respective communities. You must know your work environment and the people who live there. "If you look like a target, you will become one," said one veteran paramedic working in Chicago's busiest EMS district. You need to know how to talk your way out of bad situations. "Most of the gang members have guns on them; you need to know what to say, when to say it, and how to say it," the paramedic said of his district. "Say the wrong thing, and you are going to get hurt or, worse yet, killed!"

The United States Fire Administration (USFA) addressed these issues in its 1994 publication, EMS Safety Techniques and Applications. The publication is free and can be ordered through the USFA Publication Office or on the Internet at

Body Armor


In 1996, the National-Louis University study recommended that body armor be used by or be available for all EMS personnel working in the prehospital setting. Many fire departments are deploying body armor as part of their personal protection equipment. Since the study, many fire and EMS agencies across the United States have issued body armor and have developed policies regarding its use. The best method for determining body armor guidelines for your agency is to look at your local law enforcement agency's specifications on body armor. In many cases, the local police department's specifications are more than adequate for your department's needs. In addition, there are many types, levels of protections, and styles of armor on the market. A well-informed manager will be able to make appropriate selections after meeting with police officials. Body armor can be hot and uncomfortable to wear, so purchasing heavy and overprotective levels is counterproductive.

Today's fire and EMS services need to incorporate "street smart" safety training as part of their everyday training, drills, and in-services. Fire departments and EMS agencies need to add protective body armor to their employees' personal protective equipment inventories. Interagency intelligence and information cooperation among fire, police, and EMS disciplines are highly recommended as an ongoing process in all jurisdictions.



"Police Find Body in Debris at Scene of Shootout in Kansas City, Arrest warrant issued only hours earlier," Kevin Hoffmann, MARÁ Rose Williams, and Mark Morris, News: all news channels Monday, March 08, 2004, 9: 45 AM PST.

"Man fighting 'evil alien clones' accused of killing two women"; Ellen R. Stapleton, Associated Press, February 15, 2004.

"EMS Safety, Techniques and Applications," United States Fire Administration, Federal Emergency Management Agency, U.S. Government Publication FA-144/April 1994.

Krebs, Dennis, R., When Violence Erupts, a Survival Guide for Emergency Responders, American Academy of Orthopedic Surgeons, (Sudbury, Mass: Jones and Bartlett), 2003.

Dennis B., "Patient's attack hurts paramedics." St. Petersburg Times online, Pasco County edition, Feb. 9, 2001.

Walsh, DW. "An analysis of paramedic-encountered violence in a large urban EMS system," National-Louis University, 1997.

"Protecting the EMS Care Giver: A Study of Work Place Violence Risks & Controls Within the Emergency Medical System of Virginia," Virginia Dept. of Health, Office of Emergency Medical Services. Circle Safety & Health Consultants.

Walsh, DW. "An analysis of EMS-encountered violence in rural American EMS." Emergency Medicine Researchers International, 1999.

Thomsen TW, AJ Sayah, M Eckstein, HR Hutson. "Emergency medical services providers and weapons in the prehospital setting," Prehosp Emerg Care 4(3): 209–16, Jul.–Sept. 2000.

Spielman F. " 'I thought I was going to die,' paramedic says," Chicago Sun Times, June 19, 2001.

Krebs D, K Henry, M Gabriele. When Violence Erupts: A Survival Guide for Emergency Responders, (St. Louis: Mosby, 1990), 1-8.

Mock EF, KD Wrenn, SW Wright , TC Eustis, CM Slovis. "Anxiety levels in EMS providers: Effects of violence and shifts schedules," Am J Emerg Med 17(6): 509–11, Oct. 1999.

FireEMS May, 2004
Author(s) :   Donald W. Walsh