We must question the sanity of the world we live in. First responders – police, fire and ambulance – are generally people trying to save the community from danger by putting themselves in harm’s way. Yet the incidence of assaults against them has grown to shocking levels around the world. These are not exhaustive stats (this will come in a more comprehensive piece) but this piece paints a picture of what is going on and why we shouldn’t be surprised at the growing incidences of PTSD suffered by first responders. Something must be done. The next journey for CM is to provide a solution.
The FBI noted in 2016 that 57,180 (c.10% of all) US police officers were assaulted while performing their duties. 28.9% were injured (enough to enforce time away from work). The largest percentage of victim officers (32.2%) were assaulted while responding to disturbance calls (domestic violence, family disputes, pub fights).
Assailants used hands, fists or feet in 78% of the incidents, firearms in 4.2% of incidents, and knives or other cutting instruments in 1.9% of the assaults. Other types of dangerous weapons were used in 16% of assaults. Assaults on police in the US are up 17% in the past two years.
In NSW, Australia some 2,343 (13.3%) police officers out of 16,500 have been at the receiving end of assault in 2017. That’s 6 per day. With regard to official statistics, the NSW Police Force indicated that over a three year period from 2013 to 2015, an average of 2,236 police officers per year were assaulted during the course of their duties. Around 7% of officers actually end up physically injured.
In the US health care professionals experience the highest rate of workplace violence (WPV) compared to all other industries, with the majority of violent injuries committed by their patients according to the Bureau of Labor Statistics. Studies show EMS responders were three times higher than the national average for all other occupations to suffer WPV. In regards to occupational fatalities, the rate among paramedics is more than twice the national average for all occupations and is comparable to those of police and firefighters at 12.7 per 100,000 workers per year.
The rate of nonfatal injuries among US paramedics was 34.6 per 100 full-time workers per year — a rate more than 5x higher than the national average for all workers. In regard to fatal injuries, a retrospective cohort study of nationally registered emergency medical technicians (EMTs) in the U.S. found that 8% of fatalities were due to assaults.
Males have been reported as the most frequent perpetrators of violence however, a separate study found female patients of the mean age of 32.5 years +/- 8.1 years to be the most frequent perpetrators.
In the NSW Ambulance Service, approximately 51% of assault incidents were attributed to mental illness, 22% to alcohol, 15% to drugs. Similarly, statistics provided by the NSW Bureau of Crime Statistics and Research (BOCSAR) concerning violence against Police from July 2006 to June 2016 suggest alcohol is a factor in many incidents. Assaults on ambos in NSW are up 8-fold since 2001. Median lost hours for those EMS crew assaulted is around 8.6 weeks.
In what world do people shoot fireys? Here are 3 specific incidents in 2016 of attacks on fire fighters in the US.
April 15, 2016: Firefighter fatally shot, second wounded in Prince George’s, Baltimore, Maryland
Jan. 22, 2016: Ark. firefighter shot, killed on EMS call, Pulaski County, Arkansas,
Jan. 20, 2016: Denver fire chief stabbed near station, Denver, Colorado,
Fire and Rescue NSW indicated its officers do not have the sort of violence prevention training of police and paramedics better able to protect their crew’s health and safety, including in respect of violent incidents. At the Parliamentary Committee’s hearing on 14 November 2016, Fire and Rescue NSW witnesses provided the following evidence:
“Basically, when a crew arrives at an incident, you have a station officer and a station commander in charge of the crew and the…truck. That person undergoes promotional programs to get to that position. Part of that is understanding how the legislation is applied in reality from a practical point of view. Also, during that experience – we are talking probably eight to 10 years for that to occur …The promotional programs…cover the responsibilities of the officer and advise around the standard operational guidelines of when to withdraw and ask for police support and what is safe or not safe.
…If we look overseas for experiences and tried to align our experience to that, you would have to say that the civil unrest that is happening in the United States probably would not occur here to that degree. However, there is also an underlying issue in the United States where emergency service is seen as part of an arm of government and there is, hopefully, a small growing trend where emergency service ambushes are occurring…random shooters are calling emergency services to locations to make a point. We hope that never crosses to this country here, but we would always have an eye on what happens in other jurisdictions…because it is quite possible someone would pick that up as a possibility in this jurisdiction….”
The UK HMPS note that there were 7,159 assaults on staff in the year to March 2017 up 32%YoY. Serious assaults were up 25%YoY to 805 incidents. The National Tactical Response Group (NTRG) which is only called under extreme levels of prisoner violence surged from 120 in 2010 to an annualized 630 by the end of 2016.
THE PTSD IMPACT
This was the fascinating part of the research. It isn’t that the job isn’t hard enough already, it’s the lack of resources to support first responders when waiting for incidents. Lots of idle time to ponder.
US FEMA note stress has not only been categorized by exposure to traumatic incidents, but also the monotonous operational characteristics of EMS organizations, such as paperwork, lack of administrative support, low wages, long hours, irregular shifts, and cynical societal attitudes toward public safety officers.
Cumulative stress associated with the monotonous duties or low acuity calls has led to feelings of desensitization for patients, and their job as a whole. Concerns have also been raised regarding sleep quality and fatigue and the impact it has not only on the provider, but also job performance and patient outcomes. Some research has posited that organizational stress often contributes more to the development of PTSD than traumatic events.
Also noteworthy is the notion that paramedics are often the source for a lot of criticisms by society for the decisions they make in determining life or death situations for patients and themselves. This can affect EMS providers in many ways and may contribute to the slow decline in provider morale.
Burnout (emotional exhaustion) is one of many organizational outcomes that may arise as a result of violence experienced by EMS responders. The question of whether or not violence would eventually lead to burnout was first raised in the early 1990s . Exposures to violence were noted as a reason many EMTs, especially volunteers, left the profession. In an early study from 1998, 7% of survey respondents within one urban fire department considered leaving EMS as a direct result of an abusive situation they encountered while on the job. Knowing how to emotionally cope following a tough incident can help to reduce anxiety and burnout.
Mixed methods studies conducted in the U.S. and Sweden found that violent encounters altered the patient-provider relationship. Yet, some in the industry feel that exposures to violence do not cause stress or negatively impact providers. This lack of effect has been attributed to the internalization of the mentality that violence is a part of the job. It has been posited that years of experience may be a protective factor that allows more experienced responders to experience less stress and anxiety after violent events.
Evidence weighing the social and economic costs associated with increased violence and burnout is based mostly upon anecdotal evidence, with no assessments conducted on monetary value. Some suggest that, as violence increases, the need for police backup also increases, thereby increasing response time and delaying potentially critical care to a patient in need.
Other concerns include altered operations for the private sector of EMS. Intent to leave the profession is also a concern. As more EMS responders leave the profession, numerous organizational and patient impacts have been hypothesized, including increased costs for training new EMTs and paramedics, greater numbers of inexperienced paramedics serving at any one point in time, and increased error rates committed by new and inexperienced paramedics. EMS responders also report seeking a job change away from their ambulance role. In some cases, responders stated they lost interest in fieldwork and tried to get off the road and into desk positions.
What’s clear is that not enough is being done to help first responders cope with occupational hazards and handling the stress that comes from it. That is going to change very soon. Stay posted!
While you’re at it, why not thank those first responders randomly in the street for the great work they do. It goes a long way! They need you just as much as you will need them when you’re in a bind!