Workplace Violence Against Emergency Medical Services (EMS): A Prospective 12-Month Cohort Study Evaluating Prevalence and Risk Factors Within a Large, Multistate EMS Agency.

Abstract

Objectives: To determine the prevalence and associated risk factors of workplace violence (WPV) experienced by emergency medical services (EMS) clinicians across a large, multistate ground/air EMS agency.

Methods: We used a prospective cohort study design from 1 December 2022 to 30 November 2023. A checkbox was added within the electronic medical record (EMR) asking staff to indicate whether WPV occurred. Patient characteristics, encounter (run), and crew factors were abstracted. Potential risk factors for WPV were assessed using logistic regression, with the occurrence of any form of violence as the primary outcome of interest. Models were both univariable, assessing each risk factor individually, and multivariable, assessing all risk factors together to identify independent factors associated with higher risk of WPV. Multivariable model results were reported using adjusted odds ratios (aORs) and 95% confidence intervals.

Results: A total of 102,632 runs were included, 95.7% (n = 98,234) included checkbox documentation. There were 843 runs (0.86 per 100 runs, 95% CI 0.80-0.92) identified by EMS clinicians as WPV having occurred, including verbal abuse (n = 482), physical assault (n = 142), and both abuse and assault (n = 219). Risk factors for violence included male patient gender (aOR 1.45, 95% CI 1.24-1.70, p < 0.001), Richmond Agitation-Sedation Scale (RASS) >1 (aOR 16.97, 95% CI 13.71-21.01, p < 0.001), and 9-1-1 runs to include emergent (P1; aOR 1.75, 95% CI: 1.17-2.63, p = 0.007) and urgent (P2; aOR 1.64, 95% CI 1.08-2.50, p = 0.021) priority, compared to P3/scheduled transfer or P4/trip requests. Factors associated with lower risk for violence included older patients (aOR per 10 years = 0.95, 95% CI 0.91-0.98, p = 0.007) and run time of day between 0601-1200 h compared to 0000-0600 h (aOR 0.67, 95% CI 0.51-0.88, p = 0.004). Only 2.7% of violent runs captured through the EMR were reported through official processes.

Conclusions: Verbal and/or physical violence is recognized in nearly 1% of EMS runs. We recommend prioritizing WPV prevention and mitigation strategies around identified risk factors and simplifying the WPV reporting process in order to reduce staff administrative burden and encourage optimal capturing of violent events.