If you were to guess which jobs put personnel at higher risk of being physically assaulted, you'd probably guess police officers, firefighters, security guards and bouncers, right? While these positions do increase the likelihood of a physically violent encounter, there's one profession that may be even more dangerous. According to research out of Drexel University’s Dornsife School of Public Health, emergency medical technicians (EMTs) are 14 times more likely to be violently injured on the job than the firefighters they work with.

Researchers compared statistics from the Federal Emergency Management Agency-funded Firefighter Injury Research and Safety Trends (FIRST) project with the verbal accounts of paramedics who had been injured by patients. The first thing they noticed was that assault-related injuries are often not reported or, in the case of paramedics, acknowledged by administration. Instead, injuries are internalized as "part of the job."

"First responders are an interesting group. They go in because they want to help, and when they go in they encounter there situations they never got training for," said lead investigator of the study Dr. Jennifer Taylor, an associate professor at the Dornside School of Public Health, in a press release.

Taylor, along with Drexel students and Alumni, originally set out to investigate violent injuries as a gender issue since numbers seemed to indicate female firefighters were more likely to be victims of violent injuries than male workers; however, it soon became clear a person's occupation in a fire department mattered more in terms of violent injury risk.

"As an epidemiologist, I started describing the risk factors that public health researchers usually use: age, race, sex, etc. But we had some members of the responder community tell us to look at the paramedics because women are more likely to be paramedics than firefighters," Taylor said. "This is why stakeholder engagement is so important n all phases of scientific research. By having a group of advisors who could look at preliminary data, they prevented me from making an incomplete conclusion."

Of the first responders studied, paramedics were more than 14 times as likely to be assaulted than their firefighting counterparts. Male paramedics were more than 12 times as likely to be injured than male firefighters, and female paramedics were 9.3 times more likely to be violently injured than female firefighters. When Taylor did one-on-one interviews to gain a deeper understanding of these findings, she found a reoccurring issue paramedics had was with the little information they were given before being dispatched.

"We're dispatched in a way to many incidents that we have no idea what we're walking into," one EMT said.

Other complaints included inadequate training for handling combative patients, and that dispatch was too slow to send backup once a situation was deemed dangerous. The first responders studied also fielded more than 700 calls requiring an ambulance each day, which only added the stress of going on so many calls to the mix.

Taylor and her team looked at multiple options for improving the situation, including allowing dispatch to flag locations where past assaults occurred, better preparing paramedics, and putting up signage that it is a felony to assault a paramedic. This would not only help alert patients, but it would also show paramedics management supports them.

"No one has looked at what the implication is for patient and public safety if we beat our medics into the ground," Taylor said. "For cities that are large and have huge issue of poverty, we’re exhausting our workers. We don’t have standards for how many medics we should have per 100,000 people. I’m very worried about exhaustion, burnout, and possible emotional detachment by the responders."

Source: Taylor, J. Expecting the Unexpected: A Mixed Methods Study of Violence to EMS Responders in an Urban Fire Department. American Journal of Industrial Medicine. 2016.