EMS World

AUG 2018

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18 AUGUST 2018 | EMSWORLD.com A nyone who has worked on an ambulance long enough has had to deal with a violent or threat- ening patient, family member, or person on scene. These situations are all too common in our field, and unfortunately, anecdotal evidence and some published literature suggest EMS workplace violence events are increasing. While there has been some research describing workplace violence in EMS, this month's Trip Report reviews a manuscript focused on preventing it. The authors had the novel idea to actually ask EMS provid- ers who have been victims how they thought these incidents could be prevented. This was an international study, promoted in four countries. The authors also distrib- uted a survey link at EMS meetings and con- ferences, sent e-mails, had stories published in magazines, and even used social media to elicit participation. The authors used a World Health Orga- nization definition of violence: "Physical violence refers to the use of physical force against another person or group that results in physical harm, sexual, or psychological harm. It can include beating, kicking, slapping, stab- bing, shooting, pushing, biting, and/or pinch- ing, among others." It included 163 questions about demographics, career experience, job title, hours worked, and violence-related experiences. This manuscript focused on just one of those questions: Specifically, individuals who indicated they'd been physically attacked on duty within the last 12 months were asked if they thought the incident could have been prevented. If they said yes, they were asked to describe how. The authors reviewed the responses and identified common themes. They used a Haddon Matrix to organize their findings into six groupings. Commonly used in injury prevention, the Haddon Matrix is a method to group factors or attributes into categories before, during, and after an event. It is often used to develop interventions. Results There were 1,778 individuals from 13 coun- tries who replied. The manuscript did not report which countries were included, nor did it report a response rate. The authors likely lacked a reliable denominator to calculate a response rate due to the multiple methods used to distribute the survey. Of those who responded, 633 reported an assault within the previous 12 months—more than a third of respondents! About one-third of those who reported an assault (203) indicated they believed it could have been prevented. Almost all of those (193, 95%) added a free-text response describing how. The six themes identified were: 1) Human factors: Specific populations and de-escalation techniques—This theme included aggressors with mental health issues or those who had alcohol or drugs in their system, as well as responding to calls in dangerous neighborhoods. A contributing factor identified within this theme was insuf- ficient training on how to prevent and man- age aggressive behavior. Recommendations to prevent these incidents included training EMS professionals in verbal de-escalation techniques and having law enforcement present for calls in neighborhoods known to be dangerous. 2) Equipment factors: Self-defense equip- ment, restraint equipment, and resources— This theme included situations in which an aggressor likely should have been chemi- cally or physically restrained. Contributing factors included low-quality restraints and lack of availability of chemical measures to restrain or subdue an aggressor. Measures recommended for prevention included the ability to administer ketamine for excited delirium, training and the ability to use OC spray, early application of restraints, and self-defense training. 3) Operational environment factors: Sys- temwide advance warning—This theme included situations where the aggressor was known to be violent. Contributing fac- tors included staff at pickup locations such as nursing homes, prisons, and hospitals who failed to warn the EMS providers of the patient's violent behavior. Recommendations to prevent these types of incidents included providing warning to EMS providers when a patient or addresses have been associated with violence previously. 4) Social environment factors: Public and interagency awareness and support—This theme included suggestions that better col- laboration and support among "ambulance agencies, legislators, the public, nursing homes, jails, dispatch services, police, fire departments, and hospitals" were required to prevent violence against EMS providers. A contributing factor was the inability of EMS providers to refuse to treat threatening drunk or abusive patients. Recommendations included better awareness among the public and other healthcare and public safety per- sonnel regarding the risks of violence faced by EMS as well as legislation with stronger punishments for assaults on EMS providers. 5) Human factors: Situational awareness— This theme included situations where the EMS provider acknowledged their role in A survey asks assaulted providers what might have prevented it By Antonio R. Fernandez, PhD, NRP, FAHA THE TRIP REPORT: TURNING RESEARCH INTO PRACTICE Look for PCRF research podcasts based on the topics featured in this column at www.pcrfpodcast.org. REVIEWED THIS MONTH Preventing EMS Workplace Violence: A Mixed-Methods Analysis of Insights From Assaulted Medics. Authors: Maguire BJ, O'Neill BJ, O'Meara P, Browne M, Dealy MT. Published in: Injury, 2018 Jul; 49(7): 1,258–65. Could the Attack Have Been Stopped?

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