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International Survey of Violence Against EMS Personnel: Physical Violence Report

Published online by Cambridge University Press:  31 October 2018

Brian J. Maguire*
School of Health, Medical, and Applied Sciences, CQUniversity, Rockhampton, Australia
Matthew Browne
School of Health, Medical, and Applied Sciences, CQUniversity, Bundaberg, Australia
Barbara J. O’Neill
School of Nursing, Midwifery, and Social Sciences, CQUniversity, Rockhampton, Australia
Michael T. Dealy
New York University, New York, New York, USA
Darryl Clare
School of Health, Medical, and Applied Sciences, CQUniversity, Rockhampton, Australia
Peter O’Meara
La Trobe Rural Health School, College of Science, Health & Engineering, La Trobe University, Bendigo, Australia
Correspondence: Adj. Prof. Brian J. Maguire, Dr.PH, MSA, EMT-P CQUniversity, Australia 39 Bellevue Pl. New London, Connecticut 06320 USA E-mail:



Each year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.


The objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.


An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.


There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as “urban.” Approximately 68% described their employer as a “public provider.” The majority of respondents were from the US.

When asked “Have you ever been physically attacked while on-duty?” 761 (65%) of the 1,172 who answered the question answered “Yes.” In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.


In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals.

MaguireBJ, BrowneM, O’NeillBJ, DealyMT, ClareD, O’MearaP. International Survey of Violence Against EMS Personnel: Physical Violence Report. Prehosp Disaster Med. 2018;33(5):526531.

Original Research
© World Association for Disaster and Emergency Medicine 2018 

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Conflicts of interest/attribution: The institution to which the work should be attributed is Central Queensland University, School of Health, Medical, and Applied Sciences, Rockhampton, Queensland, Australia. The authors declare no conflicts of interest.


1. Maguire, BJ, Walz, BJ. Current emergency medical services workforce issues in the United States. J Emergency Management. 2004;2(3):17-26.CrossRefGoogle Scholar
2. Australian Government Productivity Commission. Report on Government Services, Chapter 9, Fire and ambulance services. 2015. Accessed May 12, 2015.Google Scholar
3. The Health and Social Care Information Centre. Ambulance Services, England - 2012-2013. 2013. - no longer available. Accessed December 24, 2013.Google Scholar
4. Maguire, BJ, Dean, S, Bissell, RA, et al. Epidemic and bioterrorism preparation among emergency medical services systems. Prehosp Disaster Med. 2007;22(3):237-242.CrossRefGoogle ScholarPubMed
5. Milsten, AM, Seaman, KG, Liu, P, et al. Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings. Prehosp Disaster Med. 2003;18(4):334-346.CrossRefGoogle ScholarPubMed
6. Walz, BJ, Bissell, RA, Maguire, B, et al. Vaccine administration by paramedics: a model for bioterrorism and disaster response preparation. Prehosp Disaster Med. 2003;18(4):321-326.CrossRefGoogle ScholarPubMed
7. Mitchell, CS, Maguire, BJ, Guidotti, TL. “Worker Health and Safety in Disaster Response.” In: Ciottone G, (editor). Disaster Medicine. Philadelphia, Pennsylvania USA: Elsevier; 2015: 192-199.Google Scholar
8. World Health Organization. Emergency Medical Services Systems in the European Union. 2008. Accessed January 14, 2017.Google Scholar
9. Razzak, JA, Kellerman, AL. Emergency Medical Care in Developing Countries: Is it Worthwhile? Geneva, Switzerland: World Health Organization. 2002. Accessed January 14, 2017.Google ScholarPubMed
10. Al-Shaqsi, Sultan. Models of international emergency medical service (EMS) systems. Oman Med Journal. 2010;25(4):320-323.Google ScholarPubMed
11. Maguire, BJ, O’Meara, P, Brightwell, R, et al. Occupational injury risk among Australian paramedics: an analysis of national data. Med J Aust. 2014;200(8):477-480.CrossRefGoogle ScholarPubMed
12. Maguire, BJ, Hunting, KL, Smith, GS, et al. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002;40(6):625-632.CrossRefGoogle ScholarPubMed
13. Maguire, BJ. “Ambulance safety.” In: Cone DC, (editor). NAEMSP Emergency Medical Services: Clinical Practice & Systems Oversight. Hoboken, New Jersey USA: Wiley Pub; 2014.Google Scholar
14. Maguire, BJ. Transportation-related injuries and fatalities among emergency medical technicians and paramedics. Prehosp Disaster Med. 2011;26(5):346-352.CrossRefGoogle ScholarPubMed
15. Maguire, BJ, Hunting, KL, Guidotti, TL, et al. Occupational injuries among emergency medical services personnel. Prehosp Emerg Care. 2005;9(4):405-411.CrossRefGoogle ScholarPubMed
16. Maguire, BJ, Smith, S. Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehosp Disaster Med. 2013;28(4):1-7.CrossRefGoogle ScholarPubMed
17. Maguire, BJ, Hunting, KL, Guidotti, TL, et al. The Epidemiology of Occupational Injuries and Illnesses among Emergency Medical Services Personnel. Bethesda, Maryland USA: ProQuest; 2004.Google Scholar
18. Amiry, AA, Bissell, RA, Maguire, BJ, et al. Methicillin-resistant staphylococcus aureus nasal colonization prevalence among Emergency Medical Services personnel. Prehosp Disaster Med. 2013;28(4):1-5.CrossRefGoogle ScholarPubMed
19. Maguire, BJ, O’Meara, P, O’Neill, BJ, et al. Violence against emergency medical services personnel: a systematic review of the literature. Am J Ind Med. 2018;61(2):167-180.CrossRefGoogle ScholarPubMed
20. Dean, L. London ambulance medics assaulted almost 600 times during 2013. International Business Times. Published March 31, 2014. Accessed April 13, 2014.Google Scholar
21. Maguire, BJ, O’Neill, BJ. EMS personnel’s risk of violence while serving the community. Am J Public Health. 2017;107(11):1770-1775.CrossRefGoogle Scholar
22. Petzäll, K, Tällberg, J, Lundin, T, et al. Threats and violence in the Swedish pre-hospital emergency care. Int Emerg Nurs. 2011;19(1):5-11.CrossRefGoogle ScholarPubMed
23. Suserud, BO, Blomquist, M, Johansson, I. Experiences of threats and violence in the Swedish ambulance service. Accid Emerg Nurs. 2002;10(3):127-135.CrossRefGoogle ScholarPubMed
24. Bigham, BL, Jensen, JL, Tavares, W, et al. Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: a mixed-methods cross-sectional survey. Prehosp Emerg Care. 2014;18(4):489-494.CrossRefGoogle ScholarPubMed
25. Gershon, RR, Vlahov, D, Kelen, G, et al. Review of accidents/injuries among emergency medical services workers in Baltimore, Maryland. Prehosp Disaster Med. 1995;10(1):14-18.CrossRefGoogle ScholarPubMed
26. Maguire, BJ, O’Neill, BJ, O’Meara, P, et al. Preventing EMS workplace violence: a mixed-methods analysis of insights from assaulted medics. Injury. 2018;49(7):12581265.CrossRefGoogle Scholar
27. World Health Organization. Workplace Violence in The Health Sector; Country Case Studies Research Instruments. 2003. Accessed June 7, 2016.Google Scholar
28. Maguire, BJ, O’Meara, P, O’Neill, BJ. Violence against paramedics: developing the tools to end the epidemic. Response. 2016;43(1):24.Google Scholar
29. EMS World News. University Conducting International EMS Workplace Violence Study. 2016. Accessed November 21, 2016.Google Scholar
30. JEMS. The international impact of violence against EMS providers. 2016. (no longer available). Accessed November 21, 2016.Google Scholar
31. UK College of Paramedics. Violence against paramedics questionnaire. 2016. Accessed May 28, 2018.Google Scholar
32. US Fire Administration; Emergency Management and Response, Information Sharing and Analysis Center. Workplace violence and EMS personnel. Infogram. 2016 May 19:2.Google Scholar
33. Team R Core. R: A language and environment for statistical computing. Foundation for Statistical Computing; Vienna, Austria. 2013.Google Scholar
34. US Bureau of Labor Statistics. Handbook of Methods. Chapter 9. Occupational Safety and Health Statistics. 2015. Accessed March 28, 2016.Google Scholar
35. US National Highway Traffic Safety Administration. National EMS Assessment. 2011. Accessed January 16, 2015.Google Scholar
36. Grange, JT, Corbett, SW. Violence against emergency medical services personnel. Prehosp Emerg Care. 2002;6(2):186-190.CrossRefGoogle ScholarPubMed
37. Taylor, JA, Barnes, B, Davis, AL, et al. Expecting the unexpected: a mixed methods study of violence to EMS responders in an urban fire department. Am J Ind Med. 2016;59(2):150-163.CrossRefGoogle Scholar
38. Gormley, MA, Crowe, RP, Bentley, MA, et al. A national description of violence toward emergency medical services personnel. Prehosp Emerg Care. 2016;20(4):439-447.CrossRefGoogle ScholarPubMed
39. Boyle, M, Koritsas, S, Coles, J, et al. A pilot study of workplace violence towards paramedics. Emerg Med J. 2007;24(11):760-763.CrossRefGoogle ScholarPubMed
40. Corbett, SW, Grange, JT, Thomas, TL. Exposure of prehospital care providers to violence. Prehosp Emerg Care. 1998;2(2):127-131.CrossRefGoogle ScholarPubMed
41. Alexander, C, Fraser, J, Hoeth, R. Occupational violence in an Australian healthcare setting: implications for managers. J Healthc Manag. 2004;49(6):377-390.CrossRefGoogle Scholar
42. Duchateau, FX, Bajolet-Laplante, MF, Chollet, C, et al. [Exposure of French emergency medical personnel to violence]. Ann Fr Anesth Reanim 2002;21(10):775-778.CrossRefGoogle Scholar
43. Findorff, MJ, McGovern, PM, Wall, MM, et al. Reporting violence to a health care employer. AAOHN J. 2005;53(9):399-406.Google ScholarPubMed
44. Arnetz, JE, Hamblin, L, Ager, J, et al. Underreporting of workplace violence comparison of self-report and actual documentation of hospital incidents. Workplace Health Saf. 2015;63(5):200-210.CrossRefGoogle ScholarPubMed
45. Gerberich, SG, Church, TR, McGovern, PM, et al. An epidemiological study of the magnitude and consequences of work-related violence: the Minnesota Nurses’ Study. Occup Environ Med. 2004;61(6):495-503.CrossRefGoogle ScholarPubMed
46. Gosling, SD, Vazire, S, Srivastava, S, et al. Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. Am Psychol. 2004;59(2):93.CrossRefGoogle ScholarPubMed
47. Australian Government Productivity Commission. Report on Government Services. Volume E: Health. 2017. Accessed May 17, 2017.Google Scholar
48. National Ambulance Service. Service profile: our staff. 2017. Accessed May 28, 2018.Google Scholar
49. Pozzi, C. Exposure of prehospital providers to violence and abuse. J Emerg Nurs. 1998;24(4):320-323.CrossRefGoogle Scholar
50. Gates, DM, Ross, CS, McQueen, L. Violence against emergency department workers. J Emerg Med. 2006;31(3):331-337.CrossRefGoogle ScholarPubMed
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