If Cumberland Goodwill EMS transports you in an ambulance, you may see a new sign on the wall with a piece of advice.
“It is a felony to assault a first responder,” the signs warn. “Committing a crime against a provider will result in charges being filed.”
Sadly, such signs are needed as part of an to attempt to curb assaults by patients on EMTs and paramedics attempting to save their lives, according to Cumberland Goodwill EMS Assistant Chief Nathan Harig. He’s pushing for more stringent prosecutions of patients who commit assault, and publicly warning people that Cumberland Goodwill will prosecute you if you attack an EMT or paramedic.
Other EMS leaders, however, said more prosecutions won’t stop patients in mental and physical turmoil from acting in ways they later regret, and there are questions about the propriety of charging patients not in their right mind with a felony.
Frequency of assaults
Recently, Cumberland Goodwill EMS responded after a man complained of abdominal pain. Once he was in the back of ambulance with a female EMT, it became clear he had other motivations.
The patient indecently assaulted an EMT and caused additional mischief when interacting with staff at a local hospital, according to Harig. Most patients aren’t that bold, but situations where patients slap or inappropriately touch a first responder are distressingly common.
Harig said a Cumberland Goodwill EMT or paramedic reports being assaulted once or twice per month, double the rate at which assaults used to be reported. He isn’t sure if that is because assaults are becoming more frequent or because EMTs are becoming more willing to report them.
“This has been seen for the longest time as a career where (being attacked) is part of the job,” Harig said.
A study conducted by the Center for Firefighter Injury Research & Safety Trends, or FIRST, at Drexel University with the Philadelphia Fire Department found that the department’s paramedics were 14 times more likely to suffer an assault-related injury than its firefighters when controlled for gender. Yet EMTs don’t often receive the same level of recognition as firefighters from the public for what they do.
“It’s not that the public doesn’t appreciate them, it’s just that they don’t understand what they go through,” Jennifer Taylor, director of the FIRST Center, said in an email.
The center is working on a project to collect data on workplace violence experienced by first responders. For now, “we know only anecdotally that sexual assault and sexual harassment by patients and bystanders are experienced by EMS responders,” said Regan Murray, EMS project manager for the FIRST Center.
Facing a felony
Under Pennsylvania law, felony aggravated assault is typically reserved for cases in which a person attempts to cause “serious” bodily injury. However, any assault is considered felony aggravated assault if the person attacked belongs to several enumerated categories, like police officers, firefighters and teachers. That list also includes “emergency medical services personnel,” which covers EMTs and paramedics.
Harig said he would like to see a similar carve-out in the indecent assault law to create enhanced penalties for indecently assaulting first responders.
He acknowledged that there are conditions that can cause a person to behave inappropriately — for example, hypoxia (an insufficient supply of oxygen) can cause patients to become combative — and Cumberland Goodwill doesn’t seek charges in those cases, he said. “What we’re really looking at is someone who is being purposefully aggressive,” he said.
Most often, though, the assaults are not because of an uncontrollable psychological reason but a willful act of the patient, he said.
Susquehanna Township EMS Director/Chief Matthew Baily agreed.
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First responders at Susquehanna Township EMS in Dauphin County have been hit, spit on and kicked by people who knew what they were doing and were just being belligerent, Baily said. Female EMTs are particularly likely to be groped or touched inappropriately. Some patients have even attempted to tip over the ambulance.
“I think, from the prosecution side, they need to be more aggressive in making sure these get prosecuted,” Baily said.
Cumberland County District Attorney Skip Ebert said his office typically decides whether to file charges in cases involving a nurse or first responder based on the wishes of the victim.
If mental health issues are a factor in the assault, the defendant may be a candidate for TOMS Court, a diversionary program in which patients can have the charges reduced or expunged after successful completion of mental health treatment, Ebert said. He doesn’t typically completely avoid charging someone because of the circumstances of the patient, however.
“If they’re harming somebody, they need to be held accountable,” he said.
‘They need help’
Shippensburg Area EMS Capt. Heather Franzoni views the situation somewhat differently, saying most people who assault first responders do so because of mental distress, not criminal intent.
“Somebody is calling us because they need help,” Franzoni said.
Shippensburg Area EMS works with law enforcement on a case-by-case basis, she said, and there are circumstances in which criminal charges would be warranted. Still, she believes the more effective approach to limiting the hazards facing first responders is training them on how to handle mentally ill or agitated patients.
The FIRST center also doesn’t believe more prosecutions are the most effective way to prevent assaults.
“Felonious assault statutes are important as an expression of society’s value that it is unacceptable to harm a first responder,” Taylor said in an email. “Our research at the FIRST center shows that, although the current prosecutorial environment usually fails to provide procedural justice (for first responders), prosecutions will not prevent assaults. The best stance to take is a focus on primary prevention strategies that keep violence from happening in the first place.”
Shippensburg Area EMS has held self-defense training classes for its EMTs. Franzoni, who is also a correctional counselor, preaches mental health awareness to the company’s first responders, including training on how to de-escalate a situation or deal with a person suffering delusions or not cooperating. For example, if a patient doesn’t want to wear the third safety belt in the back of the ambulance because of a traumatic experience they are undergoing, it might be better to leave that seat belt off than try to force it on the patient.
The FIRST center has suggested big-picture solutions like “community paramedicine,” in which paramedics become more integrated into the health care system. When people call 911 for nonemergency needs, that approach allows EMTs to identify their health problems and connect them to the services they need. It could help curb the perception that first responders are a “taxi service,” as one EMT put it.
Susquehanna Township EMS also preaches situational awareness, Baily said, but that isn’t always enough to prevent incidents.
“Stuff happens very, very quickly,” he said. “It’s not like we carry guns or tasers.”
Baily acknowledged that there are gray areas where circumstances lead people to do things they wouldn’t normally do. Sometimes people become “reckless with grief” because of what happened to their family members, he said. First responders try to be understanding in such cases, but the EMT suffers the same assault regardless of the reason.
“The outcome is the same,” he said.