• J E Tintinalli and M McCoy.
• Department of Emergency Medicine, University of North Carolina, Chapel Hill.
• Ann Emerg Med. 1993 Aug 1; 22 (8): 1276-9.

Study ObjectivesTo estimate the frequency of violence directed toward prehospital providers; to identify the methods used to manage violent patients in the prehospital setting; and to identify the educational, medical, and legal issues in the prehospital management of violent patients.DesignA convenient sample survey and a descriptive review of ambulance call reports from June to December 1991.SettingThe survey was distributed to registrants at the National Association of EMS Physicians in Pittsburgh, Pennsylvania, in June 1992. Ambulance call reports were reviewed for a metropolitan county with a service population of 60,000.InterventionsNone.ResultsOnly about 50% of survey respondents reported having protocols for the management of violent patients. Law enforcement officers provided assistant in managing violent patients for 97% of respondents, and 81% reported that a violent patient who refused transport could be arrested. Injury to prehospital providers in the past year was reported by 67% of respondents. Although 67% reported some training in the management of violent patients, only 9% had training by law enforcement officers and only 25% thought that they were trained in assessing the scene for potential violence. Ambulance call report review identified an 0.8% incidence of violent episodes. Weapons were evident in 12% of violent encounters. Transport was refused by 18% of violent patients. In 9% of violent encounters, patients were hypoglycemic. No emergency medical technician injuries were reported for the study period.ConclusionThe potential for injury to prehospital providers from violent patients is probably widespread, and no mechanism for identifying injuries or exposure to violent patients currently exists. All systems should have protocols for managing violent patients and for restraint application. Educational sessions for self-defense and assessment of the scene for violence may be indicated.

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