Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios

Donald G Garner Jr; Mallory B DeLuca; Remle P Crowe; Rebecca E Cash; Madison K Rivard; Jefferson G Williams; Ashish R Panchal; Jose G Cabanas

doi:10.1002/emp2.12727

Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios

J Am Coll Emerg Physicians Open. 2022 Apr 21;3(2):e12727. doi: 10.1002/emp2.12727. eCollection 2022 Apr.

Authors

Donald G Garner Jr¹, Mallory B DeLuca¹, Remle P Crowe², Rebecca E Cash³, Madison K Rivard⁴, Jefferson G Williams^{1

5}, Ashish R Panchal^{6

7}, Jose G Cabanas^{1

5}

Affiliations

¹ Wake County Government Emergency Medical Services Raleigh North Carolina USA.
² ESO Austin Texas USA.
³ Massachusetts General Hospital Department of Emergency Medicine Boston Massachusetts USA.
⁴ South Shore Health EMS Division Weymouth Massachusetts USA.
⁵ University of North Carolina Department of Emergency Medicine Chapel Hill North Carolina USA.
⁶ National Registry of Emergency Medical Technicians Columbus Ohio USA.
⁷ Wexner Medical Center, Department of Emergency Medicine The Ohio State University Columbus Ohio USA.

Abstract

Introduction: To evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics.

Methods: EMS professionals of a large county-based system participated in 1 of 4 standardized patient care scenarios. Each 8-minute scenario included escalated threats of violence such that EMS personnel should escape the scene for safety. Trained evaluators recorded EMS professionals' performance using standardized data elements. Outcomes included EMS personnel escape and verbal de-escalation attempts. Descriptive statistics and univariable odds ratios (OR) with 95% confidence intervals (95% CI) are reported.

Results: There were 270 EMS professionals evaluated as individual members of 2-person crews. Overall, 54% escaped the unsafe scene and 54% made an adequate de-escalation attempt; 20% did not make an adequate de-escalation attempt nor escape the unsafe scene. Paramedics demonstrated lower odds of escaping compared to emergency medical technicians (OR: 0.40; 95% CI: 0.17-0.94), yet greater odds of adequate de-escalation (OR: 3.17, 95% CI: 1.38-7.31). EMS professionals with more than 20 years of experience (OR: 0.32, 95% CI: 0.13-0.79, ref:2 years or less) and those with military experience (OR: 0.37; 95% CI: 0.17-0.81) demonstrated reduced odds of escaping. Crisis intervention team (CIT) training was associated with reduced odds of escape (OR: 0.38; 95% CI: 0.21-0.69), but increased odds of adequate de-escalation (OR: 2.19; 95% CI: 1.19-4.04).

Conclusions: Nearly half of EMS professionals did not remove themselves from a simulated patient care scenario with an escalating threat of physical violence. EMS-specific training for de-escalation as a first-line technique, recognizing imminent violence, and leaving a dangerous environment is needed.

Keywords: education; emergency medical services; occupational violence; simulation.