Safety matters: an important issue

While patient safety and treatment are the foremost concerns for practising paramedics, personal safety is often overlooked. Due to the nature of work undertaken by paramedics, the likelihood that they will encounter hostile and dangerous situations is high. The prevalence of binge drinking, which has become

an increasing part of UK culture, has meant that many paramedics working night shifts are faced with inebriated and potentially aggressive patients. This combined with psychotic, confused or panicked patients, emphasises that

this is very much a real problem that needs to be taken into consideration. Only recently has it emerged that staff of the London Ambulance Service (LAS)

have been advised not to visit more than 200 homes without police assistance. The information comes following a freedom of information request, which revealed that

of 390 households on LAS’ Location Alert Register, 226 fell under its most serious classifications (Savage, 2013). The alert register is divided into four categories, with the 226 homes falling under categories one and two, where physical violence, threats with a weapon or ‘aggravated verbal abuse’ lead to the need for a police call-out. As in any other occupation, paramedics should not be expected to work when placed under abuse or in hazardous environments. It therefore begs the question as to the level of risk paramedics are taking when dealing with dangerous patients, as well as a number of ethical concerns regarding when a paramedic should or should not treat a patient.

This issue of the Journal of Paramedic Practice addresses this notable concern for pre-hospital professionals. Robert Kaiser argues that not enough is being done to reduce operational risks for paramedics. He calls for the urgent need of UK Home Office certified stab-resistant vests for all front-line ambulance professionals, disagreeing with many Ambulance Trusts that body armour can be perceived as too confrontational, aggressive or authoritative. Providing recent statistics for the number of physical assaults of ambulance personnel, Kaiser presents a convincing defence for increased personal protective equipment provision.

The conventional advice that is given to those unsure of what to do in dangerous situations is to withdraw and summon support. However, as Iain Bourne points out, this is something which is not always possible or appropriate. Bourne’s article introduces paramedics to the Instant Aggression Model, a guide for the helping professional to help them through dangerous encounters as they happen, moment by moment. By providing paramedics with a step-by-step account of how to act depending on an aggressor’s actions, it is hoped that readers will be able to use this information to positive effect in the workplace.

It might not be possible to eliminate the dangers faced by paramedics, but being aware of potential threats and knowing how to act in hostile circumstances is an integral way to reduce risk.


Savage J (2013) London paramedics need police assistance ‘at 200 homes’. BBC News. london-23501832 (accessed 2 September 2013)

Taken from Journal of Paramedic Practice, published 9 September 2013.