Abstract Providing prehospital care poses unique risks. Paramedics are essentially the only medical personnel who are routinely at the scene of violent episodes, and they are more likely to be assaulted than are other prehospital personnel. In addition to individual acts of violence, emergency medical services (EMS) providers now need to cope with tactical violence, defined as the deployment of extreme violence in a non-random fashion to achieve tactical or strategic goals. This study reviewed two topics; the readiness of EMS crews for violence in their environment and the impact of violence on the EMS crew member. This latter also evaluated the access and effectiveness of emotional support available to caregivers exposed to violent episodes.

The results of the survey indicate a significant lack of preparedness for situations involving tactical violence. A total of 89% of respondents either had never had such training or had been trained more than one year ago. Thirty-six percent of respondents had never engaged in a field exercise with other responding agencies, and 4.5% of respondents were not aware of who would be in charge in such an event. In addition, this study indicates that EMS crews are exposed to events with significant emotional impacts without access to appropriate training and adequate support.