Aggressive Behavior Risk Assessment Tool for Emergency Medical Services

Emergency medical services (EMS) clinicians are at risk of on-the-job violence that can result in serious injuries. A majority of such violence is associated with underlying behavioral health emergencies. However, no simple screening tools have been validated for use in prehospital settings. This study aimed to examine the utility of the 7-item Aggressive Behavior Risk Assessment Tool for Emergency Departments (ABRAT-ED) modified for prehospital settings in identifying patients at risk for violence.

This prospective study included adult and pediatric patients aged ≥10 years transported by 2 private EMS agencies between March 11 and April 21, 2024. EMS clinicians completed the modified ABRAT-ED before initiating transport and captured any subsequent physical assault, physical threat, or sexual harassment using the Violent Event Severity Tool. Logistic regression and receiver operating characteristics (ROC) analysis were performed.

Of 11,292 EMS dispatches, 9,024 patients were evaluable, and 105 had ≥1 violent event (1.16 %). The logistic regression model resulted in a 3-item ABRAT-EMS, including agitation, confusion, and aggressive/threatening behaviors. ROC analysis showed the area under the curve of 0.89 (95% CI, 0.85-0.94; P < .001). At the cutoff score of 1, the sensitivity and specificity were 82.9% (95% CI, 74.0%-89.3%) and 88.1% (95% CI, 87.4%-88.8%), respectively, indicating that the ABRAT-EMS would correctly identify 82.9% of violent patients while correctly identifying 88.1% of nonviolent patients.

The ABRAT-EMS is a brief 3-item checklist with satisfactory sensitivity and specificity for identifying potentially violent patients during EMS encounters. The use of ABRAT-EMS can help EMS clinicians identify potentially violent patients and allow the implementation of proactive, targeted violence prevention measures.