Prehospital Workplace Violence (WPV) Dispatch Alerts: Anticipating Behavior and Preventing Violence

Within our emergency medical services (EMS) agency, workplace violence (WPV) is captured through a documentation feature in the electronic medical record. Leveraging this data, we implemented WPV dispatch alerts for addresses where physical violence occurred. Our primary objective was to assess the association of these alerts on the rate of WPV against EMS clinicians.

This observational cohort study took place 11/20/2022-11/20/2024 at a hospital-affiliated EMS agency with 23,300 average annual ground calls for service. Alerts were implemented on 12/26/2023 and consisted of a notification at time of dispatch stating "WPV Flag- Information only: previous documented assault at this address." Alerts were updated monthly with a 1-year expiration, unless renewed due to repeat physical violence. Rate of WPV in the pre-alert period (11/20/2022-12/25/2023) was compared with the post-alert period (12/26/2023-11/20/2024) using risk differences (RDs) and 95% confidence intervals (CIs).

A total of 254 (0.78 per 100 EMS calls, 95% CI: 0.69 - 0.89) violent incidents (verbal abuse and physical assault) occurred pre-alerts compared to 153 (0.53 per 100 calls, 95% CI: 0.46 - 0.63) post-alerts (RD= -0.25 cases per 100 calls, 95% CI: -0.37 to -0.12, p < 0.001). Among these were 96 (0.30 per 100 calls, 95% CI: 0.24 - 0.36) assaults pre-alerts, compared to 63 (0.22 per 100 calls, 95% CI: 0.17 - 0.28) post-alerts (RD= -0.07 cases per 100 calls, 95% CI: -0.16 to +0.01, p = 0.068). Seventy-seven alerts were placed on identifiable addresses; among these, two (2.6%) were renewed due to repeat physical violence and 31 (40.3%) were ultimately removed due to no repeat violence in a 12-month period. During the post-alert period, EMS clinicians were dispatched a total of 853 times to addresses with preexisting alerts (median = 6; range: 1 - 234 dispatches per address), although this included calls with alerts specific to the address but a different unit number from the initial alert (e.g., same nursing facility but different resident unit number).

Providing EMS clinicians with alerts on addresses with previous physical violence at time-of-dispatch was associated with a significant decrease in the rate of WPV against EMS clinicians overall within our agency.