Mitigating the risk and impact of assaults on EMS responders

The SAVER checklist helps departments assess and implement training, policies and practices to mitigate assaults on EMS responders.

Posted: Jan. 13, 2020

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paramedics placing a patient into an ambulance

Many studies have shown that firefighters and emergency medical services (EMS) responders have a high likelihood of experiencing verbal or physical violence at least once in their career. Fire-based paramedics and EMS are at particularly high risk of experiencing an assault since they respond to calls in varied locations, often paired with only one or two colleagues. In these situations, they may come into close contact with people who have mental health issues.

Researchers on the Stress and Violence to Fire-based EMS Responders (SAVER) study found many improvements organizations can make to mitigate the risk and impact of assaults on their responders. High-reliability organizations — those that have fewer than normal accidents, such as the airline and healthcare industries — have mitigated risks through the adoption of systems-level, organizational checklists.

SAVER study researchers wanted to develop a systems-level checklist for violence against fire-based EMS responders using findings from a comprehensive literature review. They also gathered input from subject matter experts at a national stakeholder meeting.

What the research shows

Prevention opportunities exist when we look as far upstream as possible from the likely source of harm. Therefore, it's best to focus on organizational policies that can shape solutions before the problem occurs.

When management and unions can put effective policies in place, responsibility for safety is firmly on the organization rather than on the individual EMS responder. This is important since management organizes training opportunities and establishes standard operating procedures that can minimize the risk.

Organizational-level checklist

The final SAVER checklist consists of 174 items organized by six phases of EMS response:

  1. Pre-event.
  2. Traveling to the scene.
  3. Scene arrival.
  4. Patient care.
  5. Assessing readiness to return to service.
  6. Post-event.

The organization, not individual EMS responders, is responsible for nearly all the 174 checklist items. Fire departments and labor unions can use the checklist to accurately assess and implement training, policies and practices that promote the prevention and mitigation of assaults on EMS responders. Organizations can provide training to their personnel to recognize and react appropriately to potentially dangerous situations by using “pause-points” to protect their health and safety while on calls.


While the checklist is organizational in implementation, the result impacts the individual worker.

— SAVER study researchers

Individual-level checklist: pause points

EMS responders focus on a six-item individual-level checklist, also referred to as “pause points.” Department-level training provides EMS responders with the knowledge of how to call a safety “time-out” at one of six specific pause points.

  • Traveling to the scene: If you know there has been violence at a location in the past, request and wait for law enforcement backup.
  • Scene arrival: Before exiting the ambulance, are all the resources you need in place to safely begin patient care?
  • Patient care: Before transport, does your patient require restraint and have they been checked for weapons?
  • Assessing readiness to return to service: Are you mentally and physically ready to return to service?
  • Post-event (reporting): If you have experienced verbal or physical violence, have you reported it?
  • Post-event (resources): Have you sought and received the physical and long-term mental health resources you feel will enable you to return to work whole and ready?

These six individual-level actions give EMS responders the organizational mandate to protect themselves while providing vital patient care. They also put into place a feedback mechanism to management on what might not be working in the field.

More content on the web

This research was supported by a Fire Prevention and Safety Grant (Research and Development) Grant under the Federal Emergency Management Agency's FY2016 Assistance to Firefighters Grant Program (EMW-2016-FP-00277). Learn more about this project.


Learn more about this research

Summary information for this article was provided by the NETC Library. Read the research paper.

Taylor, J. A., Murray, R. M., Davis, A. L., Shepler, L. J., Harrison, C. K., Novinger, N. A., & Allen, J. A. (2019). Creation of a Systems-Level Checklist to Address Stress and Violence in Fire-Based Emergency Medical Services Responders. Occupational Health Science, 3(3), 265–295. doi: 10.1007/s41542-019-00047-z


This summary is for informational purposes only. More +
As such, the content does not reflect any official positions, policies, or guidelines on behalf of the sender, the U.S. Fire Administration, FEMA, DHS, nor any other federal agencies, departments or contracting entities. Similarly, this summary does not represent in any manner an official endorsement or relationship to any private or public companies, organizations/associations, or any authors or individuals cited or websites associated within the article.

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