Just today I spoke to Jonathan Fox, a good friend of mine, ex-spokesman of the Association of Professional Ambulance Personnel and a paramedic with more than 30 years of operational front-line experience in London.
When I explained to him that I was writing this article, I also decided to ask him for his honest opinion on this issue.
Jonathan answered as follows:
‘You can never eliminate the risk of assault on staff. The risk of injury can, however, be minimised significantly by the provision of body armour for front-line ambulance personnel. Good radio communication, computerised flagging systems relating to previous violent incidents by specific individuals, national physical assault reporting systems and conflict resolution training are measures commonly used in the work place. These measures are however undermined by the absence of body armour provision, which provides effective personal protection, completing the package of measures necessary for a safer working environment should the worst case scenario occur.’
I do, of course, full heartedly agree with his comment. However, I do not agree with this comment because I own UK-based PPSS Group, a firm specialised in the design, development and manufacturing of high-performance body armour and subsequently financially benefit from the sales of such, but because I do very much indeed understand real operational risks, threats and duties, and I have certainly seen my fair share of professionals getting severely injured or not returning home at all from ‘a day at work’.
In December 2011 I reported in this very same publication that the then called NHS Security Management Service (SMS) confirmed 1 262 physical assaults against ambulance staff in England during 2009/10 (NHS SMS, 2010).
Today I can offer you the latest figures; NHS Protect has recently announced that 1 630 physical assaults have been committed on ambulance staff in 2011/12 (NHS Protect, 2012), which is without question a significant increase.
We must accept the simple matter of fact that front-line ambulance professionals who deal with potentially intoxicated and hostile members of the public are working within a higher risk environment, especially when operating at night times, when the risk of alcohol or drug-related violence increases, hence they are more likely to overreact to anything a paramedic says or does.
Dealing with highly emotional individuals who might feel you are not arriving at their premises within their expected time frame, or you are not doing your absolutely utmost to assist their family member can also put you in the firing line. This might be absolutely out of your hands, and even your kind personality, your warmth, your willingness, your in-depth understanding of the subject matter and any on-hand alarm, training and policy will not make a difference if this human being overreacts and commits a physical assault he or she may well regret the following day for the rest of his or her life. This is reality!
However, in the UK most Ambulance Trusts are still opposed to issuing any type of body armour, e.g. stab-resistant vests. Apparently some research projects conducted by NHS Ambulance Trusts have concluded that body armour could be perceived as too confrontational, aggressive or authoritative. I think this is ludicrous!
Why has no one approached us as a respected body armour manufacturer, asking us to design and develop outer covers that look like high visibility vests, making no real visual difference to the design of current jackets worn by paramedics up and down the country?
How is it possible that the London Ambulance Service NHS Trust (501 physical assaults in 2011/12) are issued with stab-resistant vests, but the North West Ambulance Service NHS Foundation Trust (274 physical assaults) or the West Midlands Ambulance Service NHS Trusts (206 physical assaults) (NHS Protect, 2012) are not issuing stab-resistant vests to front-line paramedics? Are we trying to say that paramedics in London are at risk, but paramedics in Manchester, Liverpool or Birmingham are not? I personally know enough about operational risks in these cities that paramedics in other cities also require appropriate personal protective equipment (PPE) because of the risk of ‘unforeseen circumstances’.
I am not saying that a paramedic is likely to get shot or stabbed to death The real operational risk and threat is not the risk of being stabbed or shot!
In the UK we have one primary risk which all Ambulance Trusts seem to overlook, and that is the risk of blunt force trauma injuries. It is a matter of fact that an incident involving a punch, kick or blow is much more likely than the risk of being faced by someone waving a firearm or edged weapon at you. Not many aggressors leave home with the intention to shoot or stab a paramedic at some point during the day or evening. Most confrontations faced by ambulance professionals escalate from one second to another, there are no warning signs, there are no computers able to tell you don't go there and there are no signs on the door saying ‘here lives a dangerous or very angry or frustrated human being’.
A paramedic might attend the scene of an incident and some minutes later be confronted by a hostile member of the patient's family or one of his drunk friends who expresses his anger. For any of the previously highlighted or other reasons they might make you responsible for the suffering of a loved one; however, it is much more likely they will express their distress with a punch, hard push or impulsive kick. They might grab something nearby, anything like a glass, stick, remote control or vase to hit you on your back whilst kneeling down doing your utmost to assist the injured person.
Ask yourself, how many paramedics do you know that have been shot or stabbed? More than a handful? Now ask yourself another question, how many of your colleagues have been punched, kicked or got hit by some sort of object?
Can such types of assault lead to serious injuries? Yes.
Is the risk or probability of such incident limited to London and are we saying these incidents are unlikely to happen in other cities in this country? No.
One paramedic, who wishes to remain unnamed, sent me a message today:
‘I am a 52-year-old paramedic based around 300 miles outside London, with over 22 years’ service. After being attacked to such an extent that I feared for my life last year, I asked my service to supply me with body armour. I was told that was not service policy. I then offered to buy my own and wear it covertly. I was told this was against dress code. It appears that life is cheap in the ambulance service. Staff safety is of little consequence in comparison to overall cost.’
I strongly suggest we all review the current help and support we offer our front-line ambulance professionals and the urgent need for UK Home Office certified stab-resistant vests. The key must be that any body armour issued must offer the highest possible level of blunt force trauma protection. I suggest to view our very real video demonstration in which I personally test the performance of our PPSS UK Home Office certified stab-resistant vests (PPSS Group, 2010). This video is without question physical evidence that covert or concealable protection can offer an outstanding safety net for those moments when everything we know and have learned has failed.
I can only invite all key decision makers to sit down with me. Let us discuss in a very relaxed but focused manner how we can help you effectively protect your colleagues. One day we will look at a casualty. One day one paramedic will not return home. We don't know when it will happen, but there is no question about it, it will happen. The question I invite you to answer then is this: ‘Have you really done your very best to reduce the risk of this incident?’ Right now the answer to this question is a simple no!