For paramedics, assaults become part of the job


Paramedic Tim Mollman was in his ambulance waiting for a call near NE 82nd and Sandy in Portland when he saw muzzle flashes and heard gunfire. Soon after he and his partner ducked down and called in the shooting, their ambulance was dispatched to respond to a victim of the shooting, just down the street.

“That was really what triggered me into going ahead and getting [body] armor for myself,” Mollman says. An employee of American Medical Response (AMR), Mollman has worked in emergency medical response since 1998, and never felt a need for body armor until recently. 

Jody Caprino, a lead paramedic in Clackamas County and union steward for Portland-headquartered Teamsters Local 223, says assaults have increased dramatically in the last five years, changing the nature of a job for workers who didn’t historically face on-the-job violence.

“It’s become part of the job description,” says Caprino, who’s been a paramedic for 27 years, including 21 with AMR. “I mean, I never in my career thought we would ever be wearing bulletproof vests, but we are.”

Teamsters Local 223 represents 450 AMR workers in Multnomah and Clackamas counties, and Local 58, based in Vancouver, represents 200 AMR workers in Clark and Cowlitz counties in Washington. 

[pullquote] “They’re out there saving lives, and it’s past time that they get paid and treated accordingly.” –Teamsters Local 223 secretary-treasurer Leslie Sloy [/pullquote]

The Labor Press spoke with a handful of paramedics, and they all agreed that worker safety is the top concern right now.

In mid-May, Mollman and another paramedic responded to a call from a bar where a drunk man had fallen and injured his head. The man was unable to answer basic questions, and they transported him to a hospital for evaluation. Halfway to the hospital the man removed his safety belts, climbed off the gurney, and began trying to kick the paramedics. Mollman stopped the ambulance and climbed into the back to help his partner. As they struggled to get him back onto the stretcher, the man punched Mollman in the face.

Mollman says he’s lost count of how many times he’s been hit, punched, kicked. It doesn’t always result in an injury, and workers don’t always report these incidents, because they don’t see results from logging the assaults, Mollman says.

As for shootings, Mollman’s close encounter with a drive-by is not an isolated case. On Southeast 82nd Avenue outside one of AMR’s designated “quarters” (buildings where workers rest between emergency calls), he says there have been at least four shootings in the past year.

“I’m just desensitized to this anymore. It’s like, yeah, it’s a matter of fact that these things happen,” Mollman says.

Window smashing

Joshua Prull, an AMR paramedic in Multnomah County since 2014, recalls on-the-job assaults and harassment starting to rise in 2016 and 2017. The worsened conditions have changed how paramedics approach the job. Training new paramedics, he now urges them to be more cautious around patients: Watch the patient’s hands as you approach. Don’t get too close.

“It’s this hypervigilance of everybody, and it takes a toll on you in a couple of ways,” Prull says. It’s mentally exhausting. It can make the paramedic jumpy to think everyone is a threat. It can seem like paranoia. But Prull says assuming there’s a threat is a correct assumption as often as it’s not.

“It becomes like this permanent change in who you are as a person,” he says, explaining it’s hard to turn off those mental threat assessments even after the shift is over.

Prull described a particularly harrowing incident that his wife, also a paramedic, experienced last October. Six weeks pregnant at the time, she was in the passenger seat of an ambulance eastbound on Powell Boulevard. She and her ambulance partner were waiting to turn left onto 82nd Avenue when she noticed a man running through the intersection with a baseball bat. He smashed the bat through the passenger window and it sprayed glass on her face and hands. The driver floored the accelerator and got them away. The man took off running and wasn’t caught.

The bat attack came two months after a separate incident in which a patient tried to attack her and her ambulance partner with a box cutter in the back of their ambulance.

Another incident, from early 2019, is notorious among AMR workers. A man approached an AMR ambulance stopped for a red light at Southwest Fifth and Sherman in downtown Portland, opened the passenger door, and got inside. Paramedics struggled with the man, who attacked them with a knife and bit one of them. The attacker was arrested and charged, but was released to a pretrial supervision program (despite the county’s Pretrial Services Program recommending against release, according to news reports at the time). Ultimately he was sentenced to two weeks in jail with credit for time served, and probation. AMR paramedics packed the courtroom during a 2019 hearing, and expressed alarm at his light sentence.

The assaults aren’t limited to Portland. Caprino sees the same in Clackamas County. She herself was punched by a woman while on the job in Lake Oswego. And she says paramedics represented by Local 58 in Clark County, Washington report similar assaults.

In response to the increase, workers have received defensive tactics training. In a written statement to the Labor Press, AMR said it implemented “a combination of didactic and practical training to help empower our first responders and begin implementing those systemic changes within our community.”

“Our team members are trained on de-escalation techniques, evading threats, and escaping dangerous situations,” AMR said.

By AMR policy, workers can’t carry weapons or self-defense tools. Caprino recalls there was talk of outfitting paramedics with pepper spray, but she says that’s a bad idea: Assaults frequently take place in the back of a closed ambulance, where spraying mace would hit the paramedics as well.

As for the body armor many workers now wear, it isn’t mandatory but is available to buy, and employees receive a yearly uniform allowance ($420 for full-time workers) that could go toward a vest. (AMR confirmed workers can “utilize ballistic vests at their discretion.”) 

Caprino says new employees typically don’t have enough to cover a bulletproof vest with their initial uniform allowance, so they have to buy it out of pocket or go without.

What’s driving the increase in assaults?

Workers say one factor in the assault increase is that AMR, like other ambulance providers in the area, is designated as a “secure transport provider,” a change that began in 2016 (around the time paramedics say assaults began to rise).

That means paramedics transport mental health patients, both those going voluntarily into treatment and involuntarily under a police hold.

That puts paramedics in a tough position, according to workers. Other secure transport vehicles typically have a barrier between the person being transported and the driver, like in a police car. Ambulances don’t have those security components, as they’re not primarily used for transporting people in custody.

In a typical involuntary transport, police have responded to a call and determined the patient needs to be taken in for psychiatric care. The paramedics respond and the patient is loaded into the ambulance. Then, the police leave and the paramedics are on their own with the patient. There’s usually a driver and another paramedic who is in the back of the ambulance with the patient.

Sometimes, a secure transport patient will start out calm—when there are police around—but then get aggressive during the ride, Caprino said.

“It’s kind of like they know we don’t have anything to protect ourselves,” Caprino said.

Josh Miller, an emergency medical technician with AMR in Clackamas County, says he’s been swung at and spit on while working these types of transport calls.

“Obviously, they’re not thrilled,” Miller said. “We just ended up standing in place of the cops because we are taking them into custody.”

Workers say another contributing factor is the dispatch system they use, called “system status management.” Designed for efficiency, the system uses a computer to determine where calls will likely come in based on historical data. Ambulances are stationed in those areas to minimize response time when calls come in. Some of those areas have facilities where paramedics can rest while waiting for calls, but in other locations, paramedics are just waiting in the ambulance on the street. That was the case when the drive-by shooting occurred next to Mollman’s ambulance.

In its written statement to the Labor Press, AMR acknowledged that paramedics in Multnomah and Clackamas counties are “exposed frequently to volatile situations in the field” and said reducing violence against workers is a “top priority” for the company.

AMR representatives have met with local officials, including Portland Mayor Ted Wheeler and Multnomah County Commissioner Sharon Meieran, “to ask that they implore local law enforcement and fire departments to resume responding to calls alongside our teams to help increase scene safety,” the statement said. 

An AMR spokesperson said the company has noticed law enforcement and fire departments responding less frequently to calls alongside AMR teams for about three years now.

Miller, the Clackamas County EMT, said in the past, police would typically respond alongside AMR in situations involving mental health, when someone was reportedly suicidal, for example. But more recently, if a caller says the person in crisis will be cooperative or is not a threat, police typically don’t get involved.

Burnout on the rise

Workers say the conditions are making it hard to hire more paramedics. Current job listings show AMR is offering an $18,000 sign-on bonus for new employees who commit to at least one year on the job. Metro West, the non-union ambulance provider that covers Washington County, is offering a $17,000 sign-on bonus.

Union leaders say it’s about time.

“It shouldn’t have taken the pandemic for AMR to finally realize how valuable their paramedics are,” said Leslie Sloy, secretary-treasurer at Local 223, in a statement the two locals emailed to the Labor Press. Sloy said emergency medical workers deserve far more recognition than they are currently given. “They’re out there saving lives, and it’s past time that they get paid and treated accordingly.”

Medical response workers face a level of on-the-job pressure most people can’t even fathom, said Local 58 secretary-treasurer Walter LaChapelle in the statement. 

“They are the first thread in the social safety net of our community,” LaChapelle said.

LaChapelle wants to see AMR work with municipal leaders to increase staffing and improve the work environment for all emergency medical services workers.

On top of the harassment, Caprino, the union steward, says workers are burned out from working through COVID-19 the past two years. Prull, the Multnomah County paramedic, recommends AMR adopt a system where paramedics can rotate out of the field when field work becomes too much, to work in the office for some period of time.

If that change comes, it will be too late for him. Near the end of May, he put in his two-week notice after eight years. He left the job in June, explaining it had become physically and mentally overwhelming.

“It’s just not human to sustain,” Prull says.


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