We have been coughed on and shouted at by people refusing to wear face masks. We need more protection
The outpouring of appreciation for NHS staff during the Covid-19 crisis has been extraordinary. Yet reports of a recent rise in attacks on emergency workers, including ambulance crews, in England and Wales suggests the Thursday evening applause was hiding a less positive reality. Abuse of emergency workers is a growing issue: a 2018 survey found that 72% of ambulance staff have been attacked on duty, and figures have repeatedly pointed to an upward trend. As an NHS paramedic for 10 years, this aligns with my own experience.
The consultation on increasing sentences for assaults on emergency workers seeks to discourage attacks on them. My hope is that it will also challenge what has become an ingrained view – that being abused and assaulted somehow goes with the territory.
In 10 years, I’ve been physically assaulted three times (excluding episodes where I’ve anticipated an assault and acted to prevent it). In one instance, working alone in a car at night, I was called to a male collapsed in the middle of the road. I approached with caution, ready to step away if necessary. I squeezed the flesh above his shoulder and told him who I was and why I was here, and he didn’t seem to mind. His physical observations were normal; he was probably drunk. But then he tried to get up. His speech was garbled and his movements were lumbering, and I reached out to stop him falling over. Suddenly alert, he struck me square in the chest and advanced on me, muttering a string of slurred threats and swinging at me like a prize-fighter whose laces had been tied together.
It was fairly easy to dodge his advances, and the ambulance crew soon arrived and helped calm him down. We requested police, but the patient shuffled off before they arrived, apparently recovered. I reported the assault internally, but the unknown patient was never called to account, and probably doesn’t even remember assaulting an emergency worker.
This is the kind of unremarkable tale any of my colleagues could relate: an unpleasant incident that could have been much worse. Others have not been so lucky. In the heat of such encounters, the well-meaning statements of corporate policy seem a long way away.
Yet physical assaults are just the sharp end of the wedge. A more prevalent issue is verbal abuse. I would be unable to count the number of times I’ve been verbally abused doing my job: I’d say it happens frequently enough to feel completely routine.
I’ve been called most names you can imagine. I’ve been sworn at casually, hysterically and menacingly. I’ve been on the receiving end of sexist, racist and homophobic insults (and I’m a straight white male, so imagine what it’s like for my colleagues who aren’t). When I have challenged abusive language, I’ve been told being sworn at is part of my job.
Ambulance crews know we go into highly charged situations, and we understand that aggression is often an expression of fear or panic. We tolerate a certain amount of hostility purely because we’re on someone else’s turf – or because it’s expedient to do so. There’s a balance to be struck. Sometimes, the medical emergency takes precedence. Sometimes, you just accept the abuse because it feels normal.
At the height of the coronavirus crisis, however, the delicate interactions of real-world treatment carried an extra tension. Often, we went into rooms where patients had been coughing freely for days, and wondered if we’d be next. We donned our aprons and surgical masks, and gave patients face coverings before transporting them to hospital, but much of our initial assessment and treatment took place in environments that were highly infectious. When patients pulled down their masks to cough on us, or came close to shout at us, or refused to wear a mask at all, it added an extra element of conflict to what were already anxious times. Alongside the rainbows and clapping, you might hope that abuse of emergency workers would have decreased – but initial reports suggest the opposite was the case.
Of course, there’s a cost to all this. Some clinicians suffer physical injuries, and some experience post-traumatic stress disorder. Others develop compassion fatigue and start treating all patients with suspicion or disapproval. Some, after one aggressive patient too many, simply leave the job. My experience is a little more subtle: the slow coagulation of a kind of internal bleakness – what my friend describes as a shadowy distrust of everyone he meets.
Ambulance staff (and other workers in the community) need protection. We’re supported by the police, but they are as stretched as us. We have radios with emergency buttons, and some protective clothing. Body cameras would not solve all the problems, but they would help to convict and discourage offenders. They are being trialled in some areas, and I hope they’ll be standard issue in the future. Tougher sentencing will act as a deterrent. But crews should also receive more support from management when abuse does occur, and be given confidence by employers to make dynamic risk assessments in volatile situations.
One phrase that’s often thrown around is, “They’re not attacking you; they’re attacking the uniform.” In other words, Don’t take it personally. The logic is that people who are incapacitated should be granted extra licence – to make crude remarks, or grab a bit of uniformed flesh. But there’s a human being inside that uniform, and if you punch it, or cough on it, or grab its backside, then remember that you’re attacking the person inside it as well.
• Jake Jones is an NHS paramedic and author of Can You Hear Me? An NHS Paramedic’s Encounters with Life and Death, published in paperback on 3 September by Quercus.