Background In the United States, calls for emergency medical services (EMS) have increased approximately 20% each year. A major challenge confronting EMS is understanding the organizational, mental health, and safety burden that providers experience as they respond to increasing community demand. An understudied aspect of this demanding work is the impact of violence from patients against EMS responders. A multitude of best practices to address violence are outlined in industry trade journals, but none are organized in a way that first responders and leadership can readily implement.

Objective To develop a multi-level industry-specific systems checklist of policies and procedures for preventing and mitigating violence against fire-based EMS responders.

Methods Initial content and format of draft checklist items were informed by a previously published systematic literature review. Fire and EMS leaders, academic researchers, front line workers, and labor representatives were convened for a two-day consensus building conference to establish agreement on checklist items. ThinkTank and ThinkLets technology facilitated brainstorming, convergence, organization, evaluation, and consensus building activities. A brief processing period followed, and a final review of the checklist then proceeded amid a large-group facilitated session.

Findings We will present the resultant systems checklist, a comprehensive inventory of best practices, policies, and procedures for all levels of the fire department including dispatch, EMS responders, leadership, and union officials. Strategies and barriers to consensus building will be discussed as well as a timeline for checklist implementation and evaluation.

Conclusions and policy implications A multi-disciplinary consensus building process led to a systems checklist that speaks to each phase of emergency response. The checklist has the potential to reduce injury exposures from violence, impact self-reported mental health metrics, and improve organizational outcomes (e.g., burnout, job satisfaction, engagement). These improvements- intended to benefit the worker- may also lead to improved patient outcomes and quality of care.