From handling combative patients to being exposed to contagious diseases, emergency medical workers face one of the most dangerous and injury-prone jobs in the country, according to researchers and federal workplace safety data.
Emergency medical technicians (EMTs), who provide basic life support services, and paramedics, who also provide advanced life support services, suffer injuries requiring treatment in the emergency room at a rate four times higher than workers in all other professions in the United States, according to one federal study.
That study, conducted by a researcher at the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention, showed between eight and nine out of every 100 EMTs and paramedics is treated in the hospital for an occupational injury. That's compared to two out of every 100 workers in all other jobs.
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"The big thing they're being hurt from is bodily motion injuries, and that's mostly due to lifting patients," said Audrey Reichard, an epidemiologist at NIOSH who studied the data.
MORE: The EMT whose partner was repeatedly stabbed in Boston last month is speaking out to NBC10 Boston to draw attention to the risks that emergency medical workers face.
Emergency workers do a considerable amount of kneeling, bending and lifting on the job -- movements that leave them prone to back injuries and sprains. The vast majority of injuries documented in the federal study happened while workers were lifting a patient, and injuries to the trunk and neck were most common.
The second highest occurrence that leads to emergency room treatment is exposure to harmful substances, such as blood and body fluids, or being spit on. Exposure incidents account for about 27 percent of injuries, although they're often quickly treated.
"When you're looking at what's likely to take a worker out of work for a period of time, it's going to be those [body movement] injures," Reichard said.
Assaults account for a much smaller portion of all injuries, though being attacked on the job happens much more often to paramedics and EMTs than people in other lines of work.
"It's a very dangerous profession," said Brian Maguire, a Connecticut epidemiologist and former New York City paramedic.
Maguire, one of the only researchers in the United States to study the subject in depth, said the rate of assaults against EMS personnel is at least 22 times higher than all other occupations. And it may be much higher.
"One of the findings is that it happens way more frequently than is generally recognized," he said, "and the vast majority of cases go unreported.
"So the EMS person is assaulted, and then there's no report or there's no follow-up. And that's for a variety of reasons. Sometimes people think that this is part of their job, and there may be organizational or cultural pressure to just accept it and not report it."
Reichard, the researcher at the CDC, said her group reached a similar conclusion.
"Our [injury] numbers aren't huge in the violence area, but we suspect that there's a large amount of underreporting that occurs -- that EMS workers often feel like it's just part of the job," she said, "so I feel that our numbers just aren't a good representation of what's happening out there in violence."
There are about 4,600 EMTs and paramedics working in greater Boston and southern New Hampshire, according to data compiled by the Bureau of Labor Statistics. The job pays a mean salary of about $41,000 in the region.
The issue of workplace safety was thrust into the spotlight last month when a pair of EMTs were attacked in Boston. A 31-year-old patient with a history of mental health issues is accused of stabbing one of the workers in the back of ambulance, then spraying her partner in the eyes with a mace-like chemical. The attack and others like it sparked concern among local emergency workers, who are calling on the state to adopt tougher laws to protect ambulance crews.
Maguire said there's only scant research to date on effective methods to reduce workplace injuries for emergency medical workers.
"That's one of the big problems, especially when it comes to assaults," he said, "because ... EMS agencies with the best of intentions are implementing what seem like reasonable attempts to reduce risk for their personnel, but they're doing it without any idea of what actually works because there's nothing that's been documented to actually reduce risks. It's a big problem."
For example, many agencies -- including some in Massachusetts -- have distributed bulletproof vests to protect ambulance crews, but Maguire said it's unclear whether vests make EMTs safer. Wearing them might make workers feel comfortable entering a dangerous situation they would otherwise avoid, Maguire said. Vests can also make physical work, like pulling people out of car wrecks, more taxing.
Reichard, at the CDC, said buying better equipment to lift patients, such as battery-operated power cots, can make a big difference.
"There's new technology out there, but there's also the concern that sometimes it can be cost prohibitive for some of these agencies and departments to implement," she said.