Abstract: Paramedics are increasingly being subjected to violence, creating the potential for significant
physical and psychological harm. Where a patient has a history of violent behavior, hazard flags—applied
either to the individual, their residential address, or phone number—can alert paramedics to the
possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting
process embedded in the electronic patient care record, we reviewed violence reports filed over
a thirteen-month period since its inception in February 2021 to assess the effectiveness of hazard
flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic supervisors can
generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence
reports were filed, for which paramedic supervisors generated hazard flags in 20% of cases (n = 99).
In general, cases were not flagged either because the incident occurred at a location not amenable to
flagging or because the supervisors felt that a hazard flag was not warranted based on the details
in the report. Hazard flagging was associated with an increased risk of violence during subsequent
paramedic attendance (Odds Ratio [OR] 6.21, p < 0.001). Nevertheless, the process appears to reliably
identify persons who may be violent towards paramedics.