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Two blocks away from a gunfight, Dmitriy Stalmakov pulled over and looked at where a bullet had ricocheted off the back of his ambulance. If it had hit 2 inches higher, the 28-year-old paramedic doesn't know if he'd be here to tell the story.

"If it would have pierced the door, it would have went straight into my back," said Stalmakov.

Over the past three years, emergency medical responders in Hennepin County say they've witnessed an unnerving rise in violence that's made the job more dangerous at a time when surging call volumes already are stretching the workforce thin. A week after getting caught in the middle of the shooting in downtown Minneapolis, someone hurled a vodka bottle that shattered on Stalmakov's ambulance windshield as he was racing through south Minneapolis. In the dark, he said, he mistook the thud for a shotgun blast that had just blown through the window.

After that, Stalmakov and other leaders of the Hennepin County Association of Paramedics and EMTS sent a survey to the union's 160 members to get a better handle on the scope of the problem. The results showed a staggering trend throughout the ranks of paramedics in Minnesota's largest county.

Of those surveyed, 87% reported being affected by gun violence in their daily operations. 78% had been physically assaulted by a patient or bystander. Nine out of 10 paramedics and dispatchers believe the job has become more dangerous since their employment started.

Last week, Shane Hallow, paramedic union president, sent the data in a letter to Hennepin County commissioners and Hennepin Healthcare leadership, saying staff is not receiving adequate support for what's become a daily occurrence of violence.

"I am writing this letter on behalf of the paramedics and dispatchers, who provide 911 services at Hennepin EMS, with a plea for help," wrote Hallow. The first responders are assaulted and injured on a daily basis. The conditions are driving some to leave the job.

"The only thing that has spared the life of our members and our union partners members is luck."

Causes unknown

The EMS union survey showed assaults primarily are falling into three categories: Emergency vehicles attacked on the way to calls or outside hospitals, such as a recent case where someone unloaded a paintball gun on an ambulance in front of Abbott Northwestern Hospital; patients or bystanders attacking paramedics who are rendering treatment in the field; or police in agencies across the county calling paramedics into "abnormally unusual" and dangerous situations in an attempt to "recategorize a criminal event into a medical event," decreasing police liability but increasing the risk to the paramedics, according to the summary of results.

In a statement, an Minneapolis police spokesperson said the paramedics' concerns have not been communicated to department officials, "who maintain a very clear lines of communications with Hennepin EMS."

"Undoubtedly, the duties of any first-responder have significant risk, but it is baffling that anyone would believe that MPD would deliberately put a paramedic or other fellow first-responder in danger," the statement said. "MPD takes the safety of all people very seriously, and 911 call-takers and dispatchers do not have EMS respond to a scene that is potentially unsafe until after MPD officers are present and render the scene safe."

The EMS union survey found that a significant number — about 20% — of those who'd been assaulted had never filed a police report. This, in large part, is because people don't believe doing so will lead to criminal charges, Hallow said. Stalmakov said this was the outcome when he reported the bottle incident and the shots fired at his ambulance this summer, even though the latter took place across from the First Precinct headquarters.

Many paramedics don't even report the assaults internally to Hennepin Healthcare because of a cumbersome process that makes them stay up to an hour later to fill out paperwork, Hallow said. "Most people, after working a long shift doing call after call after call, just want to go home."

Hennepin EMS Chief Marty Scheerer agreed reporting has been a problem in the past. Starting in November, to help streamline the process, Hennepin EMS placed a new reporting function on computers inside each ambulance. Scheerer said it's too soon to know if it's making a difference. The ambulances also are now equipped with placards that state the law against assaulting medical workers in Minnesota, an offense punishable by five years in prison and a $10,000 fine.

Scheerer said there's no clear explanation as to what's driving the attacks on paramedics. The job has always been dangerous, but he saw a new trend emerge during the riots that followed the police murder of George Floyd, he said. "We are confused as to why there's violence directed toward us."

The assaults track with a rise in violent crime that began in 2020 in Minneapolis. Though on pace for lower figures than last year, crime trends remain above the city's average in the decade prior to the pandemic. In 2022, Hennepin paramedics responded to more shooting and stabbing calls than ever before, Scheerer said. "This is a record year for us."

Hallow said he doesn't think the rise in crime alone explains the increase in assaults on paramedics. EMS workers also are responding to more mental health or drug calls in recent years. Some people who don't trust police mistake paramedics as an extension of law enforcement. "It's hard to pinpoint exactly what it is," he said. "I think it's a combination of everything, to be honest."

Not just paramedics

A similar trend is playing out inside the hospitals as well.

In 2020, about 280 attacks — triple that of 2019 — injured hospital staff in Minnesota and forced them to miss work, according to the latest data from the U.S. Bureau of Labor Statistics. In a survey by the nurse's union, 75% said they observed or experienced physical violence at work over the past two years, and, just like paramedics, many were too busy to file a report.

The letter asks for additional safety measures for paramedics as well as hospital workers, including providing panic buttons that hospital staff can wear, implementing visitor check-in with metal detectors, a plan to improve security and a better process to identify patients with a history of violence so paramedics can go into future calls prepared.

In the meantime, the number of calls for Hennepin paramedics is up 35% from 18 months ago, said Hennepin Healthcare spokesman Thomas Hayes.

"It was a pretty tough summer, and it's going to be a tough winter," said Scheerer.

He said the hospital system is planning to hire 50 paramedics in the next six months to offset the staffing shortage. In the shorter term, Scheerer said he's working closely with the union to help address violence and pay more attention to mental health needs of EMS workers in the field. He also started a safety committee with paramedics to examine these issues.

But the assaults are contributing to lower morale, Stalmakov said. Some paramedics have quit.

"The tools we have in place just aren't designed to fix the problem," he said.

Correction: An earlier version of this article incorrectly stated the number of members in the Hennepin County Association of Paramedics and EMTs. The union has 160 members.