On July 8, 2026, a three-person medic crew in Ohio responded to an outpatient behavioral health clinic to transport a patient under an involuntary commitment order. The case manager who called 911 said the patient was not causing a problem. When the patient refused to go, they pulled a pocketknife, opened the 4-inch blade and stabbed the paramedic in the lower back as the crew retreated.
The crew was in duty uniforms and police were still at shift change roll call. The paramedic was off work for three weeks. NIOSH investigated the incident as a serious injury because the call looked routine, in a building where weapons were prohibited and the staff were licensed clinicians.
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“Medic 6 officer asked the case manager if the patient was willing to go to the hospital. She replied that she “thinks so.”"
Key findings
Police were not on scene when the threat developed. Law enforcement units were attending shift change roll call, and fire units on another call were told police would be delayed. The paramedic was stabbed before officers arrived. The medic officer radioed for immediate police response, then repeated the request as emergent when none came.
The crew’s perception of risk was low. The clinic prohibited weapons, staff were licensed clinicians and the case manager said the patient was not causing a problem. NIOSH found that this reduced the crew’s sense of danger. The crew wore duty uniforms, not the ballistic vests the department’s own procedure calls for on mental health calls, and the report notes the vests carried are not rated against edged blades.
Dispatch sent fire and EMS to a transport that did not call for them. In this jurisdiction, involuntary commitment transports went out under generic emotionally disturbed person codes, with no code of their own. The department ran 512 such transports in 2025, most at repeat locations. Nothing in the dispatch process separated a medical need from a custody and security task.
Strained resources normalized working without police. Firefighters told investigators they sometimes arrived before police or waited more than 20 minutes for them. To clear transports and return to higher-priority calls, crews began engaging patients without law enforcement present. NIOSH called this normalization of deviance.
The patient learned of the commitment in a public lobby. Staff asked the patient to wait there, where the patient paced and then heard the news in front of staff and firefighters. NIOSH noted that a private setting and unhurried conversation may allow for de-escalation.
Recommended department actions
Train members to request emergent law enforcement response at the first sign of an imminent weapon threat. The department’s tiered request procedure only works if crews use the top tier early. NIOSH also supports coded language that signals a life-and-death situation without escalating the patient, and joint training with police, consistent with NFPA 1550.
Collect patient history from clinicians before contact and wear the vest. Ask about violence, elopement and whether restraint or sedation will be needed. Revisit procedures that let the senior member discontinue ballistic protection, and train crews that vests do not stop blades.
Work with the public safety answering point (PSAP) to dispatch the right agency. Create dedicated involuntary commitment codes and send fire and EMS only for a reported medical need. Send law enforcement whenever threats, violence or weapons are reported. The PSAP in this case has since stopped dispatching fire directly to mental health codes unless police are already on scene and request it.
Write response agreements with law enforcement and use data to staff them. Identify call types and locations that require police on scene first, an approach NFPA 1550 and NFPA 3000 support. Use CAD data on concurrent calls and response times to show where police and fire availability do not line up, and see NFPA 1750 on deployment and staffing.
Push local partners to close the gaps upstream. NIOSH recommends a 24/7 mobile crisis team for non-violent patients, and asks healthcare providers to deliver commitment news in a private, secure setting.
“The PSAP changed emergency dispatch protocols for all mental health-related response CAD codes at the direction of the fire chief. The fire department will not be dispatched directly to these incidents unless law enforcement is already on scene and specifically requests fire department activation based on medical necessity.”
Training discussion questions
- The case manager said the patient was not causing a problem. What would you want to know before leaving the apparatus and who should you ask?
- At what point in this call would you have asked for police as emergent, and what would you say on the radio?
- If your crews sometimes wait 20 minutes for police on these calls, what unwritten practice has your department adopted, and who approved it?
Share how your department is using this report for training.
