One had his nose broken four times. Another was attacked with cinder blocks dropped off the roof of a housing project. Others have been stabbed with drug-filled syringes, chased by dogs, and strafed by gunfire after arriving at crime scenes before the shooting stopped.
Boston's emergency medical technicians, who often run red lights and speed through the opposite lane of traffic to save lives, are trained to confront broken bones and cardiac arrest.
But EMTs, who are responding to more calls each year, often become victims themselves as they face Boston's rampant street violence without the guns, mace, and nightsticks that police officers carry.
Last year, 28 percent of the 193 injuries suffered by city EMTs were the result of violence, a figure that has held constant over the past five years, according to Boston Emergency Medical Services. This year EMTs have been injured in 24 attacks.
Since 1994, four EMTs have left the department as a result of injuries from violence.
Nationally, no one tracks the number of EMTs and paramedics -- highly trained EMTs -- injured in violence on the job, but the National EMS Memorial Service, a volunteer group in Virginia, said 30 EMTs have died because of violence since 1993, 14 of them while responding to the terrorist attacks on Sept. 11, 2001.
"Violence isn't something an EMT should have to deal with," said Richard Serino, chief of Boston EMS, who noted that more than half of last year's total number of injuries left his employees out of work for a day or more. "One EMT injured as a result of an assault is too many."
Last fiscal year, the city's 333 EMTs responded to 99,266 calls and made a record 68,943 trips to hospitals-- an increase of about 5,000 since 2002 -- without a significant change in staff.
Many EMTs said they are overworked and undertrained for what they confront. They said they are increasingly sent to calls that in the past may have been answered by the police -- such as a report of a "man down" or someone drunk in the street -- and too often must work without police assistance to subdue hostile patients or others interfering with their care.
When they encounter trouble, they have only a radio to call for help and handcuffs to restrain the attacker. Their radios, they say, aren't much help, because they can't call police directly; they must wait for an EMS dispatcher to e-mail police dispatchers.
James Orsino, who has suffered a broken nose four times during his 23 years as a city EMT, said he has dodged bullets after being caught in the crossfire and been punched more times than he can remember. Like other EMTs, he has also been injured by people not willing to accept his help; he once tore his rotator cuff in a struggle with a man trying to jump off the Massachusetts Avenue Bridge.
"We're in a time when there's a lot more going on in the street, and you can feel it," said Orsino, president of the EMS division of the Boston Police Patrolmen's Association. "With everyone's resources stretched thin, we often arrive on the scene before police. Those are classic cases to get hurt on."
Boston EMS, overseen by the Boston Public Health Commission, dispatches teams of two medical technicians from an office adjacent to police dispatchers at police headquarters. When a 911 call comes in, an operator determines whether to transfer the caller to a specially trained EMT dispatcher.
The department, which has a $37 million budget this fiscal year, offers EMTs the opportunity to take a two-hour self-defense class, but Orsino and others contend it's not enough. He said the city should require EMTs to be certified annually in self-defense, as they are for defensive driving and CPR. He said the department should also outline standard procedures for how to deal with violent patients.
EMTs also worry about fighting back for liability reasons, he said, which is why they don't carry mace.
"When someone is violent in a hospital, six people are used to restrain the person," he said. "In the street, it's you and your partner. There's no one else, nothing to help you out. Whatever comes out of it is what happens, which is why so many people get injured. It's a crazy situation."
Nearly every city EMT has a story about being attacked.
Jim Allen, 33, who has worked as an EMT for 11 years, said it's not uncommon for people to start yelling as his ambulance passes and to "make violent gun gestures."
"I've been bitten by more people than dogs," he said. "It seems every other call they dislike you for something. I think it's because of the badge we wear."
Alcohol and drug abuse are fueling the violence against EMTs. Zach Schiess, 29, who has worked as an EMT for six years, said he was called to a bar in South Boston after a man's arm was twisted in a fight. When he arrived, he said, the man and his girlfriend started swinging at him and his partner, forcing them to lock themselves in their ambulance.
"You can never take for granted what can happen when someone is drunk," he said.
City EMTs receive at least eight months of training, from life support to how to use the radios to how to operate the ambulances. The advanced EMTs, or paramedics, receive two years of training, which includes more advanced life-saving techniques.
Serino said all EMTs are trained to manage aggressive behavior, but he said, "We're always looking for ways to improve our training."
To cope with the stresses of the job, one city paramedic is writing about his experiences on a blog, "Other People's Emergencies: Random Thoughts of an Urban Paramedic."
Jay Weaver, a 22-year veteran and the author of urbanparamedic.blogspot.com, has been stuck with a needle by an AIDS patient, confronted people wielding guns and knives, and dragged three blocks by a man who grabbed him through the window of a car.
On his blog, he covers subjects ranging from how EMTs deal with drunken doctors interfering at scenes, how they subdue people trying to commit suicide, and among other things, how they handle grumpy patients and drivers who cut off their ambulances.
At the end of a December entry titled "Danger," the 47-year-old paramedic wrote: "We are forever one misstep away from serious injury or even death. The next time we fly through an intersection, the impact might be more powerful. The next time I get stuck with a needle, it just might contain a lethal virus. The next time I walk through a door in the projects, there might be a lunatic waiting for me on the other side with a handgun or a knife. I'm not going to dwell on any of this. You can't do the job if you're afraid of each call."
On a recent shift, Weaver and his partner weaved through rush-hour traffic. They raced through streets that looked like parking lots for calls that required them to do everything from subduing a large psychiatric patient who began beating his social worker on Boston Common to treating a father who was stabbed while taking his 2-year-old son for a stroll in Charlestown.
At the end of the night, as their radio continued to squawk, Weaver said the key to surviving was expecting the unexpected.
"We have family members screaming in our face and people throwing things at us," he said. "You just don't know what you're going to experience on any call."
David Abel can be reached at email@example.com.