Scene safety?

Fifty two percent of all EMS responders report having been physically attacked on the job at some time within the previous twelve months. According to the University of Maryland, the risk of nonfatal assault resulting in lost work time among EMS workers is 57 cases per 10,000 workers per year. The national average for all professions is about 1.8 cases per 10,000 workers per year, making the relative risk for EMS workers about 30 times higher than the national average. This isn't just EMS getting hurt: in 1999, the Bureau of Labor Statistics estimated that 2,637 nonfatal assaults occurred to hospital workers--a rate of 8.3 assaults per 10,000 workers. Healthcare providers are twice as likely, and EMS workers 15 times as likely, to be assaulted on the job than police officers or prison guards are. Some locations and cities are obviously seeing injury rates that are far above the average.
The Occupational Safety and Health Administration (OSHA) has identified violence in the medical setting as a potential hazard, and found the training of medical staff to identify and deal with potential violence ineffective. It is the third leading cause of on the job injuries in EMS (only lifting patients and vehicle collisions injure more EMS workers) and the second leading cause of on the job fatalities (behind vehicle accidents), yet the only training we get is "don't enter the scene unless it is safe." This approach is obviously not working. There remains a reluctance on the part of EMS agencies and hospital administrators to provide training to effectively address workplace violence.
This begs the question: Why are EMS agencies so reluctant to face this issue? In most agencies, there is no policy for dealing with violent encounters, training for dealing with such encounters is rare, yet the problem seems endemic. There appears to be a variety of reasons, some may not recognize the extent of the problem, and thus don't perceive the need for training personnel in basic defensive measures, while others erroneously perceive using defensive tactics as fighting, or a form of aggression. Still other agencies feel that the liability that defensive uses of force would bring upon the agency is greater than the costs of treating injured employees. Whatever the reason, allowing the situation to continue as it is now is resulting in seriously injured workers, and the problem is not going to get any better until we as a profession find a way to deal with this issue.
Some changes are desperately needed if we are to see an improvement in the number of injuries that are inflicted upon EMS workers by their violent patients. It is obvious that the current policy of "scene safety" is not working. There is a definite need for research into this area that impacts the safety of our medical workers, so that a solution can be found for preventing and dealing with this epidemic of violence.