CHARLOTTE, N.C. -- A 2017 survey of paramedics from 13 countries found 65 percent of them were physically assaulted while on duty.

• Medics say injuries from combative patients are up from 20 in 2014 to 31 in 2018
• That makes it crucial for paramedics to be trained for the unexpected
• It's why medics are trained in de-escalation

Veronica Michaelis has had some bruises in her 20 years as a paramedic.

"I have broken my thumb. I popped my hip out last year," Michaelis said.

They are accidents that sometimes come with the job. Yet, Michaelis can remember an unusual moment when a patient attacked her as she was treating him in the back of an ambulance.

"I was scared. He hit me with force so it knocked me down," Michaelis said.

It's rare but it does happen.

Medics say injuries from combative patients are up from 20 in 2014 to 31 in 2018. Workers compensation claims are also up.

Some of that has to do with a population increase but there are a number of reasons.​

"The majority of the patients that we see, even in those claims, are patients that have some sort of underlying medical condition," says Medic Operations Manager Tony Pattillo. 

That can come from patients addicted to drugs or those facing a mental health crisis.

However, paramedics can also get exposed to harmful substances and get hit by passing vehicles while they are on a call.

That makes it crucial for paramedics to be trained for the unexpected.

"Bringing someone back from a drug overdose can cause a violent reaction from that patient," Pattillo said.

It's why medics are trained in de-escalation.

"You can punch me, kick me, bite me. I'm not going to do that in return so it makes my job almost 10 times harder because I have to figure out a way not to meet his level of aggression and get him restrained and get away," Michalis said. 

Michalis was able to grab her walkie talkie and press an emergency button for help. She says despite what happened there is nothing she'd rather be doing.

"I'm proof that I come back every time. I could not do this job. I love this job," Michalis said.