Patient Experiences with Paramedics for Intimate Partner Violence-Caused Reasons: Challenges, Solutions and Next Steps for Clinical Practice

TITLE: Patient Experiences with Paramedics for Intimate Partner Violence-Caused Reasons: Challenges, Solutions and Next Steps for Clinical Practice

Nicole Merritt^1,2, Tori N. Stranges², Stephen Bartlett³, Simon Sawyer⁴, Paul van Donkelaar², Rory A. Marshall^1,2

1. British Columbia Emergency Health Services, Kelowna, BC, Canada
2. School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
3. School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
4. School of Paramedicine, Faculty of Medicine, Dentistry and Health, Griffith University, Gold Coast, QLD, Australia

INTRODUCTION: Intimate partner violence (IPV) persists as a severe and prevalent criminal, social, and health issue, most commonly affecting women. Survivors of IPV frequently engage with the healthcare system to access treatment, support, and resources. Paramedics commonly encounter, either knowingly or unknowingly, patients experiencing IPV. There is little empirical research on how paramedics manage cases involving IPV.

OBJECTIVE: To examine how the perspectives and experiences of survivors of IPV who have been attended to by paramedics can inform our understanding of paramedic services.

METHODS: Using an interpretive description qualitative approach in the context of paramedicine, self-identified women (18+ years) who reported a history of IPV and being attended to by paramedics for IPV-caused reasons participated in semi-structured interviews. Interviews were transcribed verbatim and de-identified. De-identified transcripts were inductively analyzed (NVivo) for common patterns.

RESULTS: N=9 survivors participated in interviews. Participants experienced physical, sexual, psychological, and coercive control forms of IPV with cyclic and escalating violence being common. Participants reported receiving basic and minimal paramedic services, primarily following instances of severe IPV. Challenges included bias and discrimination, poor individual paramedic conduct, undereducated and undertrained paramedics, insufficient infrastructure, inadequate transitions into healthcare and community services, perpetrator dynamics, and survivor dynamics. Corresponding solutions were safe and equitable paramedic behaviour, respectful conduct, mandatory education and training, developing functional infrastructure, develop functional transitions, and utilize techniques to engage with perpetrators and survivors.

CONCLUSIONS: Substantial challenges may cause survivors of IPV to be underserviced by paramedic services. Inaction to improve paramedic service may be fatal for survivors. Survivor-derived solutions may act as a guide to bridge gaps in paramedic service delivery. With improved service delivery, paramedics could evolve into expert resources for survivors of IPV.