Violence Against Paramedics: Findings from a Mixed Methods Research Program

Monday, March 20^th, 2023

Words: 347

Authors & Affiliations

1. Justin Mausz, ACP, PhD, the Region of Peel, Department of Health Services, Division of Paramedic Services, Brampton, Ontario; the University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada.

1. Walter Tavares, ACP, PhD, the University of Toronto, Department of Family and Community Medicine, Toronto, Ontario; York Region Paramedic Services, Markham, Ontario, Canada.

1. Mandy Johnston, ACP, the Region of Peel, Department of Health Services, Division of Paramedic Services, Brampton, Ontario, Canada.

1. Alan Batt, CCP, PhD, Monash University, Department of Paramedicine, Melbourne, Victoria, Australia; Fanshawe College, Paramedic Program, London, Ontario.

1. Elizabeth Donnelly, NREMT, PhD, the University of Windsor, School of Social Work, Windsor, Ontario, Canada.

Address Correspondence to: Dr. Justin Mausz, Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, Ontario, L6V 4R5. Justin.Mausz@peelregion.ca

Violence Against Paramedics: Findings from a Mixed Methods Research Program

Introduction

Violence against paramedics has been described as a “serious public health problem”, but one that remains “vastly underreported” - in part, owing to an organizational culture that encourages paramedics to ‘brush off’ violent interactions as ‘part of the job’. A lack of reliable reporting data hinders risk mitigation strategies. Following a lengthy stakeholder engagement process, our team developed a novel reporting tool embedded within the electronic Patient Care Record (ePCR) to capture data about violent incidents. 

Methods

Our research is situated in the Region of Peel in Ontario and uses a convergent parallel mixed methods approach, leveraging a review of External Violence Incident Reports (EVIRs) combined with user experience data from a web-based survey distributed during continuing medical education. We used descriptive statistics and logistic regression modeling to build an epidemiological profile of violence against paramedics. To identify contributing circumstances, we analyzed the free-text narratives of completed EVIRs using qualitative content analysis. Finally, we used inductive thematic analysis of survey comments to identify factors that influence paramedics’ decisions to report.

Results

Between February 1, 2021 through January 31, 2023, a total of 352 (45% of active-duty) paramedics filed 918 EVIRs, of which 368 (40%) documented some form of physical or sexual assault. Violent acts were most commonly perpetrated by patients (83%) and typically occurred at a scene (74%). Expert coders identified 37% of EVIRs as describing violence on the basis of gender, race, or sexual orientation. In all, 65 (8%) paramedics were injured as a result of an assault. Preliminary unadjusted analyses point to mental health (Odds Ratio [OR] 12.18), drug or alcohol intoxication (OR 10.17), or altered mental status (OR 4.22) as presenting a high risk for assault on a paramedic. Among post-deployment survey participants (33% of paramedics), 83% who had experienced violence chose to use the new reporting process - often citing a desire to protect coworkers as reasons for filing a report.

Conclusion

A substantial portion of the paramedic workforce is impacted by violence. Our early analysis suggests gaps in the social safety net may contribute to violent interactions during 911 service calls.