Editor’s note: This article may be distressing to some who may have experienced violence as part of their work in EMS.
As we observe EMS Week, we must address an often-overlooked topic: the safety of our EMS providers. A study in Peel Region, Canada, revealed that nearly half of EMS providers have experienced physical or verbal violence on the job. On average, paramedics encounter violent incidents every 18 hours, physical assaults every 46 hours, and are injured due to violence every nine days.
Many providers have had to develop a thick skin due to the high demands of the job, setting aside their emotions to focus on saving lives and serving their communities. However, once the workday ends, the impact of these experiences may continue. Hurtful words and harmful actions may accumulate over time, affecting paramedics at work and at home. There’s something profoundly dissonant about coming to work to serve your community and being met with physical or verbal assault.
EMS Week presents an ideal opportunity to highlight an innovative collaboration between researchers and paramedic services in Canada. They believe we must report and address violence against EMS providers appropriately, rather than brushing it off as “just part of the job.” This collaboration, the Violence in Paramedicine Research Group, involves a multi-site, multi-province study led by Peel Regional Paramedic Services, Urgences-Santé, the University of Windsor, the University of Toronto, and Queen’s University.
To understand the barriers to reporting violence, a survey of 204 paramedics was done in 2022 (33% of eligible participants). The study assessed their willingness to report violent encounters and explored factors influencing their decisions to report violence. We found that violence was widespread, often perceived as unpreventable with no consequences for offenders. Tolerating violence was normalized as an expected professional competency.
In collaboration with ESO, we launched a new violence reporting system embedded into the Electronic Patient Care Record (ePCR). After extensive organizational change management and discussions with paramedics, this novel, point-of-event tool was successfully deployed.
Two years later, we were able to use these violence reports to document how paramedics frequently experience physical and verbal abuse, with 35% of reports documenting multiple types of violence simultaneously. Violence often begins on the scene but frequently continues in transit to the hospital. Surprisingly, 38% of violent incidents occur after arriving at a hospital. Additionally, 18% of narratives involved sexist or misogynistic comments, 9% involved racial slurs, and 2% involved homophobic language, with this form of abuse linked to a 60% increase in the risk of emotional distress among paramedics.
We were able to use these data to generate reports, publish six peer-reviewed articles, obtain funding for comprehensive threat assessment and harm mitigation training for Peel Region paramedics. Last Fall, we testified before the House of Commons in support of legislation (Bill C-321) to make assaulting a paramedic an aggravating factor at sentencing.
Did it work? Were we successful at shifting those early perceptions of violence as an unavoidable part of the job? Eighteen months after launching the new violence reporting system in Peel Region, we surveyed paramedics about their experiences reporting violent encounters. Our objectives were to assess their willingness to report violence and explore factors influencing their decisions to file a report.
The answer is yes. Willingness to report more than doubled since introducing the new system and 85% of participants said their experience with the new process encouraged them to report similar incidents in the future. Participants’ belief that reporting would lead to meaningful change within the service significantly drove reporting behavior.
Free-text survey responses highlighted the accessibility of the new reporting process and the desire to promote accountability among perpetrators while contributing to a safer workplace. Decisions to file a report were influenced by the perceived severity of the violent encounters and the supportiveness of co-workers and supervisors.
Below are some of the comments pulled from the free text:
“I just felt justified and validated in filing a report and (it) normalized (me) feeling angry at what happened. It was a healthy way to share my story, even if it was just on paper.”
“I (wanted) to show that it’s not okay,” while another said they reported because they were trying to “incarcerate the perpetrator.”
Participants also explained that reporting violent encounters is an important strategy to promote co-worker safety in the event paramedics attend to a particular residence or patient again in the future:
“Wanting the data to help promote action to address violence against paramedics and have hazard flags (i.e., on the patient’s address) to mitigate violence against other responders.”
“I truly believe this program makes a difference. Getting more data (from reports) will help you solidify the program.”
The issue of violence against paramedics is huge and the broader context is sobering. According to the U.S. Bureau of Labor Statistics, EMS personnel face a risk of occupational injury from violence six times higher than the general population and 60% greater than comparable health professionals like nurses. Annually, the Bureau records an average of 426 violence-related injuries that require medical treatment or result in lost work time.
As we focus on provider safety during EMS Week, consider leveraging data to create meaningful change in our line of work. It’s essential, and you don’t have to do it alone. If you want to read more about our work, visit www.protectparamedics.com.
Violence is not an unavoidable, unpreventable part of the job. To get our legislatures to react and provide us with needed resources, we must ensure the abuse and violence our providers experience is documented, acknowledged, and the appropriate supports are provided. We encourage all EMS agencies to address the issue of violence against their providers. Together, we can make a change.
About the Author
Dr. Elizabeth Donnelly is an associate professor in the School of Social Work at the University of Windsor, a scientist with the McNally Project for Paramedicine Research, and a Nationally Registered Emergency Medical Technician. Having practiced as an EMT since 1999, Dr. Donnelly has a strong connection with the emergency medical services (EMS) community and her work focuses largely on workforce health among EMS personnel.
