A descriptive study of paramedic response to workplace violence in Canada
abc*
a
a
Adam D. Vaughan
Gregory S. Anderson & Ron R. Bowles
aJustice Institute of British Columbia; bSchool of Criminal Justice, Texas State University; cFaculty of Health Science, Simon Fraser University

Introduction
Decades of empirical evidence highlights that persons
employed in the healthcare field are at risk for exposure to
violence. Given the nature of their occupation, Emergency
Medical Service (EMS) (e.g., paramedics) personnel are at a
heightened risk for exposure to violent encounters in the field
and within institutional settings1. For instance, in a one-year
period, scholars estimate that roughly 75% of Canadian EMS
personnel will be a victim of some form of violence2.
Unlike most hospital settings, strategies to mitigate violent
events is largely absent in EMS. One potential option is to
develop prevention-based policies, to make EMS work
environments safer. An initial evidence-base of what factors
are associated with violent acts and how these are processed
by the victims is necessary to generate such policies. For the
current study, we investigate two research questions.
RQ1) What are the context-specific, patient specific, and
demographic or paramedic-specific characteristics that are
associated with violence and aggression against EMS
personnel?
RQ2a) What is the level of fear associated with violence
against EMS personnel and RQ2b) what parties do victims
consult after the event?

Methods
Design
Self-report victimization data were captured through an online
questionnaire housed on a server at the Justice Institute of
British Columbia. The survey was made available to Primary
Care Paramedics (PCP) and Advanced Care Paramedics
(ACP) employed through the Alberta College of Paramedics.
Questionnaire
Using previous research as a guide3 a 96-question survey
retrospectively (within the last 12 months) investigated the
factors associated with five forms of violence: verbal assault,
intimidation, physical assault, sexual harassment and sexual
assault (RQ1). Post-event data was also captured for the
degree of fear (RQ2a) and what social group each EMS
spoke with following the violent encounter (RQ2b).
Analysis
Descriptive statistics were used to report the demographics
between victimized and non-victimized participants. Cross
tabulations were used for factors associated with violence and
well as for post-event findings.

*corresponding author (avaughan@jibc.ca)

Results

Discussion

Table 1. Victimized versus non-victimized EMS personnel (RQ1)
Victimized n (%) of mean (std. dev)

Non-victimized n (%) of mean (std. dev)

Age, yr

37.6 (9.6)

39.6 (11.9)

Experience, yr

12.5 (8.5)

14.2 ( 10.6)

Exposure, hrs

45.2 (9.7)

43.6 (10.4)

93 (35.6%)
168 (64.4%)

13 (32.5%)
27 (67.5%)

144 (55.2%)
117 (44.8)

19 (47.5%)
21 (52.5%)

139 (53.3%)
122 (46.7%)
261 (86.7%)

26 (65%)
14 (35%)
40 (13.3%)

Sex
Female
Male
Job role
ACP
PCP and other
Community served
Pop > 100K
Pop < 99K
Total

Table 2. Frequency of violent events (RQ1)
Type of violence

Once (%)

A few times (%) About once a month (%) About once a week (%)

Daily (%)

Verbal abuse
Intimidation
Physical abuse
Sexual harassment

0.7
14.6
10.3
4.6

26.5
19.5
17.2
6.6

19.9
8.9
5.0
1.7

26.5
6.0
1.7
1.7

8.9
3.0
1.0
0.7

Sexual assault

1.3

0.7

0.3

0.3

0

Table 3. Factors associated with violent events which occurred during work (RQ1)
Time of incident:
Day Shift / Night Shift

Most Common Location(s)

Most Common Perpetrator(s)

Verbal abuse

50.6% | 49.4%

Private residence (30%);
Usual work location (30%)

Patient/client (67.2%);
Patient/clients family (12.1%)

Intimidation

61.8% | 38.2%

Usual work location (38.2%);
Private residence (28.7%)

Patient/client (35.7%);
Work colleague (24.8%)

Physical abuse

38.5% | 61.5%

Public space (39.4%);
Usual work location (26.9%)

Patient/client (92.3%)

Sexual
harassment

56.5% | 43.5%

Usual work location (63%);
Public space (21.7%)

‘Other’ (67.4%);
Patient/client (23.9%)

Sexual assault

25% | 75%

Public space (75%)

Bystander (87.5%)

Type of violence

Table 4. EMS response to violent events (RQ2)
RQ2a
Fear level1

Type of violence
Verbal abuse

2.01

Talk to family or
friends
82.7%

RQ2b
Talk to coworker
90%

72.7%

79.6%

90.1%

69.8%

Female

2.22

88.5%

89.7%

78.2%

85.4%

91.8%

70.9%

Male

2.17

82%

95.5%

69.7%

Female

2.45

89.9%

87%

72.5%

Physical abuse

2.78

80.2%

90.6%

73.6%

Male

2.70

78.8%

95.3%

72.7%

Female

2.93

82.5%

82.5%

75.0%

Sexual
harassment
Male
Female
Sexual assault
Male
Female

2.02

91.3%
1.60
2.28

2.88

89.1%
88.2%
93.1%

100%
2.00
3.40

1Level of fear ranged from 1 (low level of fear) to 5 (high degree of fear).

100%
100%

88.2%
89.7%
87.5%
100%
80%

This study helps to bring empirical awareness to the spectrum
of violence against EMS. More research is needed, but
preliminary policy development to prevent or mitigate the
impact of violence against EMS should consider:
1) The impact of prolonged exposure to habitual verbal abuse
and harassment on long-term well-being in EMS
personnel;
2) That, in addition to post-event resources EMS personnel
(e.g., CISM teams), policy makers should consider the
potential vicarious traumatization on spouses, friends, and
coworkers; and
3) High rates of sexual violence towards female EMS coupled
with a low proportion that are likely to be reported to
supervisors suggests a need to improve reporting
mechanisms. Trauma-informed sexual assault investigative
practices is a potential option5.

References and Acknowledgements

1.90
2.29

Many instances of violence were relatively minor with 52% of
cases resulting in no immediate response from the
paramedic. Comparable to other work in this domain4, victims
often debriefed with coworkers and family members as
opposed to supervisors and medical professionals. In general,
a greater number of females (compared to males) debriefed
with family/friends and supervisors, whereas a greater
number of males debriefed with colleagues—with some
exceptions. Females also reported a higher level of fear in
response to all forms of violent events.

Talk to supervisor

Male
Intimidation

Results indicate that approximately 87% of front-line EMS
personnel are exposed to some form of violence. Several
factors were correlated with the likelihood for violence,
particularly those cases where the perpetrator had used
substances (such as drugs and/or alcohol).

69.6%
47.1%
82.8%
62.5%
100%
40%

1Maguire, B. J., O’Meara, P., O’Neill, B. J., & Brightwell, R. (2018). Violence against

emergency medical services personnel: A systematic review of the literature. American
Journal of Industrial Medicine, 61, 167-180.
2Bigham, B. L., Jensen, J. L., Tavares, W., Drennan, I. R., Saleem, H., Dainty, K. N., &
Munro, G. (2014). Paramedic self-reported exposure to violence in the emergency
medical services (EMS) workplace: A mixed-methods cross-sectional survey.
Prehospital Emergency Care, 18(4), 489-494.
3Boyle, M., Koritsas, S., Coles, J., & Stanley, J. (2007). A pilot study of workplace
violence towards paramedics. Emergency Medicine Journal, 24, 760-763.
4Carleton, R. N. et al., (in press). Mental health training, attitudes toward support, and
screening positive for mental disorders. Cognitive Behaviour Therapy, 1-20.
5 Elliott D. E, Bjelajac P, Fallor R. D. (2005). Trauma-informed or trauma-denied:
Principles and implementation of trauma-informed services for women. Journal of
Community Psychology, 33, 461-467.

Acknowledgements