Paramedic occupational violence mitigation: a comprehensive systematic review of emergency service worker prevention strategies and experiences for use in prehospital care

The rate and predictors of violence against EMS personnel

BACKGROUND

Violence against Emergency Medical Services (EMS) personnel vary between studies. Current studies are mainly based on self-reporting, thus other designs are needed to provide more perspective. The purpose of this study was to explore the rate and predictors of violent behavior targeted at EMS personnel by exploring the Electronic patient care records (ePCR) documentation by EMS personnel.

METHODS

This was a retrospective cohort study of EMS patients in Finland. The data were collected from three regions between 1st June and 30th November 2018. Text mining and manual evaluation were used to identify and explore predictors of violence targeted at EMS personnel from the ePCR narratives. Multivariable logistic regressions were used to determine factors that were independently associated with violent behavior. The results are presented with odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

The EMS personnel reported experiences of violence in a total of 297 identified missions (0.7%) of all EMS missions (n = 40,263). The violence was mostly verbal (62.3%) and the most common violence perpetrator was the patient (98.0%). The police were alarmed to many missions where violence was reported (40.7%). Sometimes violence occurred suddenly although the police were present. The multivariable logistic regression model indicates that violence occurred typically in urban areas (OR 1.699; 95% CI 1.283 to 2.248), at weekend nights (OR 1.357; 95% CI 1.043 to 1.765), by male (OR 1.501; 95% CI 1.160 to 1.942), and patients influenced by alcohol (OR 3.464; 95% CI 2.644 to 4.538). A NEWS2 score of 3 in any parameter (vs. score 0-4, OR 2.386; 95% CI: 1.788 to 3.185) and ALS unit type (vs. BLS, OR 1.373; 95% CI: 1.009 to 1.866) increased the likelihood as well.

CONCLUSIONS

The documentation in ePCRs show low rates of violence targeted at EMS personnel. However, violence is a multidimensional phenomenon connected to unfamiliar patients, rushed situations, and an uncontrolled environment. This means that the EMS personnels' safety cannot be ensured in all situations. Therefore, a balance between safety margins and treating patients needs to be considered.

Behind the scenes: a qualitative study on threats and violence in emergency medical services

The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events.

The recovery processes among paramedics who encountered violence during work-a narrative interview study

BACKGROUND

Almost all paramedics encounter workplace violence (WPV) during their careers. The most common form of WPV is verbal, and the perpetrator is usually the patient. It is known that paramedics suffer from post-traumatic stress disorder and other mental health problems, and WPV is one of the reasons behind that. Nevertheless, little is known about the recovery processes paramedics have had after encountering WPV. The research question was: What kind of recovery processes have paramedics had after encountering WPV?

METHODS

A qualitative, narrative interview study was done. Data was collected in individual interviews with Finnish paramedics (n = 18). Paramedics were from different parts of Finland, and their ages varied from 24 to 49 years. They had been working in EMS for an average of 10.5 years (range 1.5 to 25 years). Interviews were conducted with a narrative approach, which enabled paramedics to narrate their experiences and speak on their own terms about the subject to the extent of their choosing. The data was analyzed using thematic analysis.

RESULTS

Ten recovery process themes were identified: Strong psychological and physical reactions in a short time frame, Questioning one's profession and actions, Various support structures aided in recovery, Dysfunctional processes hindered recovery, Personal resources provided support, The support of the workcommunity as a lifeline, Left to cope alone, Permanent changes to work routines, Resulting in professional growth and Eternal crack in the shell.

CONCLUSIONS

Many internal and external factors affect paramedics' recovery processes. While some receive adequate help, others struggle to get appropriate support, especially from their organization and supervisors. The findings of this study suggest that clear protocols should be established to help paramedics recover after encountering WPV and that an individual aspect should be kept in mind, as not everybody reacts in the same way.

A descriptive study on the use of restrictive interventions for potentially or actually violent patients in the emergency department

BACKGROUND

Restrictive interventions (chemical, physical, or mechanical restraints) to manage patients who are potentially or actually violent in the emergency department (ED) can be harmful and costly. Non-restrictive interventions are advocated; but this must be preceded with an understanding of patient characteristics that influence their use. A study was conducted to describe the use of restrictive interventions and ascribe it with patient characteristics in the ED.

METHODS

Records from October 2020 to March 2021 in the occupational violence database were used to analyse patient characteristics and restrictive interventions. Logistic regression was used to establish influencing factors of restrictive interventions adjusting for clinically relevant confounders.

RESULTS

Of the N = 1276 potentially or actually violent patients, 70 % received restrictive interventions. Chemical restraint was common, with 1 in 2 patients receiving either oral medication or intramuscular injection. Probability of restrictive interventions were higher in patients who were intoxicated [(adjusted odds ratio (aOR) 3.48, 95 % confidence interval (CI) 1.675-7.21)], had high triage score (aOR 2.084, 95 % CI 1.094-3.96), and were in the ED involuntarily (aOR 1.494, 95 % CI 1.105-2.020).

CONCLUSION

The results reveal the need for multifaceted approaches that limit the presentations of, and minimise restrictive interventions among, potentially or actually violent patients.