Cruisin’ for a Bruisin’: Violence Stalks Canadian Medics

If you haven’t had someone on a call take a poke at you in the last three years or so, stay alert—you’re due.

Of course it’s not really that predictable. But consider the implications of a recent investigation into workplace violence against paramedics in the Canadian provinces of Ontario and Nova Scotia: It found more than 26% of respondents there had experienced physical abuse on the job within the last year.

Statistically, a rate like that won’t take long to encompass everybody.

“If you were to extrapolate that data,” says lead investigator Blair Bigham, MSc, ACPf, an associate scientist with the out-of-hospital research program Rescu at St. Michael’s Hospital in Toronto, “you could probably assume a paramedic’s going to be physically assaulted every four years. That’s quite a lot, especially over a career. That was surprisingly high to me.”

The data came from 1,381 medics surveyed during CME sessions in 2011. More than 92% said the violence came from their patients, but others cited patients’ families and friends, bystanders and even colleagues as its sources.

The study, “Most Paramedics Are Victims of Violence in the Prehospital Workplace,” was published in the Jan–Mar 2012 issue of Prehospital Emergency Care. It was funded by the Tema Conter Memorial Trust, which combats post-traumatic stress disorder in the Canadian emergency services.

Among its other findings:

• More than two-thirds of respondents (67.4%) had experienced verbal abuse. Again this came primarily from patients, but more than 20% of those experiencing it said it came from colleagues.

• More than two-fifths (41.5%) reported intimidation. This time colleagues were the primary offender, cited by 45.3%; another 37.8% received it from patients.

• Sexual harassment was reported by 13.6% (64.7% from patients, 41.2% from colleagues), and sexual assault by 2.7%.

How would such rates stack up against the average American system’s? For what it’s worth, in a late-’90s survey of a major U.S. fire-EMS department (Albuquerque), 90% of respondents said they’d been subject to violence or assault in their careers.¹ Around that same time in Southern California, another survey found 61% had been assaulted on the job.² More recently, a study from Australia pegged it at 87.5%.³

Whether you consider such numbers per annum or over a career, they all point to the conclusion that in a lot of places, violence against EMS seems pretty widespread, and perhaps more likely than not to visit you if you do the job long enough.

“I think EMS services across Canada and the United States share many similarities in terms of the types of patients they see,” says Bigham. “And common to all 9-1-1 calls is that we’re dealing with people in crisis. So although we were only able to look at Ontario and Nova Scotia, we believe the data is probably representative of EMS in North America.”

It also obviously prompts some further questions. Investigation of those is starting with analysis of qualitative data that can tell researchers more about what all this violence and abuse actually look like in the field. Once that’s fleshed out, they’ll look to develop strategies to combat it and ways to better deal with its aftermath.

“We know in 9-1-1, we’re not going to be to able to eliminate these types of incidents entirely,” says Bigham. “What we want to be able to do is at least manage things like post-traumatic stress and other sequelae that come from violent episodes.”

References

1. Pozzi C. Exposure of prehospital providers to violence and abuse. J Emerg Nurs 24(4): 320–3, Aug 1998.

2. Corbett SW, Grange JT, Thomas TL. Exposure of prehospital care providers to violence. Prehosp Emerg Care 2(2): 127–31, Apr–Jun 1998.

3. Boyle M, Koritsas S, Coles J, Stanley J. A pilot study of workplace violence towards paramedics. Emerg Med J 24: 760–63, 2007.