Paramedic occupational violence: A qualitative examination of aggressive behaviour during out-of-hospital care

Abstract

Occupational violence (OV) is an insidious problem for emergency medical services with continued high levels of paramedic exposure despite significant education and resources devoted to mitigation. Though there is considerable data on the epidemiology of the phenomenon, the available evidence on the experiences of paramedics exposed to acts of violence during healthcare is limited. Utilising a generic qualitative approach and a semi-structured interview framework, we examined the perceptions and experiences of 25 Australian paramedics who had been exposed to incidents of patient-initiated violence during out-of-hospital care. A general inductive methodology and a first- and second-cycle coding process assisted in the development of the principal concepts of the patient and the paramedic from the raw data. Subsequently, a further four main themes and 15 secondary themes were developed which characterise the influence of social interaction on the evolution of paramedic OV. The results of this study provide a unique insight into the phenomenon of paramedic OV. As opposed to the rudimentary manifestation of aggression typically endorsed by emergency medical services, aggressive behaviour during healthcare presents as a judicious interaction of dynamic scene management and situational context. The social interactions that occur during healthcare, and the premises which both promote and suppress this connection, were identified to exert significant influence on the evolution of aggressive behaviour. The consequences of these findings challenge traditional violence mitigation strategies which seek to position the patient as both the focal point of initiation and the key to its extenuation.