In his five years as a paramedic, Blair Bigham has seen his share of ill-treatment on the job, including being assaulted by a patient.
“The intimidation and abuse comes from both family and patients, which isn’t necessarily because they’re ill-mannered or bad willed, it’s mostly because they’re in stressful situations and when you call 911, it’s usually the worst day of your life,” said Bigham, an advanced care flight paramedic for York Region Emergency Medical Services (EMS) in Ontario.
Bigham’s experience is not unusual, according to a study he co-authored. More than two-thirds of paramedics have experienced verbal, physical or sexual abuse on the job. And those numbers might be lower than reality because many paramedics don’t report these types of events to employers, said Bigham, who is also an associate scientist at Rescu, a research group at St. Michael’s Hospital in Toronto.
“There’s also this expectation, I think, in some places that this type of violence is just part of the job in responding to 911 calls.”
When Glenn Munro of Peterborough, Ont., started his paramedic career 32 years ago, there was no training to deal with any of these issues.
“It was the old boy school of ‘Suck it up and carry on,’” he said, adding another big component to the abuse is the influence of alcohol and drugs.
But accumulated stress over a paramedic’s career can lead to early retirement, which is what happened to Munro, who was an operations supervisor for York region and a paramedic for 32 years for Toronto and York regions. He is also a co-author of the study.
In particular, verbal abuse was reported by 67.4 per cent of the 1,381 EMS workers in Ontario and Nova Scotia surveyed, perpetrated by patients (62.9 per cent), patient family or friends (36.4 per cent), colleagues (20.8 per cent) and bystanders (5.8 per cent).
Intimidation was reported by 41.5 per cent, perpetrated by colleagues (45.3 per cent), patients (37.8 per cent) and patient family or friends (27 per cent).
More research is needed to understand the numbers, said Bigham. However, “colleagues” could include allied agencies such as firefighters, police officers, hospital staff and physicians who are also in demanding situations.
“Sometimes in emergency health care, colleagues or co-workers or people on the same team can sometimes act out in similarly dysfunctional ways because of that stress,” he said. “When everybody has different priorities, and they’re all quite focused and in a stressful situation trying to manage those priorities, they may not realize that their allied workers are just trying to do their job.”
But Drew Parker wonders where all the complaints are coming from, having worked as a paramedic for 30 years for the City of Calgary.
“There’s an awfully fine line between good-hearted fun and some rather cutting comments. From my standpoint, the medics, as far as police, fire and ambulance… are always at the bottom of the pole, so typically you get a little bit of teasing that way.”
And it’s hard to know what “verbal abuse” actually means, said Parker, who is vice-president of Canadian Paramedical Services in Calgary.
“In the line of work we’re in, nobody’s calling you because they’re having a good day,” said Parker.
There are a lot of emotions involved and a lot of paramedics would have to admit much of the abuse they receive is from people who are “sick, ill or injured and… scared and upset,” he said.
Complaints about intimidation can partially be explained by the “workplace” of the paramedic, said Parker. Often there are two people in the ambulance and one is a junior person.
“There’s a lot of responsibility on one person in that truck and it’s ‘My way or the high way because I’m going to get in trouble if I don’t do it right. So if I intimidate you, I’m sorry, but that’s just the way it is.’”
Physical abuse was reported by 26.1 per cent of the respondents, perpetrated by patients (92.3 per cent), patient family or friends (11.1 per cent), colleagues (3.8 per cent) and bystanders (2.3 per cent), found the study.
The 26.1 per cent is surprising, said Bigham, suggesting every four years, a paramedic is going to experience physical assault, which adds up to five or six times in their career.
And many people say the situation has worsened, said Munro, so many paramedics are wearing body armour because of real or perceived threats.
Sexual harassment was reported by 13.6 per cent of paramedics, perpetrated by patients (64.7 per cent), colleagues (41.2 per cent), patient family or friends (18.4 per cent) and bystanders (8.8 per cent), while sexual assault was reported by 2.7 per cent.
“If you extrapolate that over a 20-year career, there’s a good chance that a paramedic is going to be sexually assaulted, and when you look at the 17,000 paramedics in Canada, that’s a big deal,” said Bigham.
Looking for answers
When it comes to possible solutions, more research must be done, said the co-authors, who hope to release qualitative data later this year. But improved training and communication are possible solutions.
While paramedics receive training on how to de-escalate these types of situations, physical training varies from service to service around the country, said Bigham. “There’s no standard for it and, for the most part, paramedics receive no physical training.”
But the newer concept of inter-professional training among the different EMS groups can help, he said.
“When they are put into these stressful situations, they’re much better able to appreciate each other and to support each other, rather than criticize each other.”
Another option is to look at the training for 911 dispatchers, as it’s not a priority for them to identify potentially violent patients, said Bigham.
“Often, when it’s quite evident over the phone, then the dispatcher will report that to the paramedics. But there’s not necessarily a process in place that paramedics can then do something differently. It’s more just a heightened sense of awareness when they’re walking in that it could be a dangerous situation.”
Another option is arming more paramedics with tools such as restraint systems or sedatives, which are largely restricted to highly trained paramedics, said Bigham.
“I’m not saying we want to run out and start sedating everybody — that creates problems as well — so it’s something that needs to be carefully considered, but it could be part of the solution.”
The culture of reporting also needs to improve, he said.
“Paramedics need to feel comfortable coming forward when these types of incidents happen and EMS employers — so management, supervisors, administrators — need to be very accepting of these reports and need to look at strategies to reduce violence in the workplace.”
Finding the individuals who are perpetrating these issues and removing them is something else management will have to look at, said Munro.
“In the last 10 years, we’ve got a lot of well-educated, experienced people that are moving up into senior management of emergency services,” he said. “In many cases, management may not be aware of what’s going on and, once awareness occurs, there’s an opportunity for better monitoring of what’s going on in the field.”
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