Paramedics: Canada's Most Respected Profession
Monday, May 23rd, 2022 | ~3 minute read
By Justin Mausz
Just days before the kick off of Paramedic Services Week 2022, a new poll found paramedics topped the list of Canada's most respected occupations. Welcome news, no doubt, especially now, more than two years into the COVID-19 pandemic, but while paramedics may be among Canada's most respected occupations, the profession is also one of our nation's most troubled.
In the years leading up to the pandemic, paramedics have been found to have some of the highest rates of post-traumatic stress injuries among Public Safety Personnel (PSP) in Canada, leading to growing recognition of a mental health crisis within the profession. Research conducted by our team found that - as recently as February 2020 - fully 1 in 4 active-duty paramedics in Peel Region met the screening criteria for any one of Post-Traumatic Stress Disorder (PTSD), major depressive disorder, or generalized anxiety disorder. We also found similarly high rates of burnout, overall, and secondary traumatic stress among Peel Region's paramedics, adding concerning evidence of a mental health crisis that - since the onset of the COVID-19 pandemic - has almost certainly worsened.
It's not hard to imagine why paramedics would be at an increased risk for PTSD and other adverse mental health outcomes as a result of their work; afterall, they are on the front lines of a healthcare system strained by an aging population, an addictions crisis, widespread social inequality, and increasingly limited access to primary health care. But the pandemic has brought to light a dimension of the problem that has been going unnoticed in the background for years: violence against paramedics.
In a 2014 survey of paramedics in Ontario and Nova Scotia, Bigham and colleagues found that more than 75% had been subjected to violence within the past year, but fewer than 20% of incidents were ever formally documented or reported. Our own research in this area sheds light on why, with the organizational culture within the profession stigmatizing reporting as paramedics are encouraged to accept paramedics as just 'part of the job.' Fast forward to the 2020s and we are seeing an erosion of trust in health care as an institution, with protests outside hospitals, vitriol directed at healthcare workers, and rocks thrown at ambulances. This unfortunately means that our paramedics - a vital, but already at-risk part of Canada's public safety infrastructure - are being subjected to more and more serious violence during the course of their work. Following the launch of a new violence reporting process in Peel Region, we have seen that paramedics are reporting being exposed to violence every single day, with nearly 40% of incidents involving some form of physical or sexual assault.
Our team is working to change this. Spearheaded by Peel Regional Paramedic Services and the University of Windsor, we are collaborating with a growing list of industry and community partners and paramedic services from across Ontario to develop evidence-informed policy that:
Mitigates the risk of violence against paramedics,
Supports paramedics who have been victimized, and
Strengthens paramedic and community safety at emergency scenes with a high risk of violence
Along the way, we need help from readers like you. Paramedics have an increasingly difficult job and they should never be subjected to verbal abuse, harassment, threats, physical, or sexual assault - they have to be safe to keep our communities safe. Please treat paramedics with respect, give them the space they need to do their job safely, and keep the conversation going. Increasing the awareness of the challenges paramedics face in their work is one of the most important things we can do to help solve this problem, because safety is everyone's responsibility.
If you see a paramedic during this year's Paramedic Services Week, say hi and thank them for doing an important, but sometimes difficult job.
Find out more about our work and follow us on Twitter @ViP_CRG.
The role of organizational culture in normalizing paramedic exposure to workplace violence
Friday, December 10th, 2021
Earlier this week, our paper on the Role of Organizational Culture in Normalizing Paramedic Exposure to Violence came out online in the Journal of Aggression, Conflict and Peace Research. We were asking an important question: why do incidents of violence against paramedics often go unreported?
Here’s the problem:
Paramedics are frequently exposed to acts of violence in the course of their duties. In Canada, a 2014 study by Bliar Bigham asked paramedics from Ontario and Nova Scotia about their experiences with workplace violence. In total, more than 75% of paramedics indicated they had been subjected to some form of violence within the past year, but less than 20% formally reported the incidents.
At the same time, a growing body of research internationally tells us convincingly that a concerning majority of paramedics have been subjected to verbal abuse, threats, intimidation, and physical and sexual assault. Epidemiologist Brian Maquire characterizes violence against EMS personnel as a ‘serious public health problem’. Compounding this problem, however, is that workplace violence against paramedics is vastly underreported. We wanted to understand why.
In 2019, we surveyed paramedics in Peel Region and asked them about their experiences with workplace violence, whether or not the incidents were reported, and - importantly - if not, why not. In qualitatively analyzing the survey comments, we constructed a framework to describe how, despite carrying significant risk for physical and psychological harm, violence is often accepted as just ‘part of the job’.
Here’s what we found:
First, our paramedics told us that the violence they encounter is so widespread that it fades into the background as just another chronic workplace stressor. Which, considering the litany of abuses they described having experienced, is horrifying. They commonly told us they’d encountered “too many (violent incidents) to count”.
Second, this drove the perception that exposure to violence is simply unpreventable. Because paramedics respond to emergencies in the community in situations that are inherently stressful and difficult to control, the paramedics pointed out that they “can’t control peoples’ behaviour”.
Third, because the majority of the acts of violence were perpetrated by people for whom criminal prosecution was either unlikely (i.e., in the case of more ‘minor’ incidents) or inappropriate (i.e., because of cognitive impairment), the perception was that there are often no consequences for offenders. This left our paramedics with a profound sense of injustice.
The result of chronic, ‘unpreventable’ and ‘unprosecutable’ violence? The ability for paramedics to simply “brush off” and “move on from” violent incidents becomes normalized as an expected professional competency.
This cyclical process is the entrenched organizational culture within the paramedic profession that we have to break. Although we may not be able to prevent all acts of violence, and even though criminal prosecution may not be appropriate in many of the situations, this does not mean paramedics should be expected to simply tolerate the abuse. And it doesn’t mean we can’t take steps to keep paramedics safe and support them when they experience violence.