Emergency Medical Systemic frustration of Aggression and Violence in Conflict Encounters: An Evolved Grounded Theory

Background Emergency Medical Services (EMS) staff worldwide have long been at risk of encountering violence and aggression (V&A) at work, including threats, verbal, physical, and sexual assault, and on rare occasions, fatalities occur. Exposure to V&A can result in stress, fear, and burnout. This is an international problem and EMS employers, trade unions and others are working towards tackling it. This paper reports the results of a qualitative study that aimed to explore protecting EMS Staff from aggression and violence in conflict encounters Methods This study took place in 2022 in one UK ambulance service covering a population of three million people. Individual, one-to-one semi-structured interviews were conducted with EMS staff via a Voice over Internet Protocol VoIP (VoIP). Data were analysed through Evolved Grounded theory methodology. Results Ten EMS staff were interviewed, and the following categories emerged: Rusted, busted and inevitability of Violence & Aggression in EMS Environment, Tolerable or intolerable Violence & aggression in EMS, Gendered violence & aggression and Genderization in EMS, modifiable factors and harm reduction of Violence & aggression in EMS, Professional, ethical & clinical judgments of Violence & aggression in EMS, and Socio-cultural and system frustrations of Violence & aggression in EMS. The Basic Socal Process (BSP) that emerged was one of Emergency Medical Systemic frustration of Aggression and Violence in Conflict Encounters . Conclusion V&A directed toward EMS staff is complex and our participants revealed how it has long been accepted and may be influenced by systemic frustration in EMS. Staff reported frustrations due to tiredness and in patients from delays in EMS response. Female EMS staff experienced sexual V&A by co-workers and patients, and these voices reverberate with female EMS staff internationally. Our study revealed how EMS has not effectively tackled V&A and many sociocultural constructs accepted within EMS. We call for the voices of our participants to be amplified internationally and for purposeful efforts to continue to be made in tackling this issue. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by a Welsh Ambulance Service pathway to portfolio funding. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Health Research Authority (HRA)/ Health Care Research Wales (HCRW) Integrated Research Assessment System (IRAS ID 313346). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the paper and its Supporting Information files.