Explorative thematic qualitative analysis of a UK emergency medical systems staff's experiences, perceptions and interpretations of violence and aggression directed towards them.
BMJ Open · 2026-08-03 · Qualitative study
Abstract
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. The aim of this research was to conduct an exploratory qualitative interview study of EMS staff focusing on experiences, perceptions and interpretations of V&A directed towards them. 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. Data were thematically analysed drawing on evolved grounded theory methodology concepts. RESULTS: 10 EMS staff were interviewed, and the following categories emerged: Rusted, busted and inevitability of V&A in EMS environment, Tolerable or intolerable V&A in EMS, Gendered V&A and genderisation in EMS, Modifiable factors and harm reduction of V&A in EMS, Professional, ethical and clinical judgments of V&A in EMS and Sociocultural and system frustrations of V&A in EMS. The basic social process that emerged was one of Systemic frustration and gender-based V&A in EMS. CONCLUSION: Protecting EMS staff from V&A is complex and multifaceted, and we have conducted a thematic analysis drawing on evolved grounded theory concepts that proposes V&A in EMS may be borne out of, and sustained, by systemic frustration and gender-based issues. We draw on Dollard's et al (1939) frustration-aggression hypothesis and Kelly's 'Continuum of Violence' (1988). Experiences of sexual V&A revealed in our study, supported by a wider body of knowledge, lay bare a caring context of rampant gender-based V&A directed towards EMS staff by members of society, colleagues and within the context of a patriarchal EMS. Our study revealed how EMS has not effectively tackled V&A and the many sociocultural constructs within EMS. We advocate for purposeful efforts, further research and systemic interventions beyond punitive measures to tackle this issue.
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Tags
Clinician perspective · Sex & gender · Abuse & interpersonal violence
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