Jump to comment:

• Response to Demographics of workplace violence-methodology is the key
  Malcolm Boyle
  Published on: 20 February 2008
• Workplace violence towards paramedics in UK
  Aadil Jan Shah
  Published on: 20 February 2008
• Demographics of workplace violence-methodology is the key
  Darren A Kilroy
  Published on: 30 January 2008

• Published on: 20 February 2008

  Response to Demographics of workplace violence-methodology is the key

  • Malcolm Boyle
  • Other Contributors:
    • Stella Koritsas, Jan Coles

  Dear Editor,

  We read with interest the comments made by Dr Kilroy regarding our study into paramedic workplace violence and offer our reply.[1]

  As this was a pilot study with no follow up letter a response rate of 28% was considered reasonable. If the paramedics saw this study as extremely important the participation rate may have been higher, even though there were a few pages to complete. There was a s...

  Show More

  Dear Editor,

  We read with interest the comments made by Dr Kilroy regarding our study into paramedic workplace violence and offer our reply.[1]

  As this was a pilot study with no follow up letter a response rate of 28% was considered reasonable. If the paramedics saw this study as extremely important the participation rate may have been higher, even though there were a few pages to complete. There was a self addressed stamped envelope to return the questionnaire in so there was no cost to the paramedic apart from the time to complete the questionnaire. From past experience paramedic questionnaire return rates have never been very high. The response rate for the study by Coles et al was slightly lower than this one. Dr Coles made the comment that GPs receive a lot of material, including questionnaires, that many get tired of looking at and consequently just ignore. A study by McAvovy et al found a low response rate in general practice research is not uncommon.[2]

  The gender response by GPs reported in the paper by Coles et al is similar to the gender distribution of GPs within Victoria, Australia.[3] In addition, the GPs who participated in the study were also representative of GPs in Australia, in terms of age[4], hours/week in general practice, and practice location.[5] Similarly, the gender distribution in our study for South Australian Ambulance Service (SAAS) and Rural Ambulance Victoria (RAV) was very close to that in both ambulance services. The gender distribution in our study for RAV was 85% for males and 14% for females (with two no replies to the gender question), the gender distribution in RAV is 87% males and 17% females. The gender distribution in our study for SAAS was 60% males and 40% females, the gender distribution in SAAS is 60% males and 40% females.[1] Even though the response rate could be considered low, the ability to generalise the findings to the general RAV and SAAS paramedic population is reasonable given the similarity in gender distribution.

  The number of females graduating from the undergraduate paramedic course at Monash University in recent years is two thirds compared to a third of males. We would expect that over time the percentage of females in RAV to increase to a similar percentage like that in SAAS.

  We acknowledge that the number of paramedics involved in the workplace violence study by Mechem et al [6] was small and of questionable quality and relevance, however, there is a lack of studies available in the scientific literature reporting the exposure of paramedics to workplace violence that we could compare with.

  We used a questionnaire that was devised for the Australian context. The questionnaire had previously been used by Tolhurst et al to elicit a response from rural general practitioners in New South Wales Australia, about their exposure to workplace violence.[7] We used the same questionnaire apart from some additional demographic type questions, e.g., number of years qualified as a paramedic, a single or dual responder, and the size of the town the paramedic works in. Most changes to the questionnaire following the pre-pilot were in relation to the paramedic demographic questions. A copy of the questionnaire was made available as supplementary material when the article was submitted.

  Three of the criterion from the questionnaire, intimidation, sexual harassment, and sexual assault, have not been solicited in any of the other paramedic workplace violence questionnaires. We perceive these types of workplace violence to be destructive in the workplace for on going morale and work performance, something that ambulance management may need to act upon.

  Questionnaires like that used by Corbet et al were aimed more towards violence by persons with weapons, which is rare in the Australian context.[8] Therefore we chose not to use a U.S.A. designed survey as they did not seek information about intimidation, sexual harassment or sexual assault, which we were interested in.

  We are not sure where Dr Kilroy extracted this figure from in the article by Coles et al [3] as none of the figures reported, whichever logical way they are manipulated, give this result. The response rate for GPs was 21.1%.

  Following a review of all literature for paramedic workplace violence that we retrieved for the study only one, the article by Corbett et al, reported data regarding a paramedic’s ethnicity. We, like other studies, investigating paramedic workplace violence, did not see ethnicity as an important criterion, especially in the Australian context. We considered exposure to workplace violence by gender to be a more important issue in the Australian context.

  Most other studies into paramedic workplace violence did not send a follow up letter to paramedics. A condition of allowing their staff to participate in the study was that both ambulance services (RAV and SAAS) undertook the distribution of the survey, due to privacy issues, and that there would be no follow up letter sent. As there had been no previous studies into paramedic workplace violence in Victoria we accepted the participation criteria and expected a participation rate of about 30%. As this was a pilot study one of the main aims was to test the questionnaire in a limited paramedic population, which we did, and to establish a need for a further extensive Australian wide study. As to why more paramedics did not respond to the survey, apathy towards completing the questionnaire, is the only reason we can arrive at.

  Malcolm Boyle Stella Koritsas Jan Coles

  REFERENCES

  1. Boyle M, Koritsas S, Coles J, et al. A pilot study of workplace violence towards paramedics. Emerg Med J 2007;24(11):760-763.

  2. McAvoy BR, Kaner EF. General practice postal surveys: A questionnaire too far? BMJ 1996;313(7059):732-3.

  3. Coles J, Koritas S, Boyle M, et al. Gps, violence and work performance - ’just part of the job?’ Aust Fam Physician 2007;36(3):189-191.

  4. Australian Institute of Health & Welfare. Medical labour force 2004. National Health Labour Force Series. Canberra: Australian Institute of Health & Welfare, 2006:36.

  5. Koritsas S, Coles J, Boyle M, et al. Prevalence and predictors of occupational violence and aggression towards gps: A cross-sectional study. Br J Gen Pract 2007;57:967-970. doi: 10.3399/096016407782604848.

  6. Mechem CC, Dickinson ET, Shofer FS, et al. Injuries from assaults on paramedics and firefighters in an urban emergency medical services system. Prehosp Emerg Care 2002;6(4):396-401.

  7. Tolhurst H, Talbot J, Bell P, et al. After hours medical care and personal safety needs of rural general practitioners. Newcastle: University of Newcastle, 1999.

  8. Corbett SW, Grange JT, Thomas TL. Exposure of prehospital care providers to violence. Prehosp Emerg Care 1998;2(2):127-31.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 20 February 2008

  Workplace violence towards paramedics in UK

  • Aadil Jan Shah, Speciality Registrar
  • Other Contributors:
    • Ovais Wadoo,Speciality Registrar,Mersey Care NHS Trust

  The violence against paramedics in UK has been of concern recently. A news article on BBC on 10 Nov 2007 mentions that there were 1,006 physical assaults against ambulance staff in England for the year 2006/7, as per the figures. It is thought that the high expectations of patients and the use of drugs and alcohol is the main reason for abuse against paramedics in UK. Paramedics in UK are feeling vulnerable and have been d...

  Show More

  The violence against paramedics in UK has been of concern recently. A news article on BBC on 10 Nov 2007 mentions that there were 1,006 physical assaults against ambulance staff in England for the year 2006/7, as per the figures. It is thought that the high expectations of patients and the use of drugs and alcohol is the main reason for abuse against paramedics in UK. Paramedics in UK are feeling vulnerable and have been demanding the stab vests. Currently only London, Essex and Dorset issue staff with the stab vests.Department of health and the local NHS trusts have been working hard in order to reduce these incidents. The Department of Heath Spokesman has said that ambulance crews across the country can have stab vests if it is decided they are necessary by their local NHS trust and an extra £97m was announced for security and measures that will make the NHS a safer place to work, including mobile alarms connected to control rooms.It is worth mentioning that these experiences of violence at work (or the enduring threat of violence) are associated with adverse psychological outcomes including burnout and post-traumatic stress amongst these professionals. These incidents can also result in some serious consequences including: poor morale, staff recruitment and retention problems, staff absenteeism, and high levels of occupational stress and psychological strain (NHSE, 1998).

  References :

  BBC News, 10 November 2007.

  Mezey, G., & Shepherd, J. (1994). Effects of assault on health- care professionals. In J. Shepherd (Ed.), Violence in health care: A practical guide to coping with violence and caring for victims (pp. 1-11). New York: Oxford University Press.

  National Health Service Executive (NHSE). (1998), A survey of violent incidents against NHS staff. Unpublished report, Department of Health, UK.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 30 January 2008

  Demographics of workplace violence-methodology is the key

  • Darren A Kilroy, Consultant in Emergency Medicine

  Boyle et al's paper is more interesting for what it doesn't say about paramedic workplace violence than what it does.Corbett, Grange and Thomas's paper (reference 8) attracted a response rate of only 67%, of whom the vast majority were white males. There is a powerful message there alone which warrants comment. It is important also to note that Mechem et al's work (reference 9) related to an occupational injury database wh...

  Show More

  Boyle et al's paper is more interesting for what it doesn't say about paramedic workplace violence than what it does.Corbett, Grange and Thomas's paper (reference 8) attracted a response rate of only 67%, of whom the vast majority were white males. There is a powerful message there alone which warrants comment. It is important also to note that Mechem et al's work (reference 9) related to an occupational injury database where of 1100 logged events, only 44 were actually deemed to be 'violent' in origin. We have to be careful about the context within which references are utilised.

  It would be extremely interesting to know more about the evolution of the questionnaire, particularly since it was pre-piloted and amended following comments. The development of the questionnaire is the cornerstone of the paper, since the wording, style and context will profoundly influence the results. I am struck that the team have also undertaken a study amongst Australian GPs (RACGP Vol 36 (3) 97-192) which also used a questionnaire, and attracted a response rate of 85 from a sampled pool of 1000. Perhaps the issue of questionnaire development needs some attention, and there is vital additional detail which we need to know to contextualise what we read in this study.

  This is exemplified by the very poor response rate of 28%which makes any kind of assertion impossible to justify. The fact that ethnicity was not addressed is a significant omission, since if those who responded mirrored the respondents of Corbett & Grange then there is a very powerful message there.

  With the topic being so potentially significant in impact, it is hard to see why there was no follow-up of nonresponders. Again, it is the reasons why paramedics failed to respond that need attention, rather than the application of statistics to the small percent who did. Therein lies the true answer to the research question.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top