INTRODUCTION: Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual's urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine. METHODS: We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23-33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences. RESULTS: Of the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases. CONCLUSION: We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict.

Charles University 3rd Medical Faculty Prague Czech Republic

Emergency Medical Services of the Central Bohemian Region Czech Republic

Emergency Medical Services of the Ústí nad Labem Region Czech Republic

Jan Evangelista Purkyně University Division of Health Studies Ústí nad Labem Czech Republic

Medical College Prague Prague Czech Republic

Prague Emergency Medical Services Czech Republic

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Pekara J, Hulinsky P, Treslova M. Prevalence of violence in nursing in the Czech Republic. J Nurs Care. 2017;6(6):438–40.

Hahn S, Hantikainen V, Needham I, et al. Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey. J Adv Nurs. 2012;68(12):2685–99. PubMed

Maguire BJ, Hunting KL, Guidotti TL, et al. Occupational injuries among emergency medical services personnel. Prehosp Emerg Care. 2005;9(4):405–11. PubMed

di Martino V. Workplace violence in the health sector. Relationship between stress and workplace violence in the health sector. 2003. [Accessed March 18, 2018]. Available at: http://www.who.int/violence_injury_prevention/violence/interpersonal/WVstresspaper.pdf.

Beech B, Leather P. Workplace violence in the health care sector: a review of staff training and integration of training evaluation models. Aggress Violent Behav. 2006;11(1):27–43.

Cresswell J. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. 4th ed. Boston, MA: Pearson Education; 2012.

Pourshaikhian M, Abolghasem Gorji H, Aryankhesal A, et al. A systematic literature review: workplace violence against emergency medical services personnel. Arch Trauma Res. 2016;5(1):e28734. PubMed PMC

Gormley MA, Crowe RP, Bentley MA, et al. A national description of violence toward emergency medical services personnel. Prehosp Emerg Care. 2016;20(4):439–47. PubMed

Gülen B, Serinken M, Hatipoğlu C, et al. Work-related injuries sustained by emergency medical technicians and paramedics in Turkey. Ulus Travma Acil Cerrahi Derg. 2016;22(2):145–9. PubMed

Rahmani A, Hassankhani H, Mills J, et al. Exposure of Iranian emergency medical technicians to workplace violence: a cross-sectional analysis. Emerg Med Australas. 2012;24(1):105–10. PubMed

Helge H, Cooper C. Destructive conflict and bullying at work. 2000. [Accessed March 18, 2018]. Available at: http://www.bollettinoadapt.it/old/files/document/19764Destructiveconfl.pdf.

Bernaldo-De-Quirós M, Piccini AT, Gómez MM, et al. Psychological consequences of aggression in pre-hospital emergency care: Cross sectional survey. Int J Nurs Stud. 2015;52(1):260–70. PubMed

Hahn S, Müller M, Hantikainen K, et al. Risk factors associated with patient and visitor violence in general hospitals: Results of a multiple regression analysis. Int J Nurs Stud. 2013;50(3):374–85. PubMed

Koritsas S, Coles J, Boyle M. Workplace violence towards social workers: the Australian experience. Brit J Soc Work. 2010;40:257–71.

Franz S, Zeh A, Schablon A, et al. Aggression and violence against health care workers in Germany: a cross sectional retrospective survey. BMC Health Serv Res. 2010;10:51. PubMed PMC

Piquero NL, Piquero AR, Craig JM, et al. Assessing research on workplace violence, 2000–2012. Aggress Violent Behav. 2013;18(3):383–94.

Gates DM, Gillespie GL, Succop P. Violence against nurses and its impact on stress and productivity. Nurs Econ. 2011;29(2):59–66. PubMed

Grange JT, Corbett SW. Violence against emergency medical services personnel. Prehosp Emerg Care. 2002;6(2):186–90. PubMed

Bigham BL, Jensen JL, Tavares W, et al. Paramedic self-reported exposure to violence in the emergency medical services workplace: a mixed-methods cross-sectional survey. Prehosp Emerg Care. 2014;18(4):489–94. PubMed

Furin M, Eliseo LJ, Langlois B, et al. Self-reported provider safety in an urban EMS. West J Emerg Med. 2015;16(3):459–64. PubMed PMC

Mechem D, 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. PubMed

Lanctôt N, Guay S. The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggress Violent Beh. 2014;19(5):492–501.