‘No one should be subjected to violence at work’: Peel paramedics fight culture that accepts harassment as ‘part of the job’
In November 2020, Peel paramedics attended a residence to assist an individual who required an emergency response. During the call, the individual verbally harassed and physically assaulted a first responder who was trying to help. A paramedic was struck on the side of the head, a paramedic was also punched in the arm, while one of the first responders was choked. They were scratched, grabbed and hit and the individual struck one paramedic in the genitals, while continuing to shout profanities.
After transferring the person to the care of hospital staff, the paramedics themselves were required to seek medical attention for the injuries they sustained while trying to provide care to a resident in need.
The actions described in a January 2021 letter, presented to Regional council on July 6, are the reality Peel paramedics face nearly every day.
“Imagine how you’d feel; someone saying or doing those things to you in this room, in this secure, government building with all of these people present, while you’re doing your job,” Mandy Johnston, superintendent of Peel Paramedic Services, asked the room full of councillors and Regional staff two weeks ago, referencing the many examples of abuse experienced by Peel paramedics on a daily basis.
“Now imagine being a paramedic, in the public, at night in a park, on a street, alone or with your partner, worried about public perception and just trying to fulfill your responsibilities and care for the patient.”
Peel Paramedics save lives, but suffer routine harassment while doing their job.
(Alexis Wright/The Pointer)
Every 18 hours a Peel paramedic experiences a form of violence, the recent report to Regional council revealed, providing an update on external violence against Peel paramedics. Every 46 hours, a Peel paramedic is physically or sexually assaulted. Physical injury from assault occurs every nine days.
“Exposure to incidents have left paramedics emotionally impacted, psychologically harmed, or physically injured,” the report states.
This is not a reality that should be tolerated, Johnston, who has experienced abuse herself while on the job, cautioned. But often paramedics do not seek help after these common attacks.
A culture of tolerance has been fostered that sees physical and verbal assault as “part of the job,” Johnston explained. As dispatch calls zip through the radio wave, paramedics get a breakdown of what to expect at an emergency scene. Their experience also tells them to prepare for violence.
This reality is not unique to Peel. Across the province, paramedics face many forms of abuse and harassment. They are hit, yelled at, spat on, seriously injured, groped, choked and sexually harassed while on the job.
It is routine.
Johnston has made it no secret that her colleagues, who race through streets in ambulances to treat and save their fellow community members, face unacceptable levels of violence which can lead to physical injuries or impacts to mental health. In the first six months of 2022, Peel Paramedics reported 249 incidents of violence, more than one every day. Despite having a platform now in place to record cases of violence when they occur, it’s estimated that many more go unreported.
Johnston, who joined Peel’s paramedic service in 2005, has been campaigning for the last half-decade to create a new culture and reporting system within paramedic services. As the External Violence Against Peel Paramedics (EVAP) program lead, Johnston is acutely aware of the dire situations Peel’s paramedics have found themselves in and has been spearheading the work of ending systemic workplace violence that crucifies Peel’s paramedic staff.
“The last time I presented to you, I told my story, but mine is just one of way too many,” she told councillors.
“EVAP began with one voice, that was mine, and in response to not one but many instances of verbal abuse, intimidation and assault in my career, I spoke up and told my supervisor ‘no, I’m not going to learn to let it roll off my back and no, it is not part of my job. That supervisor gave me an opportunity to do something about it and EVAP was born.
With decades of accepting the status quo that violence is a part of the job description, there’s no simple solution to a very complicated problem, she acknowledged.
The EVAP program was launched in 2019 after results of a survey of paramedic’s experiences with workplace violence indicated that Peel paramedics had regularly been exposed to some or multiple forms of violence, whether it was verbal abuse, physical assault, or sexual harassment, throughout their career. The program has worked over the past four years to develop and implement the recommended prevention strategies needed to mitigate external violence experienced by paramedics.
The move came after the 2019 study found 80 percent of Peel paramedics experienced physical violence at work. According to the research, which surveyed 196 paramedics (half of which had over 11 years on the job), 97.9 percent of paramedics were exposed to verbal abuse, 86.1 percent spoke of intimidation and 80 percent had experienced physical assault. In the same breath, 61.5 percent had experienced sexual harassment and 13.8 percent had been sexually assaulted.
“Survey findings also indicated that an organizational culture of tacit or implied acceptance of violence as ‘part of the job’ existed due to several factors such as frequency of occurrence, lack of a reporting mechanism, and no consequence for perpetrators,” Johnston explained. “These factors combined contribute to a psychologically harmful culture resulting in a normalization of paramedic exposure to violence.”
Despite the continued growth of the EVAP program and implemented strategies, she stressed that Peel paramedics continue to be exposed to incidents of violence at an alarmingly high rate.
“Paramedic exposure to any form of violence, threat to their physical safety or actual assault, whether a singular incident or cumulatively is a serious concern,” the July 6 report notes. “Paramedics exposed to acts of violence, are at risk of potentially significant physical and psychological harm including operational stress injuries, post-traumatic stress disorder, depression, anxiety, and suicide.”
In February 2021, the External Violence Incident report was launched to address barriers and a culture that previously discouraged paramedics from reporting violence. It provides a tool for staff to report a case where violence occurs. The incident report then provides management with information and data to address high-risk trends, mitigate specific risks, and generates data for analysis to inform and improve policy, procedure, process and training.
Following the implementation of the incident reporting tool, between February 2021 and January 2023, 48 percent of the active paramedic workforce filed 941 violence reports, which Johnston said illustrates the prevalence of violence experienced by Peel Paramedics.
“Between February 2021 and February 2023 Peel paramedics responded to over 220,000 911 calls. 941 EVIRS were filed by paramedics, which is only 0.4 percent of our calls resulting in a violent exposure, or documented violent exposure, but that was actually almost 50 percent of our active duty workforce in two years that were exposed to violence,” Johnston explained.
“In total, 40 percent of incidents documented as actual physical or sexual assaults, 81 paramedics were injured which amounted to 10 percent of our active duty workforce in that two-year period.”
Types of violence experienced by paramedics included verbal abuse (38 percent), assault (18 percent), threats (four percent), sexual harassment (two percent) and sexual assault (one percent).
A recent EVAP program evaluation found that for survey participants who had experienced violence since the launch of the incident reporting tool, 83 percent said they documented incidents at least “some of the time,” and 86 percent of participants said they would continue to report similar incidents in the future. The results show Peel paramedics’ willingness to report violence has more than doubled since the 2019 study.
Data collected from the reporting tool showed that in addition to paramedics being physically harmed, 23 percent (211 paramedics who filed a report) indicated having been “emotionally impacted” as a result of the violence and 19 percent (174 paramedics) stated “I’m uncertain” about the emotional impact of the event.
However, while the incidents persist, they represent just a fraction of the number of cases of violence and harassment that take place but are not reported. Johnston told councillors that in 2014, a joint study conducted in Ontario and Nova Scotia found that 75 percent of paramedics had experienced violence that year, but 81 percent had never reported it. Both their study and Peel paramedics’ “found that culture didn’t support it, violence is considered part of the job and happens too frequently from people whom paramedics believe there will be no consequences for, so [there is] no hope of behaviour change, and even if they wanted to report, there was lack of a purposeful place to do it.”
Attacks on Peel paramedics have long been part of a culture that expects frontline staff to just accept it as "part of the job". These attitudes are finally being confronted.
(Alexis Wright/The Pointer)
According to the staff report, the incident reporting tool, along with incident debriefs, and Peel’s specific research on violence in paramedicine has made it evident that paramedics have not been provided with sufficient training to respond to potentially violent events. The report noted that unless further training is provided, continued exposure to incidents of violence is likely.
“Despite the array of accomplishments achieved through the EVAP program, paramedics continue to experience violence. To ensure that paramedics are more equipped to identify, assess, and manage risk situations, a training program is essential to support them in avoiding situations and incidents that can cause psychological or physical harm,” the report explains.
The July 6 report and presentation also came with a financial ask. Peel paramedics requested council consider a one-time cost of $1.25 million to resource the Conflict Avoidance and Threat Management training, which Johnston said will be an important strategy to support paramedics through mitigating or reducing future incidents of external workplace violence. The request will be brought forward in the 2024 budget process.
“There’s a huge gap in our knowledge and skills related to risk intelligence and management. The [external violence incident report] is reactive but training is proactive. We need to teach paramedics to identify, and understand how to articulate the risk that they experience,” she explained. “They need to understand and know environmental cues and signs of escalation or dangerous individuals so they don’t enter or leave an unsafe scene before it escalates, before they’re exposed or before they get hurt.”
While Peel paramedics continue to see high numbers of violence and harassment among staff while out in the field, Johnston noted that as a result of the EVAP programs and incident reporting tools, the culture of Peel’s Paramedic Services has positively shifted, including addressing a culture which normalized violence as “part of the job,” Johnston explained. This is evidenced by paramedics’ willingness to report violence and their openness in speaking about incidents, both personally and professionally.
One voice led to the development of EVAP, which later became 196 voices in its early days, Johnston highlighted. Those voices then led to recommendations, culture and tangible change that improved the psychological and physical safety of Peel’s paramedics. Since making the presentation, she said the workforce has over 1,200 completed external incident reports.
Johnston acknowledged while it may sound strange that she is enthusiastic about 1,200 completed incident reports, it’s really her excitement over paramedics’ willingness to report.
“It means that we had a culture, a policy and a purpose-built place for them to document their experience,” she explained. “We gave them the opportunity to vent. We acknowledged and validated that what happened to them was wrong and it means that the service trusted that management was going to do something meaningful with the incident they documented and their time spent documenting.
“That is an incredible demonstration of culture change.”
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