‘I realized I was not alone’: Peel paramedic works to end violence plaguing first responders
“I don't think any of us expected to experience this violence in our career,” Mandy Johnston, superintendent of Peel Paramedic Services, tells The Pointer from the organization’s Fernforest Reporting Station in Brampton.
“The examples I use with council and anytime I speak to media, to be honest, are very PG compared to the reality because what we're experiencing can't even be published, or it can't be said on a live feed.”
For the last half-decade, Johnston, who has been a member of Peel’s paramedic service since 2005, has campaigned tirelessly to create a new culture and reporting system for violent incidents within paramedic services. As the External Violence Against Peel Paramedics (EVAP) program lead, Johnston has witnessed firsthand the harrowing and grave situations Peel’s paramedics are subjected to on the job. This awareness has allowed her to be instrumental in spearheading the work of ending systemic workplace violence that Peel’s paramedics can face on a daily basis.
Among paramedics, and many other first responders, a culture of tolerance has been fostered that sees physical and verbal assault as “part of the job” — a reality that is not unique to Peel — Johnston previously explained. The reality is that paramedics are hit, yelled at, spat on, seriously injured, groped, choked and sexually harassed while on the job. When responding to a call, these first responders—working long shifts and irregular hours—receive a breakdown of what to expect when they arrive on scene. What the public doesn’t know is this often means preparing for violence.
Regular exposure to these incidents has left paramedics within the organization, which provides emergency care around the clock to Peel’s residents, “emotionally impacted, psychologically harmed, or physically injured,” a recent report to council stated. Traditionally, these common attacks go unreported.
It's a very difficult thing to accept in the workplace, Johnston, who has experienced abuse herself while on the job, explains.
“If you experienced it, and ever chose to tell anybody, which is far less likely, then you will be told that it was literally part of the job, and there was nothing that could be done about it and that would be it.”
“That knowledge left a lot of people feeling very defeated, and because that was the culture, paramedics didn't openly speak about the violence that they experienced. Or if we did, we would do so in such a joking way that it becomes something that you talk about at a station, but you laugh it off, and you're never going to be honest and tell people that you felt angry, hurt, scared, upset that you went home and lost sleep that night. Those just weren’t discussions that you would have had back then.”
Johnston has spent the last four years working to repair this broken system.
As the lead of EVAP, she has made no secret of the fact her colleagues face unacceptable levels of violence which have lead to physical injuries or impacts to mental health. In the first half of 2022, Peel Paramedics reported 249 incidents of violence, more than one every day. Despite having a platform in place to record cases of violence when they occur, it’s estimated that many more go unreported as it’s often daunting for paramedics to speak up when they’ve experienced these situations.
Since 2019, Johnston has been spearheading and developing the work of the EVAP program to support paramedics across Peel.
(Alexis Wright/The Pointer)
With decades of accepting the status quo, there’s no simple solution to a very complicated problem, Johnston acknowledged. But through her efforts with EVAP, she has been working over the past four years to develop and implement the recommended prevention strategies needed to mitigate violence experienced by paramedics.
In November 2019, Johnston sat in front of Regional council and shared the concerns, fears, and disturbing stories from paramedics across the organization, her harrowing words resonating with her colleagues who filled the council chamber that day.
“It wasn't because of one violent incident that I had experienced in my career, but really many,” Johnston tells The Pointer, referencing an incident in which her partner was strangled by a patient and she fought to break them free. The incident unfolded when an elderly patient’s son met Johnston and her partner at the end of the driveway as they arrived on scene and started verbally abusing and threatening them. As the situation escalated, they called police and their superintendent to show up, which ultimately became the catalyst for the work of EVAP.
“That was probably by most people's standards, the most significant incident, but it was actually just one of many. It was something that had bothered me my entire career,” she says.
“It was that verbal abuse and the threats and the intimidation and our fear for our physical safety,” that sparked EVAP, Johnston explains, but also the response from her superintendent to the incident. When her superintendent arrived on scene with police, Johnston said he used his physical presence to make them feel protected, but never spoke up on their behalf, or told the person to stop speaking to them maliciously.
Not only was she upset about the situation that had just unfolded, but she was frustrated with the response she got from the people that were called to support her and her partner. While at the hospital following the incident, Johnston and her supervisor had a discussion about violence in the workplace, and what an employer's responsibilities are.
“I said, ‘You're telling me to let this roll off my back. But if I experienced this in any other area of my life, not at work, you would never say that’, and he said, ‘No, you're right. I never would.’ I said, ‘then why is this different?’ And it was a bit of a light bulb moment for him.”
In addition to establishing the EVAP program, Peel Paramedics introduced a violence policy for its staff in 2019 and formed a reporting system that allows paramedics to record incidents they experience. The reporting tool allows violent occurrences to be documented in the same software used to track patient calls. In the years since its implementation, the data that has been collected and analyzed internally has created a more accurate picture of how pervasive these incidents are in Peel.
The move came after a 2019 study found 80 percent of Peel paramedics experienced physical violence at work. The research, which polled 196 paramedics (half of which had over 11 years on the job), found 97.9 percent of paramedics were exposed to verbal abuse, 86.1 percent spoke of intimidation and 80 percent had experienced physical assault. According to that research, 61.5 percent had experienced sexual harassment and 13.8 percent had been sexually assaulted, which contributed “to a psychologically harmful culture resulting in a normalization of paramedic exposure to violence.”
“When we got the results of that survey, and I read them, I realized that I was not alone, that a lot of my co-workers felt the same way, because now in an anonymous way, we gave them the opportunity to speak up to have a voice and I knew that we had to do something very big and meaningful, and we had to change it,” Johnston says.
“It was hurtful to see that people that you care about, and people that you love and that you work with daily were being treated in this way, but also that it was having such an emotional or psychological impact on them.”
Peel paramedics introduced a violence policy for staff in 2019 after a survey that same year found 80 percent of Peel paramedics experienced physical violence at work.
(Alexis Wright/The Pointer)
Recognizing the desperate need to change the culture, and the lack of long-term data on the subject, Johnston knew Peel Paramedics needed to develop a reporting tool. There would also need to be a push to inform the public about what was really going on. The foundation of Johnston’s work shocks those that learn of the harsh truth pandemics face on a daily basis. Her work has illustrated a disturbing level of violence, verbal obscenities and harassment directed at paramedics, particularly for women.
“Anytime I read an external violence incident report, or I hear of an incident that involves sexual harassment, and there are many, it is, for some reason, more deeply bothersome, and maybe that's because I'm a female. The things that are said to female paramedics are disgusting. I couldn't have creatively thought of these things prior to being a paramedic and hearing them.”
“Having experienced it myself, I can't imagine being those females on the road and experiencing that. It's degrading. It's demoralizing.”
Johnston recalls one incident while responding to a scene. She was surrounded by police officers and other paramedics, a male patient under the influence of alcohol made vulgar sexual remarks at Johnston when she approached him. No one around her responded or even reacted to the words that had just escaped the patient's mouth.
“It was silence, and that was a very lonely and confusing feeling to know that there were people surrounding me, that care for me, and this was said, but because we were in a professional setting, nobody reacted and I think it's because everybody had been conditioned to respond in that way,” Johnston says.
“I don't want anybody, any paramedic to ever feel alone like that, or to feel that they need to speak up for themselves.”
A recent report presented to Regional council revealed a shocking reality: every 18 hours a Peel paramedic experiences some form of violence. Every 46 hours, a Peel paramedic is physically or sexually assaulted. Physical injury from assault occurs every nine days.
“It's a shock to everybody. I work with a lot of different people and everyone is surprised,” Johnston explains. “They expect that people will be happy and grateful when we arrive, but that's not reality. I don't think any of us expected to experience this violence in our career.
“It's a real conflict because you've been told your entire life… you shouldn't accept people treating you in that way. But as a paramedic, it's happening. You're being told that it's a normal or expected part of the job and that nothing can be done about it, and you're still trying to care for the person doing that to you.”
Paramedics are more vulnerable to these situations for a number of reasons, Johnston believes, the first being an expectation that paramedics provide emergency care under any circumstances, exposing them to higher risk situations.
“Paramedics have an innate need and want and responsibility to care for the public, regardless of what their emergency is or the cause of their emergency. So unfortunately, that puts us in sometimes very unsafe situations and it is very difficult for a paramedic to decide when to step back from patient care and protect their own safety, because now they're making the choice to step away from the person that is making them unsafe, and risks their physical harm, but also the person that needs their help.
“Morally, that is a huge dilemma to overcome.”
They are also more susceptible due to the conditions they often work under, such as late at night where there is usually an absence of people. Those in emergency situations are also battling incredible amounts of stress when paramedics arrive, but this does not excuse violent or degrading behaviour.
“Paramedics only deal with people on the worst days of their lives and so if that were an excuse, every single person a paramedic comes across could treat them with verbal abuse, or threaten them or sexually harass them. It's just not appropriate and how could they effectively do their job if every patient treated them in this way? It's not reasonable for anybody.”
Mandy Johnston has been crucial in efforts to break the stigma surrounding violence against paramedics that it is simply “part of the job”.
(Alexis Wright/The Pointer)
Data from the External Violence Incident report found that between February 2021 and January 2023, 48 percent of the active paramedic workforce filed 941 violence reports, illustrating the prevalence of violence experienced by Peel Paramedics. 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 the willingness by Peel paramedics to report violence has more than doubled since the 2019 study. Data collected also showed that in addition to physical harm documented, 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.
Johnston says gauging the success of the program is difficult because there is no baseline to compare to—a reporting tool did not exist before the current program began. There’s been some trial and error, she noted, and the organization is still working to determine what works and where they can do better. A lot of the program's evaluation of success is based on paramedics speaking up, reporting, and bringing their concerns forward — something that can’t necessarily be measured if it goes unreported.
The critical part right now is ensuring the organization is taking a proactive approach so that it can reduce incidents of violence in the future — a focus that is creating a positive shift, Johnston notes, because now paramedics have a voice and a place to report along with a policy in place to support them in these challenging conditions and an opportunity to get the support from the organization when they report.
“What we need to see eventually is that number of reports and the frequency of incidents actually decrease,” Johnston said.
“Right now, it's great that the reports are actually increasing, because what it means is we changed culture, that paramedics are willing to speak up, that they see value in reporting and they trust based on everything that we have done to date that we're going to do something meaningful with the time they spent reporting. But in the future, we actually need to reduce the incidence of violence to protect them. That's the ultimate goal.”
Peel Paramedics have been a provincial and national leader in violence prevention through the development of policy, process, strategy, and reporting practices. In 2021, Peel Paramedics shared the work of the EVAP program with paramedic chiefs across Ontario. Since then, there are several Ontario paramedic organizations that have taken an interest in and have decided to champion the program’s work, creating a better workplace, and shifting the culture of violence for paramedics. In June, Peel Paramedic Services were recognized nationally, receiving the Paramedic Chiefs of Canada Award of Excellence for a Quality Workplace due to the External Violence Against Paramedics program.
“I had no idea that EVAP would become what it is. It is a household name here. It is a brand here. But to know that it is a term or a name now for workgroups across the province. I think that I wouldn't have foreseen that,” Johnston says. “Even if I had said that these were my goals initially when we started, I don't know if I ever truly believed that I would see that day or that it would come so quickly.”
After spending the majority of her career caring for the public, Johnston says it feels good to spend time caring for her coworkers so that they can continue to provide vital services to residents in Peel. To see that an incoming paramedic has the knowledge of the organization’s zero tolerance for violence policy and the external violence incident report as well as the support of the superintendents when they’ve experienced an incident, makes all the work 100 percent worth it, she says.
“I think that the greatest achievement of EVAP is that we have managed to change our culture here in Peel. We have given paramedics the opportunity to have a voice and influence change with that voice to make their workplace safer for them, but also for future paramedics.
“It's paramedics knowing here in Peel that we don't tolerate violence and that we have implemented several strategies to try and protect them — their physical safety, but also their mental well being. [It’s] them knowing that they have the employer to support them and then they know there's an employer that is trying to do everything possible to protect them.
“I think that's actually the greatest achievement.”
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