Original communicationWhat do EMS personnel think about domestic violence? An exploration of attitudes and experiences after participation in training
Introduction
The intersection of the emergency medical services (EMS) and victims of domestic violence is an area that is both under-explored and under-utilized as a way to intervene in an area of significant public health concern. The most recent data on domestic violence, also called intimate partner violence, was published by the Centers for Disease Control in 2014. The data from the National Intimate Partner and Sexual Violence Survey -- a national telephone survey conducted in 2011 – revealed that in the U.S., severe physical violence by an intimate partner was experienced by 22.3% of women and 14% of men.1 The CDC considers domestic violence a public health problem that affects millions of people and has serious short and long-term health consequences including mental health problems, physical injury, and chronic physical health problems.2 Each year more than a half-million injuries resulting from intimate partner violence require medical attention, and over 145,000 injuries require hospitalization.3 Nearly one in three female trauma patients is a victim of domestic violence.4 Injuries associated with domestic violence may be physical (e.g., broken limbs, fractures, and bruises,5 contusions, lacerations, and head trauma6, 7, 8). Other symptoms associated with domestic violence may not be so obvious; medical complaints may be a result of ongoing stress (e.g., palpitations and shortness of breath, anxiety, depression, chronic pain, headaches, and other conditions.9, 10).
Thousands of victims of domestic violence use ambulance services every year.11 Emergency medical services (EMS) personnel may be the only medical professionals who communicate with victims. Victims may agree to an initial assessment, but subsequently refuse transport to the hospital.12 Victims who refuse transport have a variety of reasons for doing so. They may be afraid of the legal ramifications of divulging abuse, embarrassed about their victimization, afraid of retaliation by the abuser, or they may simply lack support such as transportation home from the hospital, or child care while they are gone.11 This common dynamic of refusal of services by domestic violence victims suggests that pre-hospital medical responders may have an advantage over other clinical medical professionals to identifying domestic violence when they have been trained to recognize the dynamics. The interaction between EMS personnel and domestic violence victims was acknowledged by the American College of Emergency Physicians (ACEP) in 2012, when they reaffirmed that domestic violence is a serious public health issue and that emergency medical services (EMS) personnel will encounter victims of the crime.13 However, extant research shows that in order for medical personnel to successfully intervene, education is key14; without it, prehospital providers cannot be a “safety net” for victims.11, 15, 16
Researchers believe that the majority of battered women who are treated by EMS providers are not identified as victims of domestic violence and are offered no assistance or information to deal with a potentially life-threatening problem.17 This represents a compounded tragedy, as EMS personnel can serve as a crucial link to more accurate diagnosis for subsequent clinical medical professionals who treat the patient when transport to a clinical setting is accepted. EMS personnel can also provide important information to victims about community resources that provide safety and support.18 These important functions can be accomplished when EMS observe the victim's environment and the batterer's behavior, and/or speak privately to the victim, documenting the scene after arrival, and providing the patient with crucial information about existing community resources when it is safe to do so.17, 18
The majority of existing research on the medical community's response to domestic violence explores the training and attitudes of physicians and nurses who treat patients in clinical settings.19, 20, 21, 22 Given the interaction between EMS personnel and victims of domestic violence and the dearth of descriptive studies in the extant literature, the goals of this study were as follows:
- 1.
Describe the professional and personal experiences of domestic violence in EMS personnel
- 2.
Explore attitudes towards domestic violence held by EMS personnel after an online training program.
- 3.
Identify the amount of training EMS personnel report having related to domestic violence
- 4.
Assess for variations in attitudes and personal or professional experiences based on demographic characteristics.
Section snippets
Methods
The training module and survey were developed in 2014. These data were collected in a prospective study conducted between March and November 2014 after EMS personnel in Florida completed an online training program on domestic violence. Data collection is ongoing. An online training model was selected for this program for several reasons. EMS personnel routinely receive online training and are familiar with the modality. Further, the use of online training allowed for dissemination across a
Results
A total of 403 responses were received. The demographic characteristics of the sample are laid out in Table 1.
In Table 2, the frequency with which respondents report their professional and personal experiences with domestic violence is illustrated.
In this sample, a majority of respondents (71%) reported interactions with patients who disclosed domestic violence or who respondents suspected were victims of violence (70%). One in three respondents (30%) reported being dissatisfied with patients
Discussion
These findings shed some light onto the experiences, beliefs, attitudes, and training of EMS personnel related to domestic violence. The first goal of this research was to describe professional and personal experiences of EMS personnel with domestic violence. These data suggest that these respondents are aware that they interact with victims of domestic violence. Further, participants reported that they have become dissatisfied with patients who do not admit abuse. Medical professionals'
Limitations
Several limitations to this study must be noted. First, these data are drawn from a convenience sample of EMS personnel, which means it is not possible to generalize the findings. The recruitment strategy, using a listserv, meant that participants were recruited through agency staff to disseminate at their discretion, so the possibility that many EMS personnel were not alerted to the training. Beyond the bias of convenience sampling, participation in the training and survey were voluntary, so
Conflict of interest
None.
Funding
The training was funded by a grant from the Verizon Foundation.
Ethical approval
The study was reviewed and approved by the Florida State University Institutional Review Board.
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