title: Perceptions of paramedic and emergency care workers of those who self harm: a systematic review of the quantitative literature.
abstract: OBJECTIVE
  The U.K. has one of the highest rates of self harm in Europe at 400 per 100,000 of population. Paramedics and emergency staff may be the first professionals encountered, therefore understanding their views and approaches to care is crucial. The aim of this study was to systematically review published quantitative literature relating to paramedic and emergency workers' perceptions and experiences of caring for people who self harm.
  
  
  METHODS
  CINAHL®, MEDLINE®, OVID ® and Psych INFO® databases were searched, PRISMA guidelines were followed, two researchers independently screened titles, abstracts and full papers against a priori eligibility criteria. Data synthesis was achieved by extracting and descriptively analysing study characteristics and findings.
  
  
  RESULTS
  16 studies met inclusion criteria; one included ambulance staff, all used questionnaires. Training, policies and guidelines improved staff knowledge and confidence in caring for people who self harm. Limited access to training was reported, ranging from 75% to 90% of staff lacking any. Limited departmental guidelines were also reported. Staff in acute settings exhibited increased feelings of negativity, becoming less positive closer to front line care. Recent studies report positive attitudes amongst emergency staff.
  
  
  CONCLUSIONS
  Despite guidelines indicating need for education and policies to guide staff in self harm care, there is limited evidence of this happening in practice. The lack of literature including paramedics suggests a gap in our understanding about care for self harm patients. This gap warrants greater attention in order to improve care for patients who self harm in their first point of contact.
authors.affiliation: Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom. Electronic address: nigel.rees@wales.nhs.uk.
authors.forename: Nigel
authors.initials: N
authors.lastname: Rees
authors.affiliation: Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Frances
authors.initials: F
authors.lastname: Rapport
authors.affiliation: Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Gareth
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Ann
authors.initials: A
authors.lastname: John
authors.affiliation: Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
mesh_terms: D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000592:standards; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D004645:Empathy; D006801:Humans; D007318:Inservice Training; D017410:Practice Guidelines as Topic; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D012938:Social Perception; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D000078329:Workforce
keywords: Ambulance; Care; Emergency self harm paramedic; Pre hospital