title: Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?
abstract: BACKGROUND
  Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies.
  
  
  METHODS
  A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis.
  
  
  RESULTS
  Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%).
  
  
  CONCLUSIONS
  This survey may not generalize to all EMS professionals in North Carolina.
  
  
  CONCLUSIONS
  Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.
authors.affiliation: Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
authors.forename: Ellen Grace
authors.initials: EG
authors.lastname: Lynne
authors.affiliation: Center for Child and Family Policy, Duke University, Durham, North Carolina, USA. beth.gifford@duke.edu.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Gifford
authors.affiliation: Center for Child and Family Policy, Duke University, Durham, North Carolina, USA.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Evans
authors.affiliation: Center for Child and Family Policy, Duke University, Durham, North Carolina, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Rosch
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002649:Child Abuse; D002983:Clinical Competence; D004634:Emergency Medical Technicians; D006801:Humans; D019221:Mandatory Reporting; D009657:North Carolina