title: Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department.
abstract: BACKGROUND
  Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence.
  
  
  METHODS
  A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders.
  
  
  RESULTS
  Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2-22.2, P < 0.001). Females reported increased odds of patient-initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8-10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94-2.85). Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention.
  
  
  CONCLUSIONS
  Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Brittany
authors.initials: B
authors.lastname: Barnes
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Davis
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Wright
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Shannon
authors.initials: S
authors.lastname: Widman
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: LeVasseur
mesh_terms: D000328:Adult; D060731:Emergency Responders / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D061388:Firefighters / Q000523:psychology / Q000706:statistics & numerical data; D017144:Focus Groups; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D060051:Occupational Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D010361:Patients / Q000523:psychology; D012107:Research Design; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D064450:Workplace Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*
keywords: assaults; emergency medical services; firefighter; paramedics; prehospital violence