Frequency and types of workplace violence against emergency medical technicians: a cross-sectional study in Tehran, Iran


Objective: This study was implemented to assess various types of violent incidents involving emergency medical technicians (EMTs) working in Tehran, Iran. Furthermore, the characteristics of violent people and possible causes of their violence were assessed. Methods: In this cross-sectional study, 500 EMTs working in the capital city of Tehran were randomly invited. The participants were asked to fill out a questionnaire of workplace violence. Univariate and multivariate logistic regression were also performed for identifying the possible risk factors of violence. In addition, the distribution and association of violence patterns were also analyzed considering demographic features and characteristics of violent people. Results: In total, 320 EMTs with the mean age of 31.8 ± 6.7 years participated, 315 (98.4%) of whom were men. Overall, 279 (87.2%) out of the 320 participants experienced 654 episodes of violence, mostly bullying, in the last 4 months. The relationship between the level of education and experiencing violent incidents was statistically significant (p=0.035). Also, non-Persian EMTs had experienced significantly more violent behaviors than Persian EMTs [171 (91.0%) vs. 108 (81.8%); p=0.016]. Nonetheless, the prevalence of violent incidents was not significantly correlated with marital status, years of work experience, employment situation, and working hours. The odds of facing violent behavior among EMTs with associate degree was 2.9 times higher than those with technical diploma (p=0.048). Furthermore, the odds of experiencing violence among non-Persian EMTs was 2.2 times higher than Persian EMTs (p=0.039). Conclusion: We found that EMTs had faced numerous episodes of violence in their workplace, especially verbal threats, which were more prevalently committed by patients’ relatives during night shifts.

1. Workplace Violence United State: Occupational Safety and Health Administration; [Available from:].
2. Samsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Individual antecedents of workplace victimisation: The role of negative affect, personality and self‐esteem in junior doctors' exposure to bullying at work. Int J Health Plann Manage. 2020;35(5):1065-82.
3. Li X, Liu X, Chen W. The impact of workplace bullying on employees’ turnover intention: the role of self-esteem. Open J Soc Sci. 2020;8(10):23-34.
4. Schmidt MJ, Wessling EG, McPhaul K, London M, Lipscomb J. Workplace violence in health care: An overview and practical approach for prevention. Psychiatr Ann. 2019;49(11):482-6.
5. Wang PY, Fang PH, Wu CL, Hsu HC, Lin CH. Workplace violence in Asian emergency medical services: a pilot study. Int J Environ Res Public Health. 2019;16(20):3936.
6. Pourshaikhian M, Abolghasem Gorji H, Aryankhesal A, Khorasani-Zavareh D, Barati A. A systematic literature review: workplace violence against emergency medical services personnel. Arch Trauma Res. 2016;5(1):e28734.
7. Maguire BJ, O'Meara P, O'Neill BJ, Brightwell R. Violence against emergency medical services personnel: a systematic review of the literature. Am J Ind Med. 2018;61(2):167-80.
8. Aboosalehi A, Kolivand P-H, Jalali A, Saberian P, Asiabar AS, Baratloo A, et al. Clients’ satisfaction with services provided by ambulances and motor ambulances of Tehran emergency medical services: a cross-sectional study. Med J Islam Repub Iran. 2022;36:78.
9. Petzall K TJ, Ludin T, Suserud BO. . Threats and violence in the Swedish pre-hospital emergency care. Int Emerg Nurs. 2011;19:5-11.
10. Sheikh-Bardsiri H, Eskandarzadeh S, Aminizadeh M, Sarhadi M, Khademipour G, Mousavi M. The frequency of violence in workplace against emergency care personnel in Kerman, Iran, and the factors affecting the occurrence. 2013;1(2):11-7. [Persian]
11. Meysam S-K, Davoud K-Z, Katarina B. Factors affecting emergency medical technicians’ on-scene decision-making in emergency situations: a qualitative study. Front Emerg Med. 2020;4(4):e88.
12. Murray RM, Davis AL, Shepler LJ, Moore-Merrell L, Troup WJ, Allen JA, et al. A systematic review of workplace violence against emergency medical services responders. New Solut. 2020;29(4):487-503.
13. van Reemst L. A theoretical framework to study variations in workplace violence experienced by emergency responders: integrating opportunity and vulnerability perspectives. Erasmus Law Rev. 2016;9:135-45.
14. Maguire BJ, O’Neill BJ. Emergency medical service personnel’s risk from violence while serving the community. Am J Public Health. 2017;107(11):1770-5.
15. Boyle M, Koritsas S, Coles J, Stanley J. A pilot study of workplace violence towards paramedics. Emerg Med J. 2007;24(11):760-3.
16. Lindquist B, Koval K, Mahadevan A, Gennosa C, Leggio W, Niknam K, et al. Workplace violence among prehospital care providers in India: a cross-sectional study. BMJ open. 2019;9(11):e033404.
17. Suserud B-O, Blomquist M, Johansson I. Experiences of threats and violence in the Swedish ambulance service. Accid Emerg Nurs. 2002;10(3):127-35.
18. World Health Organization. Workplace Violence in the Health Sector - Country Case Study Research Instruments - Survey Questionnaire. 2003; [Available from:].
19. Gormley MA, Crowe RP, Bentley MA, Levine R. A national description of violence toward emergency medical services personnel. Prehosp Emerg Care. 2016;20(4):439-47.
20. Jiménez RE, Bachelet VC, Gomolán P, Lefio LÁ, Goyenechea M. Violence and burnout in health care emergency workers in Santiago, Chile: A survey-based cross-sectional study. Int Emerg Nurs. 2019;47:100792.
21. Bigham BL, Jensen JL, Tavares W, Drennan IR, Saleem H, Dainty KN, et al. Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: a mixed-methods cross-sectional survey. Prehosp Emerg Care. 2014;18(4):489-94.
22. Fernandes A, Sa L. Psychosocial risks of relief professionals: violence in pre-hospital settings. Rev Enferm Ref. 2019;4(21):131-40.
23. Coskun Cenk S. An analysis of the exposure to violence and burnout levels of ambulance staff. Turk J Emerg Med. 2019;19(1):21-5.
24. Gillespie GL, Gates DM, Miller M, Howard PK. Workplace violence in healthcare settings: risk factors and protective strategies. Rehabil Nurs. 2010;35(5):177-84.
25. Edward KL, Ousey K, Warelow P, Lui S. Nursing and aggression in the workplace: a systematic review. Br J Nurs. 2014;23(12):653-4, 6-9.
26. Pai DD, Lautert L, Souza SBCd, Marziale MHP, Tavares JP. Violence, burnout and minor psychiatric disorders in hospital work. Rev Esc Enferm USP. 2015;49(3):457-64.
27. Rahmani A, Hassankhani H, Mills J, Dadashzadeh A. Exposure of Iranian emergency medical technicians to workplace violence: a cross-sectional analysis. Emerg Med Australa. 2012;24(1):105-10.
28. Hosseinikia SH, Zarei S, Najafi Kalyani M, Tahamtan S. A cross-sectional multicenter study of workplace violence against prehospital emergency medical technicians. Emerg Med Int. 2018;2018:7835676.
29. Nikathil S, Olaussen A, Gocentas RA, Symons E, Mitra B. Workplace violence in the emergency department: A systematic review and meta analysis. Emerg Med Australas. 2017;29(3):265-75.
30. Grange JT, Corbett SW. Violence against emergency medical services personnel. Prehosp Emerg Care. 2002;6(2):186-90.
31. Shields M, Wilkins K. Factors related to on-the-job abuse of nurses by patients. Health Rep. 2009;20(2):7-19.
32. Taylor JA, Barnes B, Davis AL, Wright J, Widman S, LeVasseur M. Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department. Am J Ind Med. 2016;59(2):150-63.
IssueVol 6 No 4 (2022): Autumn (October) QRcode
SectionOriginal article
DOI 10.18502/fem.v6i4.10436
Aggression Emergency Medical Technicians Emergency Medical Services Iran Workplace Violence

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Baratloo A, Saberian P, Rezaie M, Kolivand P, Hasani-Sharamin P, Bahreini M. Frequency and types of workplace violence against emergency medical technicians: a cross-sectional study in Tehran, Iran. Front Emerg Med. 2022;6(4):e52.


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