In general, “violence” is a behavior that a person commits against another one, causing physical, sexual, psychological, cultural, and economic harm . Severe physical injuries usually have visible physical symptoms, such as bruising, fractures, tears, bleeding, burns, etc. However, behaviors such as shouting, humiliating, breaking things, or throwing objects as a sign of anger and psychological trauma in general do not have vivid physical symptoms, while they strongly affect mental health . In this study, the causes of violence among pre-hospital emergency staff were investigated. In this study, the causes of violence were classified into three categories: human, organizational, and environmental factors.
According to the findings of the study, human factors include extreme fatigue, stress, job dissatisfaction, anxiety disorders, family problems, loss of confidence, fear, and conflict with negative thoughts. Prehospital paramedic personnel, due to the special condition of the patient, fear of incapacity in saving a patient’s life, time constraints, etc.
In Bayrami et al.’s study that was conducted on “Mashhad pre-hospital emergency challenges”, the findings showed that stress and loss of self-confidence were the main causes of violence ; it is consistent with the results of the present study.
The findings of another study by Dadashzade showed that job dissatisfaction was one of the factors affecting the behavior of employees in emergency centers.
In addition, according to the results of the mentioned study, patients or their companions violence against personnel and lack of a clear legal and protection system for dealing with violence against personnel are some of the challenges faced by personnel; it is in line with the results of the present study . In another study by Moradi et al., the findings showed that excessive workload, job insecurity, and job depression led to burnout and inappropriate behaviors . The results of Moradi’s study confirm the results of the present study.
According to the findings of this study, structural factors including dissatisfaction with work environment, large number of shifts, lack of equipment, lack of levelization, unclear job descriptions, lack of constructive communication with colleagues, ambiguity in tasks or overlap between job tasks are important causes of dissatisfaction and violence in EMS personnel. The finding of a study by Bahrami et al. showed that 85.6% of emergency stations complained about large number of shifts. A study in West Azerbaijan by Vali et al. also showed that 66% of emergency personnel were dissatisfied with the lack of job descriptions and 45.63% of employees were willing to leave their jobs due to lack of levelization .
Considering the structural challenges of pre-hospital emergencies, a number of challenges are related to equipment such as lack of medical supplies, worn-out ambulances, and improper arrangement of facilities that hinder the provision of quality services. In Vatankhah et al.’s study conducted on pre-hospital emergency challenges, the findings show that one of the most important challenges faced by pre-hospital emergency staff is the lack of resources and depreciation. The results of Vatankhah et al.’s study is consistent with the results of the present study . In a study by Erie et al., independence of Emergency and multiplicity of commands were among the challenges affecting the delivery of EMS care services . The results of the present study are in line with the findings of the mentioned study.
According to the findings of this study, environmental factors including accidents, people’s ignorance, traffic problems, and unreasonable expectations of people are important factors involved in the incidence of dissatisfaction and stress and violent behaviors among pre-hospital emergency staff. The findings of a study by Torabi et al., showed that unpredictable conditions at the scene, late arrival at the scene, and the resulting stress lead to stress in pre-hospital emergency personnel . The findings of another study by Eri et al., showed that route conditions and traffic problems were important factors affecting Emergency staff . Furthermore, the findings of Jamshidi et al.’s study, showed that the very low participation of organizations such as traffic police led to consequently and, to severe distrust, which is consistent with the results of the present study . Moreover, in Hosseinikia et al.’s study, EMS staffs’ dissatisfaction with improper expectations of people and their ignorance were the causes of dissatisfaction ; it is consistent with the results of the present study.
In general, cognitive processes related to occupational violence can be explained within six stages. Step 1: The staff encounters an event or events, such as a conflict with one of the relatives of the injured persons, making the staffs anxious and putting a lot of stress on them.
Step 2: The employee thinks the problem is unsolvable. Step 3: While expressing regret over the situation, the employee places all the responsibilities on others and does not blame himself at all.
Step 4: The employee confronts and rejects every process that indicates he or she is also involved in creating current problems. At this stage, the staff convinces himself that the situation is not his fault and at the same time, he does not think of a peaceful solution to get out of that situation. Step 5: The only solution that comes to mind is violence. The staff thinks that he or she can use violence to bring things to an end. Step 6: The employee commits a violent behavior or at least tries to show it. However, if staff learn anger and aggression control skills, they can easily prevent this recurring cycle [3, 6, 25].
Due to the fact that this study was conducted in only four provinces, to reach more accurate conclusions, it is better to conduct the study as a surveillance at the national level.