THUNDER BAY – Thunder Bay paramedics are joining a province-wide study on workplace violence, hoping to spur action on what leaders in the field call an escalating crisis.
The Violence Against Paramedics: Building the Case for Change study, overseen by Peel Regional Paramedic Services in partnership with the University of Windsor, will track incidents of violence against the first responders at more than a dozen EMS services across Ontario over the coming year.
Superior North EMS, which serves Thunder Bay and the wider district, recently signed on, joining several other Northern Ontario services including Kenora-based Northwest EMS.
Researchers will look to build data on common risk factors and the physical and mental health consequences that result, hoping to inform new policies and supports.
Justin Mausz, a longtime advanced care paramedic with the Peel service who’s leading the study, said experiences of violence play a big part in the profession’s growing mental health and burnout crisis.
“We’re looking at this situation that was widely recognized as a crisis before,” he said. “Tack on a pandemic, tack on burnout, tack on growing antipathy and even hostility towards health care workers, and this is really at a boiling point – it’s something we need to address.”
Mausz, who is completing a PhD on psychological health and safety among paramedics, said while the issue has received increased public attention in recent years, there’s surprisingly little solid data.
“I just assumed there was a literal and figurative army of researchers looking at this topic of paramedic mental health,” he said. “I mean, how could there not be? We’ve seen a lot of news coverage around suicide and PTSD among paramedics.”
The research that does exist paints a distressing picture.
A 2017 survey of Canadian emergency services personnel found nearly half of participating paramedics met the screening criteria for one or more mental illnesses. A quarter screened positive for PTSD, 45 per cent for chronic pain, and 10 per cent had attempted suicide.
In a 2014 study in Ontario and Nova Scotia, 75 per cent of paramedics reported being the victim of violence on the job over the previous year, including instances of verbal abuse, while more than a quarter had been physically assaulted.
That study also found more than 80 per cent of the incidents were never formally reported.
Superior North EMS began tracking incidents of violence only in recent years.
Since Nov. 1, 2019, the agency has recorded 90 incidents involving violence or harassment of a paramedic on the job. Of those, 59 involved physical violence, 46 required first aid, six required further health care, and three resulted directly in lost time on the job.
The issue isn’t new – local paramedics have been calling attention to it for years, requesting self-defence training and protective equipment. But Rob Moquin, who represents paramedics in the city of Thunder Bay as Unifor Local 39-11 unit chair, said it’s getting worse.
“The violence has been ever-increasing over the last number of years,” he said.
His role as peer support and wellness coordinator with Superior North EMS has also given him a window into the increasing stresses faced by paramedics.
While all EMS services appear to be facing increased violence on the job, Moquin suspects issues of addiction, mental health crisis, and gang-related drug trafficking are playing a larger contributing role in Thunder Bay than elsewhere.
“In probably the last five or six years, we’ve seen a big increase with the violence on the streets and mental health [issues],” he said. “The drug trade in Thunder Bay has certainly brought a lot of interesting aspects to the daily [experience] of paramedics… we’re seeing a lot of guns and gangs in the community.”
“It’s sad, but we have an ask with our employer for ballistic vests. We’re in situations that are quite frankly dangerous. We’ve had some close encounters with firearms in the last couple of years, more so in the last year.”
Superior North EMS chief Wayne Gates, a former paramedic, said the service has started providing new equipment to deal with the issues.
“In the last two years, we’ve had to start carrying spit hoods and soft restraints in our ambulances,” he said. “I’ve been in this business 30-plus years, and I can tell you 20 years ago, we’d never have even thought of that. There was violence back then, but nowhere to the extent that we’re seeing today.”
Experiences of violence are “a very big piece” of the profession’s growing problem with burnout, mental health injuries, and people leaving the profession entirely, Moquin said.
The rise in mental health injuries among paramedics and other emergency responders has been identified as a crisis by the City of Thunder Bay, driving more overtime demands and exploding Workplace Safety and Insurance Board (WSIB) costs.
The WSIB budget at Superior North EMS increased by $800,000 in 2021 alone, after a similar increase the previous year, and was identified as one of the biggest drivers of tax increases in city budget documents.
EMS leaders say paramedics are being asked to tackle mental health- and addictions-related issues their services weren’t designed to deal with.
“What I’ve been saying for years is EMS has become the colander of society – we respond to calls that don’t necessarily fit other first response protocol,” Moquin said. “We’re dealing with a lot of mental health issues, a lot of socio-economic issues [that] we’re truly not trained in.”
The union leader pointed to the joint mobile crisis response team, a partnership that allows mental health crisis workers to assist Thunder Bay police with some calls, as an example of the shift that may be needed in response.
“As paramedic services, we really are the safety net for the community – kind of the last resort when people call,” Gates agreed. “I’m hoping through this study, they can develop programs that will prevent us even having to be involved.”
Mausz said support from police can be crucial for paramedic safety, but he doesn’t believe it’s the main answer.
“Given that a lot of the incidents of violence that are perpetrated against paramedics come about because of conditions of social inequity, of injustice, of inadequate primary or mental health care, I would really hate for our response to this problem to be more policing,” he said. “It’s a very blunt instrument – it’s appropriate in some cases, but not all of them.”
In Peel, a smaller study on paramedic violence led to new policies like training on mental health crisis and de-escalation, and the distribution of new equipment.
Peel EMS also adopted a “zero tolerance” position toward violence.
“We’re recognizing we may not be able to prevent incidents of violence, but that doesn’t mean it’s acceptable,” Mausz said. “The value… is greatest for the individual paramedics, knowing that when they’re subjected to incidents of workplace violence, we as an organization care.
“Somebody’s going to show up and talk to that paramedic and say, ‘Hey, I’m sorry you had to deal with that – are you okay, what do you need?’ It might seem on the surface like a simple gesture, but I think it’s actually one of the most powerful ones we can make.”
The study includes EMS services in urban areas like Durham, Windsor, and Peel, alongside more rural ones, including strong Northern Ontario representation from services based in Sault Ste. Marie, Sudbury, Thunder Bay, and Kenora.
“That’s going to give us a really important opportunity to look at the differences between exposure to violence in urban versus rural settings,” Mausz said.
The first results from the study are expected to be published in late 2022 or early 2023.