Physical and verbal aggression encountered by out-ofhospital emergency responders in the autonomous community of Madrid: differences between urgent and emergent care settings

Bernaldo-de-Quirós M, Cerdeira JC, Gómez MM, Piccini AT, Crespo M, Labrador FJ

Objectives: To determine the frequency and nature of violence directed at responders

giving urgent or emergent care so that preventive measures can be proposed.

Method: A stratified random sample of 441 emergency responders belonging to the

SUMMA-112 emergency health service of Madrid (135 physicians, 127 nurses, and 179

emergency paramedics) were surveyed (response rate, 89.5%). Questionnaire items

covered sociodemographic and work variables, frequency and nature of injuries or

insults, and the characteristics of the attack. Trained assessors went to each workplace to

deliver and collect the questionnaires.

Results: Physical injuries had been sustained by 34.5% of the responders, and the

percentage was significantly higher in emergent care contexts (42.7% vs 25.7%); 75.3%

had received threats and 76.2% had received insults. We detected no significant

difference in the frequency of verbal attacks between urgent and emergent situations.

The setting was the patient’s home in 46.2% of the violent encounters. The main reason

for aggression was dissatisfaction with care provided. Significant differences between the

main reasons for attacks in urgent and emergent situations were observed: wait times

triggered aggression according to 41.3% of those responding to emergencies, whereas

disagreement with regulations led to aggressive behavior according to 30.2% of

responders in urgent care situations.

Conclusions: This survey detected a high percentage of physical violence, especially in

emergency care contexts. The patient’s home was often the scene of the more serious

attacks. The main reasons for aggression were wait times and dissatisfaction with care.

Responder safety during home visits should be improved. Conflict management training

should be provided.

Bernaldo-de-Quirós M, Cerdeira JC, Crespo M, Gómez MM, Labrador FJ, Piccini AT