"It's more than just blood pressure and stitches": a critical examination of paramedic services from the perspectives of intimate partner violence advocates.

backgroundAs a detrimental and persistent criminal, social, and health issue, intimate partner violence (IPV) is a severe threat to the well-being of survivors. The healthcare system, specifically the emergency department, has provided access to services and supports for survivors of IPV when seeking healthcare. However, many survivors of IPV are unable to attend the hospital and access the corresponding services. Paramedics, versatile in-community service providers, could play a vital role in linking survivors to healthcare and support services. In-community IPV advocates understand the circumstances of survivors and have expert knowledge of services.

objectiveTo examine how the perspectives of IPV advocates can inform our understanding of paramedic services.

methodsActioning an interpretive description approach in the context of paramedicine, IPV advocates in western Canada participated in semi-structured focus groups. Focus groups were transcribed verbatim and de-identified. De-identified transcripts were inductively analyzed (NVivo) for patterns.

resultsN = 17 IPV advocates (all women; age 42 ± 12) participated in focus groups. Participants indicated that primary and emergency healthcare, recognition of and validation for situations involving IPV, and the referral to specialized resources were desirable services paramedics could provide. Challenges for survivors accessing services through paramedics were paramedic conduct, paramedic capacity, paramedic service shortcomings, situational logistics, concurrent conditions, service access, and patient and perpetrator factors. Solutions for these challenges include adopting safe, equitable, and patient-centred practice, establishing and maintaining functional working capacities for paramedics, developing functional infrastructure and supporting policy, providing adaptable and versatile service options, avoiding biases and stereotypes, and considering holistic patient concerns, generating innovative methods to promote service access for all patients, and integrating techniques to facilitate patient engagement and mitigating perpetrator interference.

conclusionsGiven the desired services from paramedics and the challenges identified for survivors, it is likely that a practice gap exists among paramedics and paramedic services. IPV advocate-derived solutions may help inform paramedics and paramedic services to address these challenges. If the best available evidence is utilized to develop positive change, paramedics could advance into specialist resources for survivors of IPV.