Prevalence of Workplace Violence Types against Personnel of Emergency Medical Services in Iran: A Systematic Review and Meta-Analysis

  • Ali Sahebi Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Katayoun Jahangiri Mail Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Sanaz Sohrabizadeh Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Mohamad Golitaleb Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran.
Emergency Medical Services (EMS), Systematic Review and Meta-Analysis, Workplace Violence


Objective: Workplace violence is one type of occupational hazards that is increasingly growing worldwide. In the health system, one of the important groups subject to workplace violence is emergency medical services (EMS) personnel, who provide emergency services for patients and casualties as the first responders. The aim of this study was to determine the prevalence of workplace violence and its different types among Iranian EMS personnel.
Method: This study was conducted based on PRISMA guideline for systematic review and meta-analysis. The data were extracted from Scopus, PubMed, Web of Science, Google Scholar, SID and MagIran databases using Persian and English keywords. The search was conducted up to December 2018 without any limitation in publication year. The qualities of selected papers were assessed by STROBE checklist. I2 index was used to evaluate heterogeneity, and random effects model was used in meta-analysis. Data were analyzed using Stata14.
Results: A total of 9 studies entered the meta-analysis. The total sample size was 1257 Iranian EMS personnel, with an average age of 32.21 ± 2.01 years. The prevalence of physical, verbal, and cultural workplace violence among EMS personnel was 36.39% (CI 95%:27.29–45.50, P<0.001, I2 = 90.8%), 73.13% (95% CI=68.64-77.62, P=0.013, I2 = 62.7%), and 16.51% (95% CI =3.49- 29.53, p<0.001. I2 = 94.7%), respectively.
Conclusion: Considering the high prevalence of workplace violence among EMS personnel in Iran, more studies should be conducted to determine the underlying causes of EMS staff workplace violence in Iran. Training violence prevention methods as well as assigning national protective rules are highly suggested. Insufficient studies on Workplace violence among EMS personnel in Iran and high heterogeneity were the limitations of this study.


1. Campo VR, Klijn TP. Verbal abuse and mobbing in pre-hospital care services in Chile. Rev Lat Am Enfermagem. 2018;25:e2956.
2. Deniz T, Saygun M, EROĞLU O, Ülger H, Azapoğlu B. Effect of exposure to violence on the development of burnout syndrome in ambulance staff. Turk J Med Sci. 2016;46(2):296-302.
3. Maguire BJ, O’neill BJ. Emergency Medical Service Personnel’s Risk from Violence While Serving the Community. Am J Public Health. 2017;107(11):1770-1775.
4. Maguire BJ, Browne M, O’Neill BJ, Dealy MT, Clare D, O’Meara P. International survey of violence against EMS personnel: physical violence report. Prehosp Disaster Med. 2018;33(5):526-531.
5. Nikathil S, Olaussen A, Symons E, Gocentas R, O'reilly G, Mitra B. Increasing workplace violence in an Australian adult emergency department. Emerg Med Australas. 2018;30(2):181-186.
6. Bayram B, Çetin M, Oray NÇ, Can İÖ. Workplace violence against physicians in Turkey’s emergency departments: a cross-sectional survey. BMJ open. 2017; 7(6):e013568.
7. Petzäll K, Tällberg J, Lundin T, Suserud BO. Threats and violence in the Swedish pre-hospital emergency care. Int Emerg Nurs. 2011;19(1):5-11.
8. Kaeser D, Guerra R, Keidar O, Lanz U, Moses M, Kobel C, et al. Verbal and non-verbal aggression in a Swiss university emergency room: a descriptive study. Int J Environ Res Public Health. 2018;15(7): E1423.
9. Pourshaikhian M, Gorji HA, 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.
10. Alharthy N, Al Mutairi M, Alsahli A, Alshehri A, Almatrafi A, Mahah A, et al. Workplace violence among emergency medical services workers in Riyadh, Saudi Arabia. Journal of Hospital Administration. 2017; 6(3):26-32.
11. 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): 150–163.
12. Rafeea F, Al Ansari A, Abbas EM, Elmusharaf K, Zeid MS. Violence toward health workers in Bahrain Defense Force Royal Medical Services’ emergency department. Open Access Emerg Med. 2017; 9: 113–21.
13. 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):167-180.
14. van der Velden PG, Bosmans MW, van der Meulen E. Predictors of workplace violence among ambulance personnel: a longitudinal study. Nurs Open. 2015;3(2):90-8.
15. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.
16. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12(12):1500-24.
17. Yousefi K, Larijani HA, Golitaleb M, Sahebi A. Knowledge, attitude and performance associated with disaster preparedness in Iranian nurses: a systematic review and meta-analysis. Adv J Emerg Med. 2019; 3(4): e42.
18. Maghami M, Aghababaeian H, Saadati M. Evaluation of Physical Violence against Emergency Personnel at Work in 2013[In Persian]. Sadra Med Sci J 2014; 2(4): 379-88.
19. Maghami M, Aghababaeian H, Bosak S. Evaluation of Verbal Violence against Emergency Medical Personnel at Work in 2014 [In Persian]. Occupational Medicine Quarterly Journal. 2015; 7(1):32-40.
20. 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 [In Persian]. Journal of Management and Medical Informatics School. 2014; 1(2):111-7.
21. Hosseinikia SH, Zarei S, Najafi Kalyani M, Tahamtan S. A Cross-Sectional Multicenter Study of Workplace Violence against Prehospital Emergency Medical Technicians. Emergency medicine international. 2018; 2018: 7835676.
22. Rahmani A. Assessing Workplace Violence toward Ems'personnel in Prehospital Settings of East Azerbaijan Province [In Persian]. Scientific Journal for Forensic Medicine. 2009; 15 (2):100-7.
23. Bozorgi F, Laali A, Khademloo M, Ehteshami S, Assadi T, Pashaie SM, et al. Incidence and Risk Factors of Workplace Violence against Pre Hospital Staffs in Mazandaran; North of Iran [In Persian]. International Journal of Medical Investigation. 2018; 7(4):15-20.
24. Soheili A, Feizi A, Rahmani A, Parizad N, Sheykh-Kanlou J. The extent, nature and contributing factors of violence against Iranian Emergency Medical Technicians. Nurs Midwifery Stud. 2016; 5(3):e29619.
25. Afkhamzadeh A, Azadi N, Farahmandian Z, Mohamadi-bolbanabad A. Prevalence of Workplace Violence of Emergency Medical Staff and Relevant Factors in Sanandaj, Iran in 2016 [In Persian] . SJNMP 2018, 4(1): 71-80.
26. Golzare Zahmatkesh Sanggouei A, Pourshaikhian M, Esmaeilpour Bandboni M, Moghadamnia MT, Kazem Nezhad Leyli E, Hasandoost F. Workplace Physical Violence against the Pre-hospital Emergency Staff in Guilan Province. Journal of Holistic Nursing and Midwifery. 2018; 28(1):56-63.
27. Bigham BL, Jensen JL, Tavares W, Drennan IR, Saleem H, Dainty KN, and Munro G. 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
28. Harorani M, Varvanifarahani P, Yazdanbakhsh SA, Pakniyat AG, Sadeghi H, Norozi M, et al. Evaluation of the Vulnerable Factors of Occupational Violence against Practitioner Medical Personnel in the Emergency Units of the Training Hospitals of Arak City. Medical Ethics Journal [In Persian]. 2017; 11(39):55-61.
29. Koohestani HR, Baghcheghi N, Rezaii K, Ebrahimi Fakhar HR. Risk factors for workplace violence in emergency medical technician students . Iran Occup Health [In Persian]. 2012; 9(1):68–75.
30. Harorani M, Pakniyat AG, Jadidi A, Sadeghi H, Varvanifarahani P, Golitaleb M, et al. The Extent of Maintaining the Privacy of Patients Hospitalized in Emergency Departments of Hospitals Affiliated with Arak University of Medical Sciences; a Cross-sectional Study [In Persian]. Iranian Journal of Emergency Medicine. 2017 Oct 8; 4(4):158-63.
31. Najafi F, Fallahi-Khoshknab M, Dalvandi A, Ahmadi F, Rahgozar M. Workplace violence against Iranian nurses: A systematic review [In Persian]. J Health Promot Manage. 2014; 3(2):72–85.
32. Grange JT, Corbett SW. Violence against emergency medical services personnel. Prehosp Emerg Care. 2002;6(2):186-90.
33. Rahmani A, Hassankhani H, Mills J, Dadashzadeh A. Exposure of Iranian emergency medical technicians to workplace violence: A cross‐sectional analysis. Emerg Med Australas. 2012;24(1):105-10.
34. Dalvand S, Ghanei Gheshlagh R, Najafi F, Zahednezhad H, Sayehmiri K. The Prevalence of Workplace Violence against Iranian Nurses: A Systematic Review and Meta – Analysis. Shiraz E-Med J. 2018; 19(9):e65923.
How to Cite
Sahebi A, Jahangiri K, Sohrabizadeh S, Golitaleb M. Prevalence of Workplace Violence Types against Personnel of Emergency Medical Services in Iran: A Systematic Review and Meta-Analysis. Iran J Psychiatry. 14(4):325-334.
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