Intimate Partner Violence and Paramedicine: An Updated Scoping Review of Perspectives and Practices.

Abstract

Objectives: Intimate partner violence (IPV) is increasingly being recognized as a clinical circumstance to which emergency medical services (EMS) clinicians attend; it refers to the use of physical, sexual, psychological, and coercive violence by a current or former intimate partner to exert power and control. The intersection of paramedicine and IPV remains largely unclear. Our objective is to provide a comprehensive synthesis of the available evidence at the intersection of paramedicine and IPV.

Methods: This review followed a published protocol (Open Science Framework), and PRISMA-ScR guidelines. Co-developed with two trained librarians, a search strategy was used to locate potential articles in MEDLINE and CINAHL, including a gray literature search. Included articles examined perceptions and/or practice of EMS clinicians and students in the context of IPV. Titles and abstracts were screened by two reviewers, followed by full text reviews when eligible; a third reviewer resolved any disagreement(s). Data were extracted using a purpose-built template and the findings were summarized and synthesized.

Results: Of the 517 articles, 34 met inclusion criteria. The literature was varied and heterogenous, preventing mass, detailed synthesis. Generally, EMS clinicians were motivated to assist IPV survivors but perceived their education as insufficient to provide high-quality care, reporting low rates of training/education with corresponding low self-efficacy. Considerations for the specific and unique environment of paramedicine were lacking. Standardized patients and/or simulations were beneficial for pre-practice students acquiring history gathering and interview skills. Jurisdictional variations in legislation, policy, and standards, as well as overlapping agency/department regulations introduced practice variance. The validity and utility of EMS clinician-collected surveillance data were unclear.

Conclusions: While EMS clinicians were recognized as a poorly understood, under-utilized, and under-equipped resource for IPV survivors, current literature is insufficient to comprehensively guide practice. Heterogeneity and limited quantity contribute to this challenge. Future research should leverage newly developed and validated measures to identify gaps responsive to educational and/or policy interventions and explore novel technologies to improve the quality of EMS clinician-collected IPV data. Equipping EMS clinicians with the tools to provide high-quality IPV care will benefit IPV survivors, EMS clinicians, and health care more broadly.