Fitting in or standing out: a scoping review of gender-related findings in Nordic EMS through an organizational socialization lens.

Abstract

Objective: To explore and map research on workplace culture, occupational health, exposure to violence, and organizational dynamics among Emergency Medical Service (EMS) professionals in Nordic countries, focusing on studies reporting gender-related findings between 2010 and 2025.

Methods: A scoping review was conducted in accordance with the JBI methodological guidance and reported using the PRISMA-ScR framework. Searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar covering the period 2010-2025. Studies focusing on EMS professionals and workplace experiences related to gender, workplace culture, discrimination, leadership, or organizational factors were eligible. Data were charted descriptively, using an inductive content analysis approach.

Results: Seven peer-reviewed studies and five master's theses met the inclusion criteria, comprising cross-sectional, prospective cohort, and observational designs. Three explicitly examined gender/equality; other gender-related differentiated findings were reported as secondary observations. Women reported higher physical and psychosocial work demands (43% vs. 22%; 41% vs. 20%), greater concerns about threats and violence (58% vs. 38%), and higher levels of mental health problems (29% vs. 8%) and sleep disturbances (60% vs. 39%). Despite this, women demonstrated higher physical capacity, while men had higher cardiovascular disease risk factors. Men reported greater exposure to certain critical incidents, whereas stress levels were similar between genders. Workplace violence was common, with differences between men and women observed in exposure, perception, and support-seeking behaviors.

Conclusion: This scoping review found that gender-related patterns are present across workplace demands, health outcomes, exposure to violence, and critical incidents, but are rarely explicitly addressed in Nordic EMS research. Rather than isolated findings, these patterns appear to be embedded in organizational processes that shape norms, expectations, and professional identities. For example, women reported higher work demands, greater concern about workplace risks, and poorer mental health outcomes, despite demonstrating high physical capacity, while men reported greater exposure to certain critical incidents. Interpreted through the lens of organizational socialization, these findings suggest unequal access to legitimacy, well-being, and career opportunities, with implications for workforce sustainability. Addressing these issues through organizational and educational strategies may improve working conditions, reduce workplace risks, and support a more equitable and sustainable Nordic EMS workforce.