The Staff Observation Aggression Scale - Revised for Ambulance Services (SOAS-RA).

Introduction: Ambulance personnel frequently encounter aggression in dynamic and unpredictable environments. Despite growing awareness of workplace violence in healthcare, few validated tools exist for systematic documentation in ambulance services.

Objective: This study aimed to adapt and validate the Staff Observation Aggression Scale - Revised (SOAS-R) for use in ambulance services (SOAS-RA), and to examine the relationship between SOAS-RA severity scores and staff's subjective perceptions of incident severity using a Visual Analogue Scale (VAS).

Methods: Using a modified Delphi method, a panel of ambulance professionals adapted the SOAS-R to the ambulance service context. Data were collected from 34 ambulance stations across Norway using paper-based SOAS-RA forms. A total of 402 reports were submitted, with 302 including valid VAS scores. Descriptive and inferential statistical analyses examined associations between objective severity scores (SOAS-RA) and subjective ratings (VAS).

Results: SOAS-RA total scores showed a small to moderate correlation with VAS ratings (r = 0.350, p < 0.001). The strongest predictor of perceived severity was "consequences for the victim" (β = 0.274, p < 0.001), followed by "means used by the aggressor" (β = 0.180, p < 0.001). Female staff rated incidents as more severe than male staff (p = 0.030), despite similar SOAS-RA scores.

Conclusions: The SOAS-RA, combined with VAS, may serve as a valid, context-sensitive tool for documenting aggression in ambulance services. Future research should explore broader implementation and digital integration to enhance usability, data quality, and support organizational learning.