Are A ustralian paramedics prepared for intimate partner violence?

Dear Editor, Intimate partner violence (IPV) is a common occurrence in Australian society, with far-reaching health, social and economic implications. The victims of IPV requiring medical care are often encountered by paramedics in the prehospital environment. However, paramedics receive little training and education in the management of such patients. Over the past two decades the international literature has repeatedly highlighted this issue and yet Australian research has stagnated in both the prehospital recognition and management of IPV. Practical attempts to improve outcomes for victims (the vast majority of whom are female) by Australian paramedic organisations have also been minimal. We recently examined the results of a questionnaire given to 50 Australian Capital Territory paramedics that measured their frequency of attending IPV cases, paramedic knowledge of IPV and their perceived preparedness for IPV cases. We found that 90% of participants had responded to at least one IPV case in the preceding year (with a range of 0–20 cases), with an average of 3.66 cases. Notably, none of the paramedics sampled used any IPV screening tools, and therefore was likely to have suspected IPV only where it was overt. Victims of IPV will not always volunteer the true cause of their trauma and might even attempt to hide the fact. Thus, there is significant underreporting in the above data. Furthermore, two-thirds of participating paramedics were unaware of the lack of mandatory reporting legislation in their state, and almost four in every five reported feeling less than confident in managing IPV cases. Although there is no other Australian literature available, our results are consistent with a previous web-based survey by Mason et al. in Ontario province in Canada. This study reported a similar frequency of IPV cases, as well as poor knowledge and preparedness of their paramedic participants, and the intention to give emergency medical services providers specific education and training on domestic violence. The USA has attempted to introduce standardised and empirically evidenced prehospital screening for domestic violence (IPV). However, at the time of writing, Australian paramedic agencies have not taken on such an initiative. Previous work has queried why IPV is not addressed to any significant extent either in prehospital educational courses or indeed by paramedic organisations themselves. The results from our research increase the urgency for an answer to such a question. Our results suggest that paramedics are not equipped to deal with this particular category of patients that they regularly encounter. In the light of the insidious nature of the trauma suffered by such patients, it is surprising that action in the form of education and awareness has not been conducted sooner. Preparing paramedics with the appropriate attitude, knowledge and skills to effectively deal with victims of IPV to the same extent as those provided for the management of road trauma will assist paramedics to better care for these patients. Among Victorian women aged 15–45, IPV is responsible for more illhealth and premature death than any other of the wellknown risk factors, including high blood pressure, obesity and smoking. Looking forward, we hope that government, health and paramedic organisations recognise the need for greater research, education and action to correct this lack of knowledge and skills. Critical next steps are to ensure the accurate reporting of IPV cases encountered in the prehospital environment, and to identify potential IPV screening tools. Once reliable baseline data are available, a national education programme for paramedics to enable them to accurately discover and effectively manage IPV cases must be implemented. Swift and decisive action from Australian paramedic agencies should then result in a significant reduction of the burden of IPV.