Ambulance staff subjected to violence and harassment on alcohol-related callouts, study finds

Scottish ambulance staff are frequently being subjected to violence, aggression and sexual harassment when they attend alcohol-related callouts, according to new research.

The first-of-its-kind study by the University of Stirling reveals anxiety and frustration among ambulance staff and warns that alcohol-related ambulance callouts have knock-on effects on responses to other patients.

The authors of the study highlight the need for improved support options for patients with chronic alcohol problems, as well as stronger government regulation. Limiting the sale of alcohol after midnight to fewer premises, and introducing restrictions on alcohol marketing, would help reduce this demand for ambulances over time, they say.

The qualitative study, funded by the Chief Scientist Office, part of Scottish Government, is believed to be the first to give voice to ambulance staff on the challenges of dealing with emergency callouts linked to alcohol consumption. Researchers interviewed 27 frontline ambulance clinicians across Scotland, including paramedics and paramedic technicians, as well as four senior Scottish Ambulance Service staff.

Unpredictable behaviour

Interviewees reported unpredictable behaviour from intoxicated patients, with callouts taking place in difficult environments – bars, clubs and streets – where ambulance staff regularly experienced violence and harassment from patients and bystanders.

One male paramedic technician who took part in the study said: “The only times I’ve been physically threatened, if not assaulted, have always been drunk patients. I’ve been punched, I’ve been kicked, I’ve been bit(ten). I’ve been chased with knives due to drunk people.”

Sexual harassment was more commonly reported by female staff. One female paramedic technician said: “The thing is that you don’t know how [intoxicated patients] are going to turn, ‘cause one minute they can be nice and the next minute they can be…It’s almost like the flick of a switch and they can just turn so nasty.”

The frequency and repetitive nature of callouts – with the same patient often needing to be attended to multiple times – were seen as having a huge impact on the ambulance service, adding significantly to an already very heavy workload. This was the case all year round but exacerbated by certain events.

Stretched to the limit

One female paramedic technician said: “I think when we are stretched to the limit, resources-wise, we are getting these calls through. We feel that they are having a massive impact on our staffing, our resources…sometimes we can go to two and three and four alcohol-related call-outs in a row. It gets to the stage where you’re thinking, oh no, not another one.”

She added: “We kind of dread the football matches and we think, oh no, where are they playing? Are they playing at home this day? Or we dread New Year, or we dread the Christmas season, where we’re having the office parties and you’re thinking, oh, here we go.”

Calls to patients with alcohol dependence were particularly time-consuming due to the complexities of these patients’ needs, commonly including mental ill-health – with ambulance staff reporting that they take a lot longer than other jobs.

One male paramedic explained: “You go to someone who’s got chest pain and is an alcoholic [sic] that could potentially go up to two hours, two and a half hours because it’s really hard to do the assessment, it just slows everything down. And you’ve got the ones that don’t want to travel, and they have to travel or they’re being awkward, or you end up with the police there as well.”

Duty of care

Dr Isabelle Uny, Research Fellow at the University of Stirling’s Institute for Social Marketing and Health (ISMH), and lead author of the paper said: “Our findings show the extent to which alcohol consumption, both on social occasions and by people with alcohol dependence, adds to the pressure on ambulance services and staff.

“We found that ambulance staff displayed a deep duty of care to these patients, despite the frustrations, challenges and aggression, and often treated experience of violence or harassment as routine.”

One in six ambulance callouts in Scotland are alcohol-related, according to previous research by the University of Stirling.

The findings come as the Scottish Government considers further action to restrict alcohol marketing, which, if implemented, is likely to be helpful over time. The UK government is currently seeking evidence on reforms to the alcohol licensing system in England and Wales that Stirling researchers say would have the opposite effect – further increasing the numbers of premises selling alcohol from an already record high and making it harder for local authorities to regulate late-night sales.

Harmful impacts

Professor Niamh Fitzgerald, the principal investigator on the study, and Director of ISMH, said “The latest UK government proposals to further liberalise the alcohol licensing system are likely to increase pressure on ambulance services in England and Wales – making alcohol even more easily available twenty-four seven, including from shops and via rapid delivery. These findings remind us that this would be bad news for efforts to reduce ambulance waiting times.

“We already know what measures work to reduce the harmful impacts of alcohol – restricting availability, increasing price, and reducing marketing – it is up to both local and national governments to decide to take those measures.”

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance UK, said: “This research provides a stark reminder of the profound impact alcohol has on our emergency services – placing an avoidable strain on hospitals, paramedics, and other frontline staff, and diverting vital resources away from patients with other urgent medical needs. Current UK Government plans to make alcohol even more accessible are deeply concerning. These proposals risk exacerbating the pressures on emergency services and making it harder for frontline workers to do their jobs and protect the public.”

Interviews were carried out between May 2019 and June 2022. The extended period of data collection was due to the impact of the Covid-19 pandemic on Scottish Ambulance Service staff.

The data is from a wider study, The Impact of Minimum Pricing of Alcohol on Ambulance Callouts in Scotland (HIPS 18/57) funded by the Scottish Government Chief Scientist Office.