Cross-sectional study of workplace violence prevention training among emergency medical services personnel and students.

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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Emerg Med . 2026 Apr 21;26:164. doi: 10.1186/s12873-026-01592-x Cross-sectional study of workplace violence prevention training among emergency medical services personnel and students Tia Windahl 1, ✉ , Jenni Hämäläinen 1 , Anu Venesoja 1, 2 Author information Article notes Copyright and License information 1 Faculty of Health, LAB University on Applied Sciences, Yliopistonkatu 36, Lappeenranta, 53851 Finland 2 Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 63, Helsingin Yliopisto, 00014 Finland ✉ Corresponding author. Received 2026 Feb 9; Accepted 2026 Apr 16; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13231783  PMID: 42014990 Abstract Background Workplace violence (WPV) in emergency medical services (EMS) has become a part of everyday life, constituting an occupational safety risk for paramedics. This study aimed to explore EMS personnel and students’ experiences and expectations regarding WPV prevention training. Methods A cross-sectional study using data collected via social media. The survey included structured and open-ended questions that were analyzed by using descriptive statistics and inductive content analysis. Results A total of 124 EMS personnel responded, with 93% having received WPV prevention training during their studies or at work. Key topics included anticipation, planning and preparedness (92%), occupational safety (87%), and situational awareness (84%). Less covered topics were organizational reporting (41%), filing a criminal report (30%), and screening previous risk information (14%). Among those who had received training, 90% found it useful, citing benefits like improved preparedness, situation management, safety, and a sense of security. As the result of a qualitative analysis, the main category Consistent training to reinforce safe practices and resilience was created. This category consisted of three sub- categories: Consistency, Safe working practices, and Attention to psychological resilience and recovery . Conclusions Training appears to be well-structured, but it seems to lack uniformity and does not fully meet the needs of EMS personnel and students. In particular, the portion of the training related to aftercare in WPV situations seems to receive insufficient attention. Further research is needed to determine how WPV prevention training should be developed. The knowledge gained from this study can be utilized in educational institutes and EMS organizations to support the development of WPV prevention training. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-026-01592-x. Keywords: Workplace violence, Workplace violence prevention training, Emergency medical services, Qualitative study, Survey Background Workplace violence (WPV) is any unacceptable act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs towards people at work. WPV can take many forms, including verbal and physical abuse, harassment, exclusion, bullying and intimidation. WPV results in physical, psychological, sexual or economic harm. It can include gender-based violence and harassment [ 1 ]. A variety of individuals can be perpetrators of WPV, such as patients, the patient’s family and friends, co-workers and management [ 2 ]. Factors that increase violence include shift work and high demands of the job, which are both common in healthcare [ 3 ]. Almost 60% of healthcare workers have experienced WPV [ 4 ]. The most common form of violence against healthcare personnel is verbal abuse [ 2 , 4 ]. Every fifth healthcare worker has experienced physical violence and every tenth sexual harassment [ 4 ]. However, WPV situations often go underreported due to dissatisfaction with how previous WPV reports were handled [ 5 – 9 ]. This includes not taking incidents seriously enough [ 5 ], a belief that violence is part of the job [ 6 , 7 ], insufficient time [ 8 ], or that no physical harm has been done [ 9 ]. Additionally, organizations can discourage from reporting such incidents, or organizations lack a policy for processing reports [ 10 ]. Overall, workplace violence in healthcare is most common in psychiatric settings, emergency departments, and emergency medical services (EMS) [ 11 ]. EMS personnel operate in high-stakes, unpredictable and changing environments, doing demanding work in various types of missions outside of the hospital [ 12 ]. In relation to unpredictable and changing environments, WPV against EMS personnel is a global concern [ 13 ]. It seems that WPV situations in EMS have become a part of everyday life, constituting an occupational safety risk for EMS personnel [ 14 , 15 ]. In the context of EMS, WPV incidents are mostly initiated by patients, their family members, acquaintances, or bystanders present at the scene of out-of-hospital care [ 13 , 16 ]. Stress caused by working in an unsafe environment can also impact EMS personnel’s clinical judgement, since perceived or actual threats of WPV may pressure them to make rapid decisions to leave the scene or delay patient care [ 17 ]. In addition to any potential harm to the patient, WPV situations can cause harm to the EMS personnel. The experience of feeling threatened has proven to be a significant predictor for emotional exhaustion and an aggressive response to emotional stress among EMS personnel [ 18 ]. In addition, a supportive team environment in the workplace can act as a protective measure against WPV [ 3 ]. Regardless of the form of WPV, it can have far-reaching physical, occupational, and negative psychosocial consequences amongst healthcare workers: hypervigilance, loss of empathy, emotional exhaustion, frustration, sleeping disorders, stress, anxiety, and social phobia [ 7 , 19 , 20 ]. Mental violence, threats and verbal sexual harassment can lead to burnout [ 21 ]. Further, it is shown that WPV and EMS personnel’s psychopathological symptoms are related. Symptoms of post-traumatic stress disorder (PTSD), depression and anxiety are related to WPV situations if WPV has caused significant injury or has been life-threatening [ 22 ]. Overall, there is a need for better understanding of contextual factors and worker’s approaches to violence [ 23 ]. Elvegård (2025) has argued that violence prevention management and training is guided by institutional logics. It seems that training is guided by user rights and needs, safety/security, health and environment (SHE), bureaucracy and system, knowledge and evidence, service delivery, applicability and practice reality [ 24 ]. In addition, it seems to be meaningful if trainers are credible, training includes possibilities to share WPV experiences and discuss those experiences, WPV training includes clinical content, and that training focuses on prevention as well as general and situational awareness. Overall, it seems important that an organization has psychologically safe environments, since these support skills that aid in preventing WPV [ 25 ]. It is stated that EMS organizations should be guided away from reactive strategies that merely mitigate WPV and instead encourage adopting approaches that enhance paramedics’ awareness and capacity to navigate dynamic social contexts. Such a cultural shift would foster a more equitable, human-centered management framework that could help to mitigate factors which contribute to interpersonal violence [ 16 ]. To our best knowledge, current research provides no evidence-based interventions to prepare EMS personnel for WPV. Although various strategies—from zero-tolerance policies to engagement with aggressors—have been introduced, there is no evidence of their effectiveness in reducing workplace violence. Most interventions focus on incident management rather than prevention. Existing literature points to significant gaps in the scope and quality of training, particularly in de-escalation that could otherwise help prevent the use of inappropriate or excessive force [ 19 , 23 ]. Therefore, our aim was to explore whether EMS personnel have received training on WPV prevention, or not, what type of training was utilized, and what kind of experiences and expectations EMS personnel and students have about WPV prevention training. Methods Study design and setting This article presents a cross-sectional survey that applies a qualitative approach. The study follows a multimethod design [ 26 ], as both a descriptive quantitative analysis of structured survey items and a qualitative inductive content analysis of open-ended responses were conducted within a single methodological framework. This methodological alignment provides a coherent framework for addressing the multidimensional nature of the research aim [ 26 ]. The Checklist for Reporting Of Survey Studies (CROSS) [ 27 ] was used to guide reporting of this study. The target group of this study consisted of personnel working in emergency medical services (EMS), such as paramedics, emergency medical technicians (EMT), and rescue workers as well as students pursuing studies in the field of EMS in Finland. For clarity and to cover all these EMS personnel groups working in EMS, we will refer to them as ‘EMS personnel’. This approach ensured that the collected data accurately reflects the experiences and expectations of individuals currently engaged or intending to engage in emergency medical services for whom preparedness for threat and violence situations is an essential part of professional competence. According to Finnish law, safety at work is the responsibility of the employer. For example, the employer must provide training to avoid hazards and threats and ensure that workers have access to appropriate safety equipment [ 28 ]. Thus, employers should provide WPV prevention training for emergency workers. Occupational safety in emergency care can be included in the paramedic curriculum [ 29 ]. However, there are no uniform criteria for what and how WPV prevention training should be provided. Survey design A purpose-designed survey was developed to gain an understanding of the views and experiences of EMS personnel and students pursuing EMS education on current WPV prevention training. The survey included structured and open-ended questions. The survey was designed by a group of EMS researchers, EMS personnel who were also EMS WPV prevention training specialists, and students pursuing EMS education. The survey was developed based on the types of WPV training available at the time in educational institutions and EMS workplaces. The survey also included items addressing post-incident support measures that are in use within Finnish EMS organizations. Before disseminating the survey, it was piloted with four EMS WPV prevention training specialists. After the pilot, minor changes were made concerning the wording and structure of the questions. The final survey contained 11 different questions, including structured and open-ended questions (Appendix 1 ). Some of the structured questions offered the possibility to choose between several options. Compulsory questions were marked with an asterisk. Data collection, participants, and sample size Data was collected for three weeks in July 2024 via social media, which has been previously shown to be an effective way to collect data in health, medical, and social research [ 30 , 31 ]. The target group of the survey was EMS personnel and EMS students. A web-based survey design and convenience sampling [ 32 ] were applied to achieve a wide number of descriptions from EMS personnel and EMS students of WPV prevention training. A web-based survey link (Webropol ® ) was shared with the target group through four closed, moderator-controlled social media groups (Facebook ® , WhatsApp ® ). In three groups, a membership requires a verified professional background in EMS and is approved by group moderators. Members in three groups are mainly EMS personnel, students pursuing EMS education, or they are EMS stakeholders. In one group, the members are generally people working in the healthcare sector. Therefore, we informed them that this survey is intended for those people who are working at EMS or are pursuing EMS education. The survey link was opened 607 times: 124 started to respond and a total of 124 people completed the survey. No incentives were given to the participants. Analysis Due to the limited number of student responses, it was decided to merge the responses of professionals and students. In Finland, EMS students complete clinical placements in EMS units, exposing them to similar operational environments and safety challenges as qualified personnel. As they are trained by the same educators and participate in comparable field contexts, their perspectives are analytically comparable to those of practicing EMS professionals. Therefore, the responses of students and qualified personnel were analyzed together. The structured data was used to elicit information about the respondents’ education, whether they had encountered WPV themselves, or not, and how often they had received WPV prevention training. Responses to the question, ‘If you have received WPV prevention training, which of the following topics did it include?’ were also counted. An inductive content analysis [ 33 ] was used to analyze the open-ended questions. The data was processed in Microsoft Excel. Otherwise, coding was done without using any other analysis software. First, all authors carefully read through the answers to the open-ended questions to get an overall impression of the data and respondents’ descriptions of their views of WPV prevention training. Next, responses were systematically coded, and similar descriptions were assigned the same open code. After coding, these codes were grouped into a sheet with other related codes. These coding sheets were then abstracted into subcategories. Subcategories were then grouped into generic categories and finally into the main category. An example of the coding tree is presented in Appendix 2 . During the analysis, there was a continuous process of moving back and forth between the entire dataset, the codes, the subcategories, and the categories. The authors held multiple discussions to ensure the reliability and credibility of the analysis. The analysis continued until consensus between the researchers was reached. All researchers had access to the data and the option to participate in the progress of the analysis, increasing the reliability of the process. The last phase of the analysis was the conceptualization of the results displayed in Fig. 2 . Fig. 2. Open in a new tab Qualitatively derived categories representing experiences and expectations towards WPV prevention training in EMS Ethics This study involves human participants and the Declaration of Helsinki’s guidelines [ 34 ] were followed. According to Finnish law and national guidelines [ 35 , 36 ], the study setting employed in this study does not need a formal ethical approval. A data protection statement and information about the study’s purpose were shared with the participants together with the survey link. The requirement for signed written informed consent was waived because of the study design. Participants received information about the study, and informed consent was implied through their voluntary completion and submission of the survey. Answering the survey was voluntary, and the participants had the right and possibility to withdraw from the study by suspending mid-survey or by choosing not to send the answers. No personal information that could be used to identify respondents was collected, and the survey platform used (Webropol) did not provide researchers with access to respondents’ IP addresses or other traceable data. Results Structured data The study consisted of 124 participants from all over Finland. 88% of the respondents encountered WPV during their work in the EMS. The majority of the respondents were EMS personnel ( n = 109). Most of the respondents (93%) had received WPV prevention training. Almost all had received training through a work organization, but less than half of the respondents reported receiving WPV prevention training during their studies. A small part of participants reported that they received their education somewhere else, for example: training offered by a trade union, conference workshops, via hobbies, or during previous occupational studies (Table 1 ). Table 1. Educational information about WPV prevention training WPV prevention training ( n = 124) n % Yes 115 92,7 No 9 7,3 Provider ( n = 115) * College 53 46,1 Workplace 92 80,0 Other 12 10,4 Educational method ( n = 113) * Contact learning 111 98,2 Online learning 13 11,5 Duration of the training ( n = 115) * less than an hour 9 7,8 couple of hours 56 48,7 1 day 47 40,9 2 days 20 17,4 Other 3 2,6 Benefit ( n = 107) Yes, define 96 89,7 No, why? 11 10,3 Refresher training ( n = 121) Yes 35 28,9 No 86 71,1 Open in a new tab *Possibility to choose multiple options Respondents ( n = 98) mentioned that a typical on-the-job instructor for WVP training is someone from the EMS personnel with a background in martial arts or previous work experience in the security sector (e.g., as police or security guard). An instructor for EMS personnel will often also have some form of WPV prevention training-instructor status. In addition, the training provided during studies is typically delivered in collaboration between the lecturer of pre-hospital care and a visiting police officer. According to the respondents ( n = 115), the content of the training focused on actions during EMS missions and legislative issues. However, respondents stated that during the training less attention was given on how to deliver aftercare to WPV victims. (See Fig. 1 ) Fig. 1. Open in a new tab Reported content of WPV prevention training in EMS ( n = 115) Qualitative data The main category Consistent training to reinforce safe practices and resilience of EMS personnel highlights the experiences and expectations that EMS personnel express concerning WPV prevention training. This main category consists of three generic categories: Consistency , Safe working practices , and Attention to psychological resilience and recovery . The main category and generic categories are presented in Fig. 2 with their subcategories. Consistency A nationally consistent educational model According to the respondents, WPV prevention training is expected to be based on a nationally consistent model, focusing on the needs of working life. Responders indicated that the frequency and regularity of the training should be nationally guided or regulated. Training should be more regular , with mandatory practice sessions , just like CPR training. One-time training doesn’t help much. You might remember something like choking someone , but nothing more. (Resp. 52) More WPV prevention training should be provided in schools , and employers should have a statutory obligation to organize training regularly , for example twice a year. The content of the training should also be defined by law or regulation. (Resp. 16) According to the respondents, lack of consistency and regularity in WPV prevention training can lead to situations where training requires only mandatory minimum needs, or training is only focusing on narrow aspects of WPV. To be honest , my employer is only concerned with fulfilling the bare minimum training requirements , with the mindset that situations in the field can be handled just by talking. (resp. 29) The training was limited in scope and consisted mainly of instructions on how to break free from a physical assault. (resp. 20) The respondents mentioned that WPV prevention training is expected to enhance both knowledge-based and practical competencies. There is a need for more information on legislation, particularly focusing on the rights of the patient and the paramedic. More information is needed on the rights of both the patient and the employee , as well as the consequences of violent situations for both parties. (resp. 36) Consistent operational models Respondents hoped for nationwide harmonized operational models between different EMS organizations and authorities. Similarly, within work communities and in collaborative work between colleagues, respondents wished for shared practices, for example, a common language. The respondents described that training should also enhance interpersonal aspects, such as establishing a shared approach with one’s work partner. There should be harmonized operational guidelines at least for collaborative areas for healthcare and social welfare. (Resp. 33) A shared approach with your coworker , anticipating the situation , and leaving before anything physical happens. (resp. 7) Safe working practices Risk analysis According to the respondents, the WPV prevention training enhanced their risk analysis skills by increasing precautionary, safety-promoting behavior at a practical level. Respondents reported having learned new (operational) risk analysis models through various real-life examples. These included, for instance, inspecting the environment, maintaining awareness of one’s surroundings, and ensuring personal safety. The respondents also mentioned the importance of pre-planning, for example, securing escape routes, using a safety code word, and executing early withdrawal from potentially escalating situations. The most important lesson is to be prepared for the worst , check every corner and hiding spot , and make sure your back is covered. (resp. 63) In everyday work , the use of the safety code word had been quite vague , and the training encouraged me to use it more proactively. (resp. 19) Co-operation with the authorities Respondents are looking for tangible methods and straightforward examples to help them maintain safety when cooperating with other authorities. They stress the need to adopt specific working procedures that improve security during joint operations with these organizations. For example, the respondents desire increased collaboration in training between different authorities (e.g., the police). More emphasis should be placed on prevention and developing collaboration with the police. (resp. 38) …joint trainings/simulations with , for example , the police. EMS personnel work very closely with the police , and I have found during my career that police officers do not always seem to realize that EMS personnel do not have the same equipment or authority as the police. (Resp. 74) Concrete ways to increase safety According to the respondents, WPV prevention training should not focus solely on lectures; it is expected to provide real-life examples and clear practical exercises. Respondents wish for more information about the emergency call button functions, how EMS personnel should position themselves related to each other and the patient, and more practical self-defense skills. Respondents suggested integrating violent situation-scenarios into regular simulation exercises. Integrate it [violent situation scenario] into something like a regular CPR simulation or similar. In WPV prevention training simulations , everyone knows something’s about to go down , but what if , for example , in a chest pain scenario , a family member suddenly pulls out a knife? (resp.74) According to the respondents, the content preferences for WPV prevention training revealed varying perspectives on necessary topics. Respondents have a hope for more practice in communication, such as verbal judo and how to approach people in challenging situations. Respondents recognized that both nonverbal communication and deliberate word choices can play a key role in preventing the escalation of challenging situations. Learning and practicing verbal judo and other proactive strategies before incidents occur. (Resp. 9) There should be much more focus on practicing and emphasizing proactive action and how to approach a person , rather than stirring up the need for using force in paramedic work. (Resp. 18) While there was a general desire for training to focus primarily on prevention, there was also support for ‘tougher’ measures. Respondents expressed a wish for additional clarifications on the EMS personnel’s authority to act, such as the permission to use pepper spray as well as more exercises on control holds and the use of force. The training should focus more on how to avoid situations where you could become a target of violence. (resp. 27) Some ‘extra backup’ needs to be gradually added to the ambulance. Like a pepper spray. (resp. 2) Situational awareness Respondents highlighted that developing situational awareness was crucial, and they credited WPV prevention training with helping them pay closer attention to their environment during emergency situations. They also mentioned that EMS personnel’s own attitude and behavior can significantly shape how others act in high-stress settings, making self-awareness essential for ensuring both safety and effective situational assessment. Overall , situational awareness is key in potentially threatening situations. It is also important to recognize how one’s own behavior and choice of words can have an impact. (resp 15) Attention to psychological resilience and recovery Managing and recognizing stress The responses highlighted the importance for paramedics to recognize their own stress. Respondents expected that WPV prevention training (and employer support) would help them to increase their resilience and abilities to recover. Respondents further mentioned that there is a desire for WPV prevention training scenarios that would allow them to realize which situations trigger reactions in themselves, and how they behave as a result. Threats are not always external. It’s important to recognize how you react in tense situations and what might trigger you. (resp. 37) Respondents state that because of the WPV prevention training, paramedics should be able to reflect on and develop their own attitude and behavior when working in a patient’s home. Further, they mention that the possibility of threatening situations is either not taken seriously enough, or the risk is ignored. Although respondents emphasized that paramedics should not have to experience violence or even the threat of it, perceptions of what constitutes a threatening situation vary widely. With known dangerous individuals still being handled , where the police aren’t seen as necessary , while the patient is there waiting with a knife. If the risk is known , it needs to be considered , even if police resources are stretched thin. (resp. 40) According to the respondents, WPV prevention training contributed to an improvement in their self-esteem. They also experienced increased confidence and assertiveness in their professional conduct because of the training. For instance, respondents perceived maintaining composure in situations involving aggression as easier. Additionally, the respondents described that their overall sense of safety has improved. A calm approach to the situation , with confidence in using control holds. (resp. 18) I got confirmation that my own safety comes first , and also some tips on how to prevent a patient from attacking. (resp. 53) Aftercare actions Respondents indicated that WPV prevention training should include additional instruction on psychological resilience and recovery skills. Furthermore, they valued the information provided regarding opportunities for post-incident debriefing. …after this , the information about defusing conversations was also helpful (resp. 48) More emphasis should also be placed on psychological resilience and recovery. (resp. 42) Respondents noted that, as part of aftercare, additional training is needed on how and when to file a criminal report following an incident. In my opinion , more emphasis should be placed , for example , on the possibility of filing a criminal report and making it clear that any form of violation of personal integrity or threats is unacceptable. (resp. 39) Discussion In this study, most of the respondents (88%) encountered WPV during their work in the EMS. This percentage is higher than that of a previous study that examined how many healthcare workers had encountered WPV in their work [ 4 ]. However, the results of the present study support previous findings that paramedics encounter violence more frequently in their work than employees in other areas of healthcare [ 11 , 14 ]. If workplace violence in a healthcare setting is not addressed, it has significant legal, ethical, and moral consequences for the industry and ultimately undermines the quality of care provided [ 2 ]. Therefore, this study’s aim was to explore if paramedics have received training on WPV prevention, what kind of training has been provided to EMS personnel and students, and what kind of experiences and expectations do EMS personnel and students have about their training. Most of the respondents had received training through a work organization, but less than half of the respondents reported receiving WPV prevention training during their studies. This means that many newly graduated paramedics might enter the field of emergency care without WPV prevention training, which can potentially weaken their occupational safety and abilities to act in WPV situations. McGuire et al. (2025) states that new EMS personnel can be inexperienced with violence in EMS and unprepared to handle it [ 7 ]. Based on our results, it could be beneficial for new employees to receive WPV prevention training provided by the employer, but training is not necessarily available before starting the employment relationship or even at the beginning of employment. Further, it is important to note that students may encounter WPV situations during their studies while on clinical placements [ 37 ]. Accordingly, it is imperative that WPV prevention training be made available to students during their studies. Previous research has proposed that WPV prevention training in healthcare should encompass formal education, opportunities for experiential learning and application in the workplace, as well as mechanisms for support, reporting, and follow-up [ 25 ]. Also, the rationale and underlying logic for WPV training are described, encompassing user rights and needs, safety/security, health and environment (SHE), bureaucratic and systemic considerations, knowledge and evidence, service delivery, and the applicability and practical realities of implementation [ 24 ]. The results of the present study somewhat corroborate these findings. It seems that WPV prevention training provided to Finnish EMS personnel reflects these earlier propositions by showing that current WPV prevention training in EMS includes elements of practical and experiential learning, workplace-applied skills, and aspects of safety and situational management, but remains inconsistent and insufficient particularly in areas such as reporting, follow-up, and broader organizational or systemic considerations. Further, the results of this study suggest that desired WPV prevention training to EMS personnel should mostly focus on factors related to the real-world activities of EMS tasks and how the EMS personnel can prevent or minimize the risk of WPV through their own actions. Similar findings have also been reported in another study [ 7 ]. When it comes to Finnish settings, our results indicate that anticipation, planning, and preparation are generally included in WPV prevention training. According to the results, WPV prevention training was generally perceived as useful, and training has provided additional skills in, for example, anticipation, preparedness, overall situation management, and maintaining general safety. This finding partly coincides with healthcare managers’ views on the content of WPV prevention training [ 38 ]. In this study, 89.7% of the respondents stated that WPV training has been useful in EMS contexts. However, 10.3% of the respondents experienced reduced benefits due to limited training and insufficient content. Similar mixed views on the content and applicability of WPV training among EMS personnel has been shown in another study [ 23 ]. Based on our results, WPV training is not organized regularly, and the content of the training requires development. The reason might be limited resources and funding, as well as lack of a consistent educational program that organizations could use [ 38 ]. The present study illustrates that training on follow-up measures and how to report WPV incidents is inadequate, even though it has been suggested that follow-up measures and reporting should be part of WPV prevention training [ 25 ]. It is important to notice that emotional stress is the most common injury after WPV situations in EMS [ 39 ]. In worst cases, WPV situations can cause post-traumatic stress [ 7 ] and PTSD symptoms [ 22 ]. However, not all WPV situations are reported through official channels, often due to fear of negative consequences, perceiving the situation as not serious, assuming it to be a normal part of the job, or because the organization’s culture or work practices do not support reporting [ 5 , 6 , 8 , 9 , 40 ]. The likelihood of increasing reporting of WPV incidents may remain low if training does not explicitly address proper reporting procedures, emphasizing its importance, and incorporating follow-up measures after such incidents. This highlights the need to incorporate and strengthen follow-up measures and reporting procedures within the content of WPV prevention training. Strengths and limitations This study acknowledges several limitations, particularly concerning data collection via social media, which may introduce selection biases and affects the generalizability and transferability of the results [ 41 ]. To mitigate the risk of responses from non-target participants, no incentives were provided. The use of social media and web-based surveys poses a risk of selection bias due to the potentially non-representative nature of the social media population and the possibility of self-selection bias, where respondents are inherently interested in the topic. Despite these limitations, social media platforms, particularly Facebook, offer significant advantages such as cost efficiency, time savings, and the snowball effect in data collection. Previous research indicates that data obtained through Facebook is comparably representative to that collected via traditional methods, thereby supporting the validity of social media as a data collection tool [ 30 , 31 ]. Further, this study shares limitations common to other research utilizing web-based surveys for data collection [ 42 , 43 ]. The aim of this study was to gain an overview of the current WPV prevention trainings in Finnish EMS and educational organizations who educate future EMS personnel, rather than to conduct a comparative study. A qualitative approach was chosen for this study, since it enabled the researchers to gain unique insights into respondents’ personal experiences and perspectives [ 44 ]. However, due to the data collection method being an anonymous survey, no follow-up questions to gain further insight into the respondents’ replies could be asked. This could be seen as a limitation. The multimethod design provided both descriptive and exploratory insights into WPV prevention training, but the results should be interpreted cautiously because the quantitative and qualitative components were drawn from the same convenience sample and were not intended to be fully generalizable. Given the qualitative nature of the study, trustworthiness [ 45 ] was strengthened through detailed reporting of the research context, participants, data collection, and analysis, with the questionnaire included as an appendix 1 and the example of the analysis process documented in a separate appendix 2 . The findings can inform WPV prevention training development, although their transferability to other settings depends on contextual fit rather than statistical generalizability. Nevertheless, this study presents valuable insights into current WPV prevention training in EMS. Practical applications The results of this study provide important insights that can inform the development of more comprehensive and consistent workplace violence (WPV) prevention training within educational institutions and EMS organizations. Given that most EMS personnel encounter WPV during their work and that training is often obtained only after entering the workforce, educational programs should consider integrating WPV prevention more systematically to ensure that new professionals are adequately prepared for the demands of emergency care. The findings further indicate that while existing training is generally perceived as useful, its irregularity, limited scope, and insufficient attention to reporting procedures and aftercare restrict its overall effectiveness. Consequently, EMS organizations may utilize these findings to establish consistent and regularly implemented training models that emphasize anticipation, preparedness, situational awareness, psychological resilience, and clear follow-up practices. Such enhancements can support safer working environments and strengthen EMS personnel’s resilience. However, the practical applicability of these recommendations may be hindered by insufficient organizational resources, inconsistent institutional priorities, and the absence of standardized national requirements that would guide uniform training implementation [ 38 ]. Conclusions According to the results of this study, WPV prevention training appears to be structured and focused on actions during EMS tasks, but it seems to lack regularity and consistency. It seems that current WPV prevention training does not fully meet the needs of Finnish EMS personnel. In particular, the portion of the training related to reporting and aftercare in WPV situations seems to receive insufficient attention. WPV prevention training is expected by Finnish EMS personnel and students to be nationally consistent and implemented equally across all regions, thereby reinforcing safe practices and enhancing the resilience of EMS personnel. Further research is required to determine how WPV prevention training in EMS can be further developed to ensure greater comprehensiveness and regularity, as well as how follow-up measures and reporting can be systematically integrated into the training content. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (283.1KB, pdf) Supplementary Material 2 (245.3KB, pdf) Acknowledgements We want to thank all the EMS professionals and students for sharing their perspectives. We also want to thank Sebastian Malinowski (LUT University, Lappeenranta, Finland) for proofreading and editing language of this manuscript, and Ella Taponen and Sanni Vainionperä (LAB University of Applied Sciences) for acquisition of data. Abbreviations EMS Emergency Medical Services WPV Workplace Violence Biographies Tia Windahl (MHSc) is a Senior Lecturer in Prehospital Emergency Care at LAB University of Applied Sciences in Finland. She has experience in EMS education, clinical practice, and applied safety research, with a particular interest in improving occupational safety, safety culture and wellbeing of emergency medical services (EMS) personnel. Windahl is engaged in developing evidence-based approaches to strengthen violence prevention training for EMS professionals and students and contributes to international discussions on enhancing safety in prehospital care. Jenni Hämäläinen (PhD) is a Senior Lecturer in Prehospital Emergency Care in LAB University of Applied Sciences. Special areas of expertise are acute care, acute pain management and research methods. Dr. Hämäläinen belongs to the team responsible for the teaching and guidance of international programs. Dr. Hämäläinen is a member of national expert working group of the Nursing Research Foundation. Anu Venesoja (PhD) is a Principal Lecturer at LAB University of Applied Sciences whose work focuses on patient and workplace safety in emergency medical services. Her expertise includes safety culture development, risk management and evidence-based practices that improve operational safety in healthcare environments. Dr. Venesoja contributes to national and international safety initiatives and advances research supporting safer systems of care. Author contributions TW: Conceptualization, Methodology, Formal analysis, Data Curation, Writing - Original Draft, Writing - Review & Editing. JH: Methodology, Formal analysis, Data Curation, Writing - Original Draft, Writing - Review & Editing, Validation. AV: Conceptualization, Methodology, Formal analysis, Data Curation, Writing - Original Draft, Writing - Review & Editing, Acquisition of funding. Funding The authors would like to acknowledge that this research was co-funded by The European Union (EURA 2021/205795/09 02 01 01/2024/KESELY). Data availability Data used and analyzed in this study are available from the corresponding author on reasonable request. Declarations The authors declare that no AI was used in this work except for syntax and grammatical error correction. Therefore, the authors take full responsibility for the content of the publication. Ethics approval and consent to participate According to Finnish law, and national ethics guidelines, the setting of the present study does not need any formal ethical approval. Participation was voluntary and sending the responses were considered as consent to participate in the study. Consent for publication Not applicable. 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