Towards a Paramedic Risk Matrix: Exploring workplace violence through ambulance clinicians’ narratives

Abstract Background: Workplace violence (WPV) against ambulance clinicians (ACs) is a persistent and complex problem that threatens staff safety, health and quality of patient care. Despite growing awareness, limited attention has been given to how paramedics reason and manage risks of WPV. Aim: This study aimed to explore ACs' lived experiences of WPV in the prehospital context and how they perceive individual and contextual factors influencing risk assessments and management. Method: An episodic narrative interview approach was employed, involving 10 paramedics exposed to WPV, to elicit narratives of WPV and broader reflections. Data were analysed inductively, drawing on thematic and interpretive narrative analysis. Peer-debriefing was used to increase the credibility and trustworthiness of interpretations. Results: Participants’ narratives revealed individual differences and changes throughout their careers in how they assessed the risk for WPV. A combination of internal willingness to help, situational awareness, professional duty, moral reasoning, and intuitive judgment influenced their assessments. In addition, challenges in conveying and documenting risk assessments, perceptions of being misunderstood by stakeholders, feeling low-ranked, and not being supported by managers challenged their risk management. Perceptions among paramedics and their stakeholders on what constitutes acceptable and unacceptable risks challenged risk management. From these insights, a conceptual framework—the Paramedic Risk Matrix for Workplace Violence—was developed. The model, based on paramedics' experiences and reasoning, can be useful for sparking discussions among and beyond paramedics on what are considered acceptable and unacceptable levels of risk in paramedic practice. Conclusion: ACs’ responses to WPV are grounded in complex, context-dependent reasoning that balances ethical, emotional, and professional factors. Understanding how paramedics construct and manage risk can inform more realistic prevention strategies, organisational support systems, and policy development. The Paramedic Risk Matrix offers a practical tool to guide reflection, training, and decision-making in WPV management within paramedicine.