Rethinking paramedic occupational injury surveillance: a systems approach to better understanding paramedic work-related injury

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Paramedic work occurs in complex, dynamic, uncontrolled, and unpredictable work environments which increase their risk of occupational injury. The complex and multi-factorial nature of paramedic occupational injury requires a holistic systems-based approach to identify and understand contributory factors of paramedic occupational injury. Systems thinking methods are useful for understanding and responding to complex issues, however these have never been applied to the surveillance of paramedic injuries. Through a narrative review of the paramedic occupational injury literature, this paper aims to establish the currently known contributors of paramedic injury, examine the extent to which a systems thinking approach has been applied in this context, and outline how these could be integrated into current paramedic injury surveillance systems. A search of Ovid Medline between the years 2004–2021. In total, 120 literature works were used to develop the systems maps and models presented in this paper. These included: a social-ecological model; an ActorMap; an AcciMap; and a PreventiMap. The findings illustrate the complexity and diversity of the factors contributing to the occurrence of paramedic injury at work. However, systems thinking-based approaches like those presented in this paper are not a substitute for the traditional epidemiological approach to injury surveillance, rather these approaches should be incorporated together to improve risk and protective factor identification, facilitating the development and implementation of targeted interventions.

Original languageEnglish
Article number106419
Number of pages17
JournalSafety Science
Publication statusPublished - Apr 2024


  • Emergency medical services
  • Injury surveillance systems
  • Occupational injuries
  • Paramedic
  • Social-ecological frameworks
  • Systems thinking

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