Characteristics of 9-1-1 Calls Associated with an Increased Risk of Violence Against Paramedics in a Single Canadian Site

<b>Background/Objectives</b>: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. <b>Methods</b>: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. <b>Results</b>: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. <b>Conclusions</b>: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use.