A cerebral approach: Recognizing the link between intimate partner violence and traumatic brain injury among paramedics could ease detriment to survivors

Rory A. Marshall^1,2,3, Isaac J. Kool^3,4, Alanna Shwed^1,5, Tori N. Stranges¹, Heather L. Gainforth^1,5, Simon Sawyer^6,7, Paul van Donkelaar¹

1. School of Health and Exercise Sciences, University of British Columbia – Okanagan, Kelowna, BC, Canada
2. Emergency Medical Services, Alberta Health Services, Calgary, AB, Canada
3. British Columbia Emergency Health Services, Vancouver, BC, Canada
4. School of Nursing, Camosun College, Victoria, BC, Canada
5. International Collaboration of Repair Discoveries, Vancouver, BC, Canada
6. Griffith University, Southport, QL, Australia
7. Australian Paramedical College, Burleigh Waters, QL, Australia

BACKGROUND:

Intimate partner violence (IPV; violence, abuse, or harmful controlling behaviours occurring between people currently or formerly in an intimate relationship) remains a public health crisis, predominantly for women. Current estimates indicate that >70% of women who experience physical IPV sustain a traumatic brain injury. Paramedics regularly treat patients who are currently or have previously endured IPV and IPV-caused brain injury (IPV-BI). However, a failure to recognize or act on suspicions of IPV often leaves survivors underserviced and at risk. No regulated IPV training for paramedics exists, indicating that each paramedic’s lived experience could impact their familiarity with this issue. Gender, an aspect of lived experience, may influence IPV knowledge.

OBJECTIVE:

To examine gender influence on knowledge of IPV and IPV-BI in paramedics.

METHODS:

Western Canadian paramedics responded to an anonymous online 7-point Likert survey including IPV (READIness to encounter patients experiencing partner abuse Scale) and IPV-BI knowledge questions, respectively. Between and within gender IPV and IPV-BI knowledge comparisons were explored using a One-Way ANOVA (mean±SD; significance p<0.05) and Cohen’s d effect size (d).

RESULTS:

N=693 paramedics completed the survey (Women 48% [n=330], Men 41% [n=286], Non-Binary <1% [n=1], Not Listed <1% [n=1], No Response 11% [n=75]). Respondents were predominantly cisgender (>99% [n=616]). Self-identified women demonstrated superior IPV knowledge (women 6.1±0.6 versus men 5.9±0.7, p<0.001, d=0.3), and IPV-BI knowledge (women 4.6±0.9 versus men 4.2±1.0, p<0.001, d=0.4) versus men. Women and men demonstrated superior knowledge of IPV versus knowledge of IPV-BI (women 6.1±0.6 versus 4.6±0.9, p<0.001, d=1.9; men 5.9±0.7 versus 4.2±1.0, p<0.001, d=1.6).

CONCLUSIONS:

The relative knowledge deficit among women and men of the connection between IPV and traumatic brain injury (large, positive effects) was substantially larger than the between-gender IPV and IPV-BI knowledge gaps (small, positive effect; medium, positive effect). Knowledge is a crucial component of readiness. Failed recognition and response may result in reoccurring harm for survivors. Universal paramedic-specific IPV education encompassing IPV-BI (e.g., Concussion Awareness Training Tool – Support Workers) could address knowledge gaps, increase recognition and screening, promote effective response, and reduce harm against survivors.