A Systems Framework for Preventing Occupational Violence in Paramedicine: An Integrative Review and Implementation Roadmap

Background: Occupational violence is a significant threat to paramedic safety, psychological wellbeing, workforce sustainability, and continuity of care. Existing prevention approaches often emphasise individual behaviour and de-escalation, with less attention to the organisational, operational, and encounter-level conditions through which violence risk develops. Objective: This integrative review synthesised evidence on occupational violence prevention in paramedicine and used the findings to develop the Paramedic Occupational Violence Systems Model (POV-SM), an evidence-informed conceptual framework for Australasian ambulance services. Methods: Whittemore and Knafl’s five-stage integrative review method was used to identify, evaluate, and synthesise evidence published between January 2008 and March 2026. Seventy-eight sources, including qualitative and epidemiological studies, intervention evaluations, systematic reviews, standards, and selected organisational evidence, were analysed using thematic synthesis and systems mapping. A subsequent translational synthesis mapped the identified determinants and interventions across system levels and stages of prevention. Results: Five evidence streams identified interacting determinants of occupational violence: system demand and workforce conditions; operational and information-system factors; encounter-level and environmental dynamics; intervention and technology considerations; and governance, reporting, and organisational-learning requirements. These findings informed the POV-SM’s interconnected domains of upstream determinants, operational triggers, encounter dynamics, downstream consequences, and system controls. Evidence-to-framework mapping was then used to identify potential prevention and implementation considerations. Conclusions: The review indicates that occupational violence in paramedicine is produced through interacting system conditions and is unlikely to be adequately addressed through isolated individual-level interventions. The POV-SM offers an evidence-informed structure for organising multilevel prevention, but it has not yet been empirically validated. Stakeholder assessment, feasibility testing, pilot implementation, and prospective evaluation are required before its effectiveness can be established.