Hamidreza Shabanikiya - Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Fatemeh Kokabisaghi - Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Morteza Mojtabaeian - Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Tara Sahebi - Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi Varmaghani - Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Violence is increasing in societies and workplaces around the world. This study aimed to review the literature on violence against paramedics in the prehospital setting and estimate the related exposure rates and types. Materials and Methods: The study was conducted based on the guidelines of systematic reviews and meta-analyses. The literature on the prevalence of workplace violence against paramedics published from January ۱۹۹۰ to September ۲۰۱۹ was searched in PubMed, Web of Science, Scopus, ProQuest, and Embase databases. The prevalence of violence was measured by using the random-effects model in Stata software. Sub-group analysis and meta-regression models were applied to explain the sources of heterogeneities. Results: The prevalence of overall violence, physical violence, verbal violence, and sexual harassment among study subjects were calculated to be ۰.۶۶ (۹۵% CI CI: ۰.۲۰-۱.۱۱), ۰.۲۵ (CI: ۰.۱۶- ۰.۳۴), ۰.۵۸ (CI: ۰.۲۹-۰.۸۶) and ۰.۱۶ (CI: ۰.۰۹-۰.۲۲), respectively. There was no significant difference between male and female paramedics in terms of violence types. However, the prevalence of sexual harassment among women was higher than men (۲۴% vs. ۶%). The highest rate of physical violence and sexual harassment belonged to Europe and North America, while they had the lowest verbal violence. Asia and Australia had the lowest rate of physical violence and sexual harassment.  Conclusion: Prehospital emergency service providers face a higher risk of potential exposure to violence in health care settings. This issue necessitates the special attention of prehospital care administrators to reduce the risk and related consequences of workplace violence by taking effective measures.

Paramedics, Workplace violence, Meta-analysis, Assaultive Behavior