Abstract Background Emergency Medical Services (EMS) staff frequently encounter violence and aggression (V&A) directed towards them, which negatively affects their wellbeing and provision of services. This is an international problem and employers and others are tackling it through policy, education, legislation, and public information campaigns. The aim of this study was to explore the Welsh publics views of V&A directed at EMS staff and their awareness of policy changes and the reach of media campaigns associated with recent policy changes. Methods In August 2022, we conducted a survey including a YouGov non probabilistic purposive sample of 1,010 Wales adults (aged 18+) from a matched panel representative of the population derived from a UK YouGov panel of >360,000 adults registered. Results Our sample included 52.4% women, median age and IQR was 52 and 52.5% were in social grade ABC1. 60.2% lived in areas with the most urban conurbations and 39.8% in the most rural conurbations. Most (62.5%) participants had heard of an instance of V&A directed towards EMS staff, but 24.4% had never heard, and 72.1% had never witnessed V&A. 15.5% had witnessed V&A directed towards EMS staff less than 10 times and these were more likely to be younger. 17.7% heard via work, and younger participants were more likely hear via social settings. 81.1% heard through media, and older participants were more likely to have heard through the media. 90.4% disagreed that V&A towards EMS staff can be acceptable in some cases and 53.3% were not aware of any related publicity and/or media campaigns. 92.4% thought intoxication with alcohol would likely contribute to V&A towards EMS staff, 90.5% thought intoxication with drugs and 84.3% thought an altered mental status following illness and/or injury would also likely contribute. 22% were aware of the Assaults on Emergency Workers Act, and 75.2% thought those intoxicated with drugs or alcohol would unlikely be deterred from V&A towards EMS staff by this act. 75.6% thought those with altered mental status following illness and/or injury would unlikely be deterred, and 42.2% thought it unlikely other members of the public would be deterred; 42.9% thought it was likely. Younger participants and those with a social grade of C2/D/E were more likely to think those intoxicated with drugs and alcohol, altered mental status following illness and/or injury and other members of the public would be deterred. Conclusion Understanding public attitudes towards V&A directed to EMS staff is important for their wellbeing and maintaining services. There appears to be good awareness of this issue in the Wales public, who also find V&A directed towards EMS staff unacceptable but underestimate the scale of the problem. Whilst the media appears to be the best form of communication, we did not find evidence of impact of current efforts to tackle this issues, as participants were largely unaware of legislation and information campaigns aimed at V&A directed towards EMS staff. Participants overwhelmingly felt current legislation would not deter V&A towards EMS staff, but younger people were more likely to think it would. We therefore recommend massages may be amplified, and targeted towards young people, men, those in social grade of C2/D/E and through social settings where V&A may be encountered more often and who were more likely to feel current legislation would deter. It is unclear if current efforts of policy, legislation and communication campaigns have any impact on talking V&A directed towards EMS staff, and we therefore recommend further research to understand and develop evidence-based interventions, along with tackling the influence of those factors involved, such as intoxication with drugs, alcohol, and altered mental status following illness and/ or injury, by improving education, support, and care provision for these groups of people.

The authors have declared no competing interest.

This study was funded by Welsh Ambulance Services NHS Trust

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the Health Research Authority and Health and Care Research Wales (IRAS ref. 313346). Organisational approval was received from the Medical and Clinical Services Directorate of the Welsh Ambulance Service NHS Trust

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