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Published: 01 March 2025
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March 2025 Tip of The Month - Identifying Intimate Partner Violence (IPV) in Prehospital Care

March 2025 Tip of the Month: Identifying Intimate Partner Violence (IPV) in Prehospital Care

Recognizing the Signs of IPV

Intimate partner violence (IPV) is a significant issue across Canada, and Northwestern Ontario is no exception. Studies indicate that up to 35% of women in the region will experience IPV in their lifetime, with higher rates reported in rural and remote communities. Certain Indigenous populations face even greater vulnerability due to unique socio-economic and systemic factors.

As frontline healthcare providers, paramedics are often the first point of contact for victims of IPV. Your ability to recognize and respond to IPV is critical for patient safety and well-being.

1. Recognizing Common Presentations

IPV victims may present with:

· Unexplained or inconsistent injuries (e.g., bruises, fractures, lacerations).

· Injuries in various stages of healing.

· Vague, non-specific complaints (e.g., headaches, abdominal pain, anxiety).

· Injuries to areas typically covered by clothing, such as the abdomen, chest, or back.

· Behavioral signs, including nervousness, avoidance of eye contact, or reluctance to provide details about injuries.

2. Observing Behavioral Cues

· A controlling or overly attentive partner insists on speaking for the patient.

· The patient appears fearful, anxious, or depressed when discussing their injuries.

· The patient hesitates or resists answering questions when their partner is present.

3. Using Open-Ended and Non-Judgmental Questions

Creating a safe and private environment allows patients to disclose abuse. Consider asking:

· “Can you tell me what happened today?”

· “Do you feel safe at home?”

· “Has anyone hurt you or made you feel afraid?”

4. Utilizing the HITS Screening Tool

The HITS (Hurt, Insulted, Threatened, Screamed) tool is a simple, validated screening method to assess IPV. Patients rate four questions on a scale of 1 to 5 (Never to Frequently):

· Hurt – "How often has your partner physically hurt you?"

· Insulted – "How often has your partner insulted or talked down to you?"

· Threatened – "How often has your partner threatened you with harm?"

· Screamed – "How often has your partner screamed or cursed at you?"

A score of 10 or higher suggests a potential IPV case, warranting further assessment and intervention. The brevity of this tool makes it especially useful in prehospital settings.

5. Identifying High-Risk Factors

Certain factors increase the urgency of IPV intervention:

· Strangulation – A strong predictor of future lethal violence.

· Pregnancy-related injuries.

· Multiple EMS calls for vague complaints in a short timeframe.

6. Documenting Accurately

· Record verbatim statements from the patient.

· Describe visible injuries and behavioural cues objectively.

· Avoid assumptions—stick to observable facts.

7. Referral and Reporting

  • Hospital Triage: Communicate any IPV concerns to your receiving facility
  • Self-Referral Support Services: IPV survivors can access support services independently. Referring patients to available programs and treatment centres can connect them with vital resources.
  • Mandatory Reporting: If there are children in the home aged 16 or under, paramedics have a legal obligation to report suspected IPV to child protective services.
  • Resource and Support Links:

Evidence-Based Practice

Research indicates that up to 40% of women treated by EMS have experienced IPV, yet it frequently goes unrecognized. The HITS screening tool has been shown to improve IPV identification and facilitate early intervention in prehospital care.

Your Role in IPV Recognition

By applying these guidelines, paramedics can play a critical role in identifying IPV and ensuring that victims receive the support they need. Early recognition and appropriate action can make a life-saving difference.

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