Do training programs improve a paramedic’s ability to identify and report child abuse and neglect? A systematic review

Kate Brooke Johnson, Elizabeth Doecke, Raechel A Damarell, Hugh Grantham



Paramedics are often the first trained personal to assess sick or injured children. This raises the question of how well trained paramedics are to identify signs of child abuse or neglect. This systematic literature review seeks to establish the extent to which training programs improve a paramedic’s competence and confidence when it comes to identifying and reporting child abuse and neglect.


Selected search terms were entered into eight databases to identify potentially relevant publications. Inclusion and exclusion criteria were applied and articles were categorised as relevant or irrelevant based on a review of title and abstract and, when necessary, full text review.


The initial electronic search yielded 872 articles. After duplicates were removed and the inclusion and exclusion criteria applied, four publications were identified as relevant and included in this systematic literature review. Of these, three were cross-sectional studies and one was a one-group pre-test post-test study. In total, 2499 subjects were examined across the four articles. Despite the limitations of each study, the results for all four studies were consistent with one another, demonstrating that higher levels of training correlated with greater knowledge and/or confidence regarding both the identification process and the correct procedures for reporting child abuse.


The limited evidence published so far suggests that training improves confidence and ability levels of the paramedic in recognising and reporting child abuse. However, the limitations of these studies need to be considered before drawing robust conclusions. We call for further research into the topic and suggest that, owing to the complexity of the issue, a qualitative study may be the best way of exploring the variety of barriers to reporting, and the extent to which training would overcome these.


paramedics; emergency medical technicians; mandatory reporting; child abuse; in-service training

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