The important gut feeling: A qualitative content analysis of ambulance nurses’ experiences of encountering victims of domestic violence

Abstract

Domestic violence is a global public health issue which violates women's human rights. Ambulance nurses may encounter women exposed to domestic violence, often under complex and time-constrained circumstances, and often in patients’ homes. The present study aimed to explore how ambulance nurses experience such situations in a prehospital setting. The study's qualitative design was based on eight semi-structured interviews with ambulance nurses in one Swedish region. The data were analysed using qualitative content analysis. The study follows the COREQ (i.e. Consolidated Criteria for Reporting Qualitative Research) reporting guidelines. The findings show that the nurses relied on subtle signs, intuition and experience to interpret the situation and assess potential exposure to violence. Creating trust was described as central, yet difficult. Participants described strategies to enable disclosure, such as separating the individual from their partner and using the ambulance as a neutral space. At the same time, a lack of guidelines and uncertainty about further steps contributed to hesitation and emotional strain. The results point to a need for increased support in the form of education, structured documentation and clear referral pathways. Strengthening these areas may help ambulance nurses feel more confident in responding to domestic violence and contribute to safer care for the victims of domestic violence.

Introduction

The World Health Organisation emphasises domestic violence (DV) as a major global public health issue and violation of women's human rights. DV comprises gender-based violence that results in physical, sexual or mental harm or suffering to women. DV includes physical aggression, sexual coercion, psychological abuse and controlling behaviours. Almost one in three women has experienced DV at some point in their lives. ¹ DV causes momentous suffering among affected persons, ¹ leading to both physical and psychological ill-health. However, hidden statistics in this area of study are substantial because many victims experience feelings of guilt, shame, and fear.^2,3 Even though violence occurs across all social strata and classes, certain factors, such as lower levels of education, a history of exposure to child maltreatment, harmful use of alcohol and community norms, are linked to DV.^1,2,4

The National Centre for Knowledge on Men's Violence Against Women in Sweden characterises DV by the victim's close relationship and strong emotional ties to the perpetrator. ⁵ The Police Authority in Sweden further describes DV as encompassing a range of offences where the victim and perpetrator have or used to have a close relationship. This can include situations where the parties are married, cohabiting, separated or share children. The crimes primarily occur within the home, making them difficult for the police to detect. ⁶

Women subjected to DV often seek healthcare for symptoms not directly related to the violence. ³ Research shows that healthcare personnel may hesitate to ask these persons about their exposure to violence due to factors such as uncertainty and lack of time. The personnel may not consider it their responsibility or fear that the question might humiliate the person.^7,8 Victims of DV tend not to disclose this information voluntarily, placing a significant onus on society to recognise and support them.^3,9

Prehospital care is provided to patients before arrival at the hospital and is characterised by advanced nursing care in uncontrolled environments. The prehospital care environment can range from the patient's couch at home to a busy road or up in the mountains. It can be very challenging due to severe weather conditions, for example, that make the situation even more complex. ¹⁰ Prehospital care places high demands on ambulance personnel, who must focus on the patient and adapt to the care environment.^11,12 Creating a sense of security through respectful patient interactions is crucial. Often, patients find themselves in vulnerable situations in the prehospital care environment, making it essential for ambulance personnel to strengthen the patients’ autonomy and participation in the care process.^11–13

In Sweden, each ambulance crew must include at least one registered nurse. ¹⁴ The primary mission of ambulance personnel is to provide equal healthcare to persons in need, prioritising those with the greatest need. ¹⁵ Ambulance personnel can act as a pivotal link in the care chain through interventions in the prehospital environment.^10,11,16,17

International research indicates that ambulance personnel frequently encounter or suspect DV during assignments.^18,19 As the first link in the care chain, they need to recognise signs of exposure to violence and document the observations. However, studies show that ambulance personnel often need specific training to manage this patient group.^11,17–19 According to Sawyer et al., ⁹ ambulance personnel have a unique opportunity to detect DV when they enter patients’ home environments, where the violence usually occurs.

DV is a social issue with high prevalence rates, both nationally and internationally. However, these figures do not reveal the whole truth. Many reports indicate significant hidden statistics. This means there is little known about what occurs within the walls of homes, which are supposed to be safe and secure, but turn into a place of anxiety and fear for DV victims. DV victims can be anyone, a neighbour, a coworker or a close friend. Upon gaining access to persons’ homes, ambulance personnel gain a unique opportunity to identify such victims. By stepping beyond their thresholds, the personnel can identify victims of violence, expose hidden statistics and ensure more persons receive assistance.

Research on DV in prehospital care is limited in Sweden and the Nordic countries. Thus, the present study contributes further important knowledge on the subject. It is crucial to increase understanding of how ambulance nurses (ANs) can identify exposure to DV and offer appropriate support and care.

Aim

The present study aimed to explore ANs’ experiences of, within a prehospital context, encountering persons affected by domestic violence.

Methods

This study employed a qualitative design with an exploratory approach, suitable for capturing experiences and perspectives. ¹⁹ Individual semi-structured interviews ²⁰ were chosen as an appropriate method for exploring how ANs experience encounters with victims of domestic violence. The interviews were analysed using qualitative content analysis, as described by Graneheim and Lundman. ²¹ Because the study aimed to gain insight into personal perceptions, emotions and contextual challenges, interviews provided the flexibility to allow participants to share rich, nuanced narratives in their own words regarding the sensitive research question.^19,20 To enhance transparency and reporting quality, the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ), developed by Tong et al. ²²

Setting

The research was conducted in a mid-Sweden region responsible for an ambulance service (AS) comprising 11 ambulance stations and one ambulance helicopter base. Approximately 170 employees work for this AS, which handles around 16,000 calls annually.

Typically, an ambulance in Sweden is operated by one AN possessing additional specialist education in prehospital emergency care or another relevant field. They work with either another AN or an emergency medical technician. ²³

Recruitment and sample

Participants were selected using strategic sampling, comprising a method appropriate for qualitative research to explore specific experiences related to the study focus. ¹⁹ Inclusion criteria were being employed as an AN within the regional AS and having experience of encountering persons with suspected or confirmed DV. This approach ensured the inclusion of individuals best positioned to provide in-depth insights aligned with the study's aim.

After providing the operational manager with written information regarding the study and the research process, permission was obtained. Information and invitations were sent via email to unit managers, who forwarded them to employees. Participants provided signed consent and contacted the researchers, after which interviews were scheduled.

The eight participants (male = 5, female = 3), aged between 28 and 53 years (mean = 43 years), had 4–25 years (mean = 14 years) of experience as ANs in the AS. Five participants were specialist nurses in prehospital emergency care, one was an anaesthesia nurse, one was a public health nurse and one was a registered nurse without specialist education. Henceforth, all are referred to as ANs.

The sample size was estimated to be sufficient as no new data emerged during the last interviews, and the number of participants was estimated to be within the range for achieving saturation.^24,25 According to the concept of information power, ²⁶ studies with a focused aim, strong interview dialogue and a specific sample may require fewer participants. The study's narrow aim, the relatively homogeneous group of participants and the expected depth of the data provide information power.

Data collection

Data were collected through semi-structured interviews ²⁰ using an interview guide (Figure 1). The interview guide was developed specifically for this study. It included open-ended questions aimed at exploring how ANs observe, interpret and respond to suspected domestic violence. The guide allowed flexibility in following the participants’ narratives at the same time as ensuring that key areas of interest were covered.

Figure 1.

Overview of interview guide.

A pilot interview with an external contact who had experience from the AS but was not currently employed was held. This interview tested the relevance and clarity of the guide. No modifications were made afterwards. Because the AS did not employ the interviewee, the interview was excluded from the study. The interviews started with the question, “Tell us about a situation where you encountered or suspected domestic violence”, followed by probing inquiries such as “Could you describe more?” or “How do you mean?”. All interviews were conducted face-to-face by one of the first researchers, digitally recorded, pseudonymised, and transcribed verbatim. Interviews lasted between 10 and 23 min (mean = 18 min), were conducted in Swedish, and translated into English during the article's writing.

Data analysis

A qualitative content analysis, as described by Graneheim and Lundman, ²¹ was performed on the interviews. The analysis began by repeatedly reading the transcripts to grasp their overall content, establishing a sense of the whole. Meaning units containing words or sentences relevant to the study's aim were identified manifestly. These units were condensed to capture their core meaning by removing excess words and leaving the core of the unit. These units were then abstracted into codes which described the content. The codes were subsequently grouped into subcategories based on similarities, differences and their connection to the aim. Common perspectives in subcategories led to the emergence of two main categories. Throughout the analysis, researchers revisited the data to verify that categories accurately reflected participants’ experiences, achieving consensus within the research group. ²³

Despite having eight participants, previous research has shown that themes in qualitative interviews often emerge within the first six to 12 interviews, ²⁴ and that saturation commonly occurs within similar ranges in focused qualitative research. ²⁵ In line with this, eight participants were deemed adequate when no new information emerged. This decision also aligns with methodological recommendations emphasising transparency and contextual justification over fixed sample sizes. ²⁷

Ethical considerations

The study was a master's thesis, adhered strictly to Swedish research ethics and data management regulations and followed the Declaration of Helsinki. ²⁸ Ethical approval was not required because the study did not handle sensitive personal data as defined by Swedish law. According to Swedish legislation, ethical approval is mandatory when handling sensitive personal information. The study did not involve such data. Therefore, formal ethical approval was deemed unnecessary. Participation was entirely voluntary. Information about the study was distributed via internal email and interested individuals contacted the researchers directly. All participants provided written informed consent before the interview and were informed of their right to withdraw without consequences.

Recruitment and data collection occurred between 16 November and 12 December 2023. To safeguard confidentiality, all interviews were pseudonymised during transcription. Participants were assigned numerical codes and only the researchers had access to the code key. Audio recordings and transcripts were stored securely on encrypted, password-protected university servers, accessible only to the research team. The study followed the university's guidelines for data management for a master's thesis, ensuring secure handling and storage.

Results

The ANs’ experiences of encountering suspected or confirmed victims of DV in a prehospital care environment were characterised as complex and emotionally demanding. The analysis resulted in two main categories: “The Complex Care Encounter in Domestic Violence” and “The Desire to Improve Care for Victims of Violence”, each comprising several subcategories (Figure 2). These categories reflect both the practical and emotional aspects of responding to suspected DV within the ambulance context, as well as the ANs’ reflections on how care could be improved.

Figure 2.

Overview of the main categories and subcategories.

The Complex Care Encounter in Domestic Violence

The complex care encounter highlights the ANs’ observations, conversations, interventions and emotions when encountering persons subjected to or suspected of having been subjected to DV. This category was derived from four subcategories: “When something is not right”, “The difficult question”, “Protective measures” and “The ambulance nurse’s emotions”.

When something is not right

ANs assessed the home environment, often experiencing an immediate, uncomfortable feeling indicating something was amiss. Suspicions particularly arose in contexts of ongoing substance abuse, as ANs frequently encountered DV under these circumstances. However, assessing the environment was challenging:

We are the ones who see the home environment, so it should be us working in prehospital care who should detect it, but I do not think it is easy. You cannot tell just by entering someone's home that there is domestic violence happening. It is not something people advertise; I mean, a home does not have to be messy just because there is domestic violence occurring. (AN05)

Another common suspicion arose when the reported cause of injury did not match the observed injuries, especially when the explanation seemed too mild. Sometimes, it became clear that the stated reason for seeking help was not genuine. During the care encounter, it could become clear that the person did not seek help for their physical injuries. The partner's behaviour also contributed to suspicions. These behaviours varied but were perceived as unusual. The partner may appear overly caring or affectionate, which can create a feeling of regret. The partner could also appear dominating by leaving no room for the person seeking care or by circulating the ambulance, forcing both the AN and the person seeking care to lower their voices.

Partners could also behave suspiciously or threateningly during examinations. Comments, jokes or insistent remarks about hitting the person or an overly defensive stance further increased suspicions. Conversely, partners demonstrating total indifference to the person receiving care also raised concerns.

Additionally, the behaviour and reactions of the person seeking care could indicate DV. They might downplay their situation or abruptly withdraw their request for assistance. Suspicions were raised if the person appeared upset or silent without an apparent reason. A somewhat strange, overstrained or anxious behaviour in the partner's presence also raised suspicions of DV.

The difficult question

The suspected victim's reluctance or fear to disclose their situation posed a challenge. ANs attempted to build trust by emphasising that no one deserves to be mistreated and offering supportive reassurance. However, limited personal time could hinder the establishment of trust in the prehospital setting. Occasionally, ANs brought the suspected victim out of their home into the ambulance, providing a more private and safe environment to facilitate conversation and build trust.

When suspicions arose, ANs sometimes repeated sensitive questions about DV, even if initially denied, emphasising the importance of follow-up questions despite difficulties in phrasing them correctly. One strategy was to state what the ANs had observed as an effort to obtain confirmation. This involved describing the injuries and emphasising that they did not match the claimed mechanism of injury:

It must not come across as accusatory so that they interpret it as me thinking they are lying to me. Instead, you have to try to convey it as supporting them in it. (AN03)

However, this was perceived as a delicate balance. Timing and sensitivity were crucial; ANs considered how they would prefer to be approached. It was essential to frame questions supportively rather than accusingly.

Protective measures

ANs emphasised the importance of transporting suspected victims of violence to the emergency department rather than leaving them at home, primarily for safety reasons. At the emergency department, ANs believed the victims could receive appropriate help. However, only in one case did a suspected victim explicitly confirm experiencing DV, after which ambulance personnel escorted the individual to a safe place and assisted in contacting the police. In other instances, ANs broke patient confidentiality and independently filed police reports due to concerns for the victim's safety:

We also went back and forth quite a bit about calling the police. In a way, we broke her trust. She confided in us, and it may have led to her not confiding in any other ambulance or healthcare personnel again. (AN07)

This decision, though necessary, caused ethical concerns about potentially damaging the victim's trust.

The ambulance nurse’s emotions

Encounters with suspected victims of violence evoked strong emotions among ANs. Frustration, anger, and disappointment arose when persons were unwilling to disclose their situation despite clear physical signs, such as bruises or redness, or when ANs felt unable to help:

One feels such strong empathy from the start, and then one is almost drained when a person is rude to you, questions you. Then, it is not easy to maintain the feeling of wanting to help. I wish I could have remained even more professional and not let my feelings affect me. (AN01)

ANs expressed hopelessness due to their limited possibilities to provide long-term assistance in prehospital care. They also described a sense of powerlessness when victims remained in violent relationships, as well as sorrow at witnessing such difficult situations.

The Desire to Improve Care for Victims of Violence

This category highlights the ANs’ reflections from encounters in a prehospital care environment where DV is either suspected or confirmed, as well as suggestions for improvement. It contains two subcategories: “Reflections provide knowledge” and “Identified need for support”.

Reflections provide knowledge

In cases where ANs knew the victim personally, they reflected on how this familiarity could complicate suspicion towards the partner and affect the victim's willingness to disclose:

It is not often I feel that it is wrong to know the person. I usually feel that they appreciate that I am the one who comes because they know me, but there … I think she found it difficult, and I can understand that given that it was domestic violence. (AN06)

A consistent view across all interviews was that DV occurs but is challenging to detect, leading to significant underreporting. Another reason could be that AS are seldom involved in these situations. This may be due to the perpetrator's reluctance to alert the services and the victim's fear of doing so. ANs also believed their professional experience could enhance their ability to recognise and suspect DV:

I had a real “aha” moment, realising that things are not always as they seem. One should be more open-minded and not just rely on the information from the emergency call. Always consider other possibilities, keep a broader perspective. (AN04)

While questioning about DV exposure was routine in emergency departments, ANs had divided opinions about introducing this routine in prehospital care. Some preferred asking only upon suspicion, to maintain sensitivity. Nonetheless, all agreed that emergency departments’ routine practice served as an important reminder for ANs to remain vigilant about DV in their daily work.

Identified need for support

All ANs expressed uncertainty regarding the existence of treatment guidelines for suspected or confirmed DV in their practice, highlighting a desire for more straightforward guidelines. Two ANs felt adequately trained, while the remaining six wanted additional education. One example of education materials requested by the ANs was how to recognise common signs of DV. They also requested improved knowledge about documenting DV safely. Few ANs knew about the DV note template in the hospital journal system, and they proposed adding a checkbox for suspected DV in the ambulance journal system to ensure documentation.

ANs frequently struggled to determine the appropriate support or assistance victims needed or desired. They emphasised the need for clearer and more direct referral pathways, such as helplines or counsellors, to support victims better, regardless of whether DV was openly disclosed or denied despite suspicion:

It is great that there are many ways to get help, which might be good for the person, but for us as healthcare professionals, it would be beneficial to have a specific pathway; call this number when this happens. Now it feels like there are so many different paths to consider. (AN07)

ANs also reported routinely filing child welfare reports when suspecting that children witnessed DV, explaining to victims that such measures were aimed to help rather than harm. Determining responsibility was more challenging in situations involving adults without children. ANs viewed this responsibility as mutual between themselves and the adult victims, but struggled due to unclear guidelines.

Discussion

The present study aimed to explore ANs’ experiences of encountering persons affected by DV in a prehospital context. The findings highlight the complexity of such situations, especially since each case is unique.

The Complex Care Encounter in Domestic Violence

The findings show that ANs often get an immediate feeling that something is wrong, and this can be due to factors such as the home environment, the injuries for which persons seek care or their behaviour. These strong but unconfirmed suspicions of DV pose challenges for ANs, partly because a lack of trust may prevent persons from confirming their experiences of violence. Previous research has shown that multiple factors, such as the home environment, the patient's condition, and the family's preferences and perspectives can create ethical dilemmas in the prehospital care setting. ²⁹ The brief duration of care can further hinder ANs attempts to establish a trustworthy relationship with the patient. ³⁰ A reciprocal trust is essential because its absence leads to patient hesitation and reluctance to cooperate. ³¹ Sometimes, a patient's self-determination can lead to non-cooperation, and the AN's interpretation of the home situation can result in ethical conflicts. ³² This means that the ANs can play a significant role for persons who have been exposed to DV, to trust that first feeling, comprising the gut feeling that something is wrong. It is important to enter these encounters with great respect and genuine care for the person. However, if the AN still does not have time to establish enough trust to gain recognition, it is of utmost importance that the AN knows how the crucial feelings that arose in the prehospital context are taken care of. Important information that can be decisive for a person's life situation.

The findings also show that ANs base their suspicions of DV on various observations and indicators. When the person seems reluctant to talk about their situation, voicing these observations can be a strategy to seek confirmation about DV. Forsell et al. ¹² state that ANs must remain attentive to the patient and the environment to understand the situation entirely. ¹² Furthermore, Holmberg et al. ³³ emphasise that embracing the patient involves respectfully observing their environment, acknowledging ANs as guests in someone's home. It is essential to remember that the prehospital care occurs in someone's personal space. Asking the wrong question can have the opposite effect. This means that the ANs must be able to ask these difficult questions delicately, while also entering these encounters with great respect and genuine care for the person.

A key strategy employed by ANs involved bringing persons from their homes to the ambulance and the emergency department. This aimed to ensure patient safety by removing them from the immediate situation, thus increasing the likelihood of disclosure. Holmberg et al. ³³ describe the ambulance as a mean to safeguard the patient's integrity while enabling the ANs to address sensitive topics. ³³ Such an approach is fundamental if, as Bremer and Holmberg ³¹ suggest, significant others in the home cause patients to feel insecure or scared. ³¹ This strategy can contribute to the person's ability to speak more openly about their situation. Still, even more so, establishing a trustworthy relationship between the AN and the person can help them disclose their victimisation.

The Desire to Improve Care for Victims of Violence

This study finds that ANs identify and criticise shortcomings within the AS. They are motivated to enhance care for persons suspected or confirmed as victims of DV, proposing improvement solutions. The most widely supported measure is increased support in daily work, primarily due to the absence of treatment guidelines. Koskemies et al. ³⁴ attribute ambulance personnel's low knowledge levels to inadequate training and guidelines, fostering feelings of uncertainty.

ANs also highlighted the importance of education to recognise common signs of victimisation better. Sawyer et al. ³⁵ emphasise the significance of education in prehospital care, pointing out that newly graduated nurses desire training on DV before encountering these patients. ³⁶ Another proposed improvement is establishing a single contact number for DV specialists, simplifying access to expert advice. Dheensa et al. ³⁷ support this recommendation, noting that similar initiatives in England enhanced professionals’ abilities to identify and support victims more effectively. ³⁷ Sawyer et al. ³⁶ address these challenges through consensus-based guidelines for ambulance personnel, recommending four key steps: identification, conversation, referral and documentation. Similar guidelines have been developed in Australia for prehospital encounters. ³⁶ This study highlights the importance of educational initiatives, guidelines and clear referral pathways to support services. This can lead to ANs’ increased ability to read the situation, notice when the story is not genuine and identify when there are hidden signs of DV. This will increase ANs’ self-confidence to make the right decisions and help those at-risk persons in the best way. Incorporating DV into ambulance-specific training is one good suggestion. It would show that healthcare takes DV seriously by highlighting it as an important topic.

All ANs agreed that violence should receive greater attention in daily practice. Although opinions differed on routine questioning, they considered it essential to ask about violence, especially when there was suspicion. Previous research^38,39 indicates that women often wish to be asked about victimisation because they may not disclose it voluntarily.^38,39 Almqvist et al. ⁴⁰ similarly found that women appreciate routine questions about DV during healthcare visits, regardless of personal experience. Shedding light on these complex care encounters, for example, by discussing different situations, important observations and referral pathways to specialist services, can help and support persons who are subjected to DV.

Methodological considerations

A qualitative method using semi-structured interviews was used to capture the participants’ experiences, which is a strength of this study.^19,20 Strategic sampling was used to recruit participants capable of addressing the study's aim, but also to include various representations of age, gender, work experience and perspectives which reflect the diversity in the AS. ¹⁹ This contributes to a richer variation of aspects while exploring this studýs research question. ²¹

The number of participants is a limitation, but qualitative research values data richness over quantity. Malterud et al. ²⁶ argue that studies with high information power, as characterised by a narrow aim, a relevant sample, strong interview dialogue and focused analysis, can require fewer participants. Guest et al. ²⁴ found that most themes in qualitative interviews emerge within the first six to 12 interviews. At the same time, Hennink and Kaiser ²⁵ noted thematic saturation typically occurs between nine and 17 interviews in similar studies. Although some nuance may be lost with a smaller sample, a transparent rationale for sample size enhances the trustworthiness of the findings. ²⁷

According to Graneheim and Lundman, ²¹ an interview guide and individual interviews further enhance credibility. ²¹ An interview guide ensures that collected data addresses the intended focus of the study, and individual interviews allow participants to describe their experiences without being influenced by others during the interview. ¹⁹ The interviews were conducted by the researcher who had the longest interviewing experience, strengthening their authenticity. Although the limited sample size of eight ANs could be viewed as a limitation, minimal new information emerged by the eighth interview, suggesting data saturation was reached.^19,24,25 A clear description of participants and procedures during data collection and analysis supported transferability.^19,23 The limited number of participants may restrict the development of categories and subcategories because fewer participants reduce the chances of capturing outlier perspectives. However, the study utilised a systematic qualitative content analysis process outlined by Graneheim and Lundman, ²¹ engaging in iterative comparisons and collaboration among researchers. The categories reflected recurring patterns across participants. The study's focused aim and specific context provided a high level of information power, ²⁶ enhancing the credibility of the categorisation. However, a larger sample could have offered more depth and nuance.

Although the present study focused on the Swedish AS, the relevance of these findings can be transferable to prehospital care settings internationally. This is partly because DV is considered as a significant global public health issue worldwide, but also because previous research has shown that educational interventions for ANs are omitted from multiple countries.^1,41

The first two researchers read and discussed all data together to ensure neutrality. Additionally, consulting an external contact with experience in police and ambulance nursing enhanced the study's credibility. ⁴² The established analytical method and repeated reference to transcripts during analysis increased confirmability.^19,21 Awareness of preconceptions and reflecting on them throughout the research process enhanced credibility.^19,21

Conclusions

This study sheds light on how ANs experience and respond to situations involving domestic violence in the prehospital setting. The findings point to a reality in which ANs are expected to act on subtle signs and “gut feeling”, often without clear guidelines or organisational support. Despite this, participants described strategies to create safe spaces and initiate dialogue, underlining a strong ethical commitment to the persons they encounter.

At the same time, the study highlights structural shortcomings that risk placing too much responsibility on the individual AN. Uncertainty about documentation, ethical boundaries and a lack of referral options contribute to hesitation and emotional strain.

These findings suggest a need for structured support through education, clear documentation routines and established referral pathways that ANs can rely on in complex situations. For victims of DV, this may enable earlier identification and safer care. It could mean reduced moral distress and greater confidence in ANs handling suspected violence. On a broader level, investment in knowledge, tools and interdisciplinary collaboration may strengthen the role of prehospital care in society's response to domestic violence.

ANs meet people in vulnerable moments, often behind closed doors. With the proper support, these encounters have the potential to make a crucial difference.