Stirling University academics interviewed 31 paramedics, technicians and senior staff at the Scottish Ambulance Service.

A groundbreaking study has exposed the alarming reality facing Scottish emergency responders, revealing widespread violence, aggression and sexual harassment during alcohol-related callouts. The research highlights the urgent need for stronger regulation of late-night alcohol sales to protect frontline staff.

The University of Stirling study, believed to be the first of its kind, gives voice to ambulance clinicians who routinely face dangerous and unpredictable situations when attending intoxicated patients. Researchers interviewed 27 frontline ambulance staff across Scotland, including paramedics and paramedic technicians, alongside four senior Scottish Ambulance Service personnel.

Frontline staff describe terrifying encounters

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The research revealed a strong link between paramedics and alcohol-related violence. One male paramedic technician described harrowing experiences: “Drunk patients are the only ones who have ever physically threatened or assaulted me. They’ve punched, kicked, and bitten me, and even chased me with knives.”

Female staff reported particular vulnerability to sexual harassment. A female paramedic technician described the unpredictability: “The thing is that you don’t know how [intoxicated patients] are going to turn, ’cause one minute they can be nice and the next minute they can be…It’s almost like the flick of a switch and they can just turn so nasty.”

Callouts typically occur in challenging environments—bars, clubs and streets—where ambulance staff face aggression not only from patients but also from bystanders, compounding the dangers they encounter.

Overwhelming demand strains emergency services

Beyond the immediate safety concerns surrounding paramedics and alcohol violence, the study reveals the enormous operational burden on Scotland’s ambulance service. One in six ambulance callouts in Scotland are alcohol-related, according to previous University of Stirling research.

The frequency and repetitive nature of these incidents—often involving the same individuals multiple times—significantly impacts already stretched resources. One female paramedic technician explained: “I think when we are stretched to the limit, resources-wise, we are getting these calls through. We feel that they are having a massive impact on our staffing, our resources…sometimes we can go to two and three and four alcohol-related call-outs in a row. It gets to the stage where you’re thinking, oh no, not another one.”

Staff reported particular dread around predictable surge periods. “We kind of dread the football matches and we think, oh no, where are they playing? Are they playing at home this day? Or we dread New Year, or we dread the Christmas season, where we’re having the office parties and you’re thinking, oh, here we go,” the same paramedic added.

Complex cases demand extended response times

Patients with alcohol dependence present particularly complex challenges, often requiring two to three times longer than standard callouts. These individuals commonly experience co-occurring mental health issues, making assessments difficult and time-consuming.

One male paramedic explained: “You go to someone who’s got chest pain and is an alcoholic [sic] that could potentially go up to two hours, two and a half hours because it’s really hard to do the assessment, it just slows everything down.”

This extended response time has knock-on effects, delaying assistance to other patients awaiting urgent care.

Call for stronger regulation

Dr Isabelle Uny, Research Fellow at the University of Stirling’s Institute for Social Marketing and Health and lead author, said: “Our findings show the extent to which alcohol consumption, both on social occasions and by people with alcohol dependence, adds to the pressure on ambulance services and staff.”

She noted that despite experiencing routine violence and harassment, ambulance staff displayed deep commitment to patient care. The research involving paramedics and alcohol violence comes as the Scottish Government considers further action to restrict alcohol marketing.

Professor Niamh Fitzgerald, principal investigator and Director of ISMH, warned against proposed UK government reforms to liberalise alcohol licensing in England and Wales: “The latest UK government proposals to further liberalise the alcohol licensing system are likely to increase pressure on ambulance services in England and Wales – making alcohol even more easily available twenty-four seven, including from shops and via rapid delivery.”

Evidence-based solutions

The researchers advocate for three proven measures to reduce harmful impacts: restricting alcohol availability, increasing price, and reducing marketing. They specifically recommend limiting late-night alcohol sales to fewer premises and introducing stricter marketing restrictions.

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance UK, emphasised: “This research provides a stark reminder of the profound impact alcohol has on our emergency services – placing an avoidable strain on hospitals, paramedics, and other frontline staff, and diverting vital resources away from patients with other urgent medical needs.”

The study, funded by the Chief Scientist Office as part of the Scottish Government, involved interviews conducted between May 2019 and June 2022. The extended timeframe reflects the impact of the Covid-19 pandemic on data collection.