The Staff Observation Aggression Scale - Revised for Ambulance Services (SOAS-RA)

Ambulance personnel frequently encounter aggression in dynamic and unpredictable environments. Despite growing awareness of workplace violence in healthcare, few validated tools exist for systematic documentation in ambulance services.

This study aimed to adapt and validate the Staff Observation Aggression Scale - Revised (SOAS-R) for use in ambulance services (SOAS-RA), and to examine the relationship between SOAS-RA severity scores and staff's subjective perceptions of incident severity using a Visual Analogue Scale (VAS).

Using a modified Delphi method, a panel of ambulance professionals adapted the SOAS-R to the ambulance service context. Data were collected from 34 ambulance stations across Norway using paper-based SOAS-RA forms. A total of 402 reports were submitted, with 302 including valid VAS scores. Descriptive and inferential statistical analyses examined associations between objective severity scores (SOAS-RA) and subjective ratings (VAS).

SOAS-RA total scores showed a small to moderate correlation with VAS ratings (r = 0.350, p < 0.001). The strongest predictor of perceived severity was "consequences for the victim" (β = 0.274, p < 0.001), followed by "means used by the aggressor" (β = 0.180, p < 0.001). Female staff rated incidents as more severe than male staff (p = 0.030), despite similar SOAS-RA scores.

The SOAS-RA, combined with VAS, may serve as a valid, context-sensitive tool for documenting aggression in ambulance services. Future research should explore broader implementation and digital integration to enhance usability, data quality, and support organizational learning.