Healthcare providers' experiences with police in Atlantic Canadian emergency departments: a qualitative study.

OBJECTIVES

Police involvement is common in emergency departments (EDs), yet evidence from Canada on its impact on care is limited. This study described how ED healthcare providers experience and manage police presence, focusing on perceived impacts on patient care, safety, confidentiality, and training needs.

METHODS

Emergency physicians, nurses, and paramedics were recruited through the Atlantic Emergency Research Organization network using purposive and snowball sampling. Focus groups were conducted via Webex using a semi-structured topic guide. Sessions were recorded, transcribed verbatim, and de-identified. Data were analyzed using an interpretivist grounded theory-informed thematic approach with iterative open, axial, and selective coding. Four investigators reviewed the coding decisions and theme development.

RESULTS

Twenty participants attended focus groups. Participants described police involvement in ED and prehospital encounters, including mental health crises, trauma, intoxication, and criminal legal presentations. Police were often required for managing rising violence and providing practical assistance, yet their presence and actions sometimes escalated agitation, delayed care, or created pressure for rapid "medical clearance." Confidentiality and ethical boundaries were major concerns. Officers positioned for safety could compromise privacy and clinicians reported uncertainty about what information could be shared outside mandated reporting. Most participants reported limited formal training and called for clearer policies, decision tools, and joint training with police and EMS.

INTERPRETATION: Police presence in EDs was experienced as simultaneously protective and problematic. Clearer institutional frameworks, operational guidance on information sharing, and joint training with law enforcement are required to support safe, ethical, and trauma-informed emergency care when police are involved.