Background: Workplace violence (WPV) is a risk to emergency medical services (EMS) personnel. The purpose of this study is to create consensus-based guidelines for EMS supervisory level to address the risk of WPV in EMS work.

Methods: Delphi method was utilised with multiprofessional Finnish expert panel (n = 43). The study included two web-based Delphi stages. Consensus was considered achieved when ≥ 80% agreement was reached.

Results: Round one comprised of EMS WPV related topics organised into five predefined thematic areas, developed by the study group based on a literature review and tacit professional expertise. Each theme included both structured statement ratings and open-ended questions to explore panellists' perspectives and reasoning. For round two, 25 statements were aggregated. Consensus agreement threshold was reached on 19 of 25 statements. Three core priorities were identified for reducing WPV in EMS: (1) defining acceptable behaviour for staff and patients in EMS, (2) mental health training and de-escalation skills, and (3) national systemic models and technology in WPV prevention.

Conclusions: Zero tolerance policies towards violence in EMS are not feasible in practise. Emergency medical services supervision should prioritise WPV risk assessment, risk management by pragmatic standardised training programs and systemic tools, and ongoing intervention evaluations.