Killing of Australian paramedic exposes the daily dangers confronting healthcare workers

Last Friday the working-class community of Campbelltown in Sydney, Australia’s largest city, was the scene of the violent death of a young paramedic, Steven Tougher.

Steven Tougher with his parents at Charles Sturt University graduation ceremony. [Photo: Facebook]

Around 5.30 a.m. at a parking lot in a local McDonald’s, as Tougher was taking a meal break in the back of his ambulance after a nightshift, he was allegedly assaulted by a 21-year-old man, Jordan Fineanganofo, who had forced open the ambulance’s rear doors. Stabbed multiple times, Tougher was rushed to hospital after police arrived to subdue Fineanganofo. Despite the efforts of fellow paramedics and health workers at Liverpool Hospital, he died from his injuries.

The 29-year-old paramedic’s death is a tragedy. Previously a registered nurse in the Illawarra region of New South Wales (NSW), Tougher had been a paramedic for just one year. Married for only five weeks, the couple were expecting their second child.

The motivations behind Fineanganofo’s assault on Tougher remain unclear. The 21-year-old was reportedly known to the police, but only for minor issues. There was no interaction between the men prior to the attack.

Defence lawyer Javid Faiz noted that the accused attacker has “psychosis issues” and that he “was off treatment and medication at the time.” Faiz also reported that Fineanganofo, currently in jail awaiting court, was “fully aware of the gravity of the offences with which he was accused.” No further information has been made public.

Two responses to Steven Tougher’s death are emerging. One is from Tougher’s family, co-workers and the broader community with one of shock and compassion. Barely 48 hours after Tougher’s death, over $300,000 had already been raised by nearly 6,000 people for his family.

The second response is that of governments, state and federal, and the health unions. While issuing the usual platitudes about the heroism of health workers, their goal is to hide from workers the deeper issues involved in Tougher’s killing.

Government and union officials offer no insight into the deeper causes of violence in Australian society nor provide any progressive response to it. Like their counterparts in the United States after mass shootings, their responses essentially boil down to “thoughts and prayers,” generally coupled with demands for increased police and state powers.

NSW Premier Chris Minns, of the newly elected state Labor government, called the stabbing a “terrible situation,” offered thanks to paramedics “for all that you do,” and reminded the public that paramedicine is “a very difficult and dangerous job.” Prime Minister Anthony Albanese said Tougher’s death was as “shocking as it is tragic” and that paramedics “deserved to be safe at work.”

NSW Health Minister Ryan Park only offered a “significant investigation” in response to a question about improving paramedic safety. NSW Ambulance placed a condolence message on its website, only saying that “support arrangements had been put in place for our workforce.”

Much like the federal and state Labor governments, the secretaries and offices of the NSW Nurses and Midwives Association, Australian Paramedics Association and the Health Services Union, which cover most paramedics in NSW, issued brief condolence statements, but made no demands for improvements in the safety and working conditions of their workers.

As of this writing, no further statements have been issued on their websites regarding Tougher’s death.

While Tougher may have been killed in a random act of violence, it is the crisis in Australian society and healthcare that has increased the risk of such events. This is the result of the policies of federal and state governments, of both Labor and Liberal parties, and assisted by the unions, to attack the social conditions of working people.

Tougher’s death is the first workplace death of an NSW paramedic since 2011. However, occupational violence against paramedics is a longstanding danger.

Back in 2003, a study of 400 health workers published in the Journal of Occupational Health and Safety, Australia and New Zealand, found that paramedics were most at risk for assault.

In 2019 there were 400 reported assaults on paramedics in NSW, leading to NSWA to develop its anti-violence “It’s Never Ok” program. Body cameras were given to NSWA paramedics in some stations, which recorded over 245 violent incidents in a three-year period between November 2019 and June 2022.

Other states in Australia have reported similar rates of violence against paramedics. In Victoria, at least 147 paramedics were assaulted last year, one roughly every two days. This is to say nothing of the assaults and threats of violence against doctors, nurses and other health workers endured daily in hospital wards, GP clinics and EDs.

That this increasing violence, documented over two decades, occurred in a period of sharply rising inequality, housing crises, job insecurity and falling wages, coupled with illegal wars abroad, is no coincidence.

Campbelltown is one of the poorest suburbs in Sydney, with chronic youth unemployment and high numbers of working-class families facing mortgages stress. According to recent research by Digital Finance Analytics, close to 89 percent of homeowners in Campbelltown were struggling with mortgages that they could not afford, one of the highest in Australia. In the nearby Liverpool region, mortgage stress rates are 77 percent.

Ongoing social assaults by Liberal-National and Labor Party governments have caused Australian society, like the US and elsewhere, to be damaged by the social ills of capitalism, leading to desperation and, in some cases, violence.

While mental health disorders and other social issues do not automatically lead to increased levels of violence, the lack of support in society creates despairing and disoriented individuals, and health workers, who are on the front lines of the social crisis, are becoming victims of this process.

Paramedics also confront a deteriorating healthcare system. Fewer hospital beds are available, increasing ambulance wait times, and a lack of affordable GPs and medicines mean patients are increasingly sicker and waiting longer for necessary treatment. The COVID pandemic, having killed at least 20,000 people in Australia and sickened millions, has worsened this crisis.

These issues, combined with cost-cutting by state and federal governments, forced overtime and lack of breaks to compensate for staff shortages, as well as wages frozen for years, have led to a mental health and burnout crisis among paramedics.

Decades of studies indicate that emergency service workers have among the highest rates of suicide in Australia. A 2016 study from the University of Melbourne indicated that paramedics have the highest suicide rate of any emergency service, twice that of the general population. Nationally, 8–10 percent of paramedics are estimated to have PTSD.

A 2010 study from Victoria University in Melbourne estimated that paramedics experienced suicidal thoughts at a rate nine times that of the general population and that 14 percent of Victorian paramedics experienced PTSD.

Nationally, in 2020 the ABC (Australia), cited studies which found that two-thirds of paramedics experienced burnout, with half stating that stress affected their personal lives.

Notwithstanding the public tears of NSW politicians on Friday over Steven Tougher’s death, neither governments nor the unions intend to improve the work conditions of paramedics and other health workers. Health workers have been abandoned throughout the COVID pandemic, with a lack of PPE, adequate air filtration systems for workplaces and a complete lack of concern for their welfare as the virus sickened them.

When NSW paramedics went on strike, the unions moved to shut them down, limiting their actions to a single day each time. NSWA already confronts a shortage of at least 1,500 paramedics, with years of frozen wages eroded by inflation and poor working conditions affecting recruitment and retention.

The average work week for paramedics is in NSW is 48 hours, with many working four to five 12-hour shifts in a row. In NSW there are only 47 paramedics per 100,000 people, compared to 70 per 100,000 in Queensland and Victoria.

According to a March 2022 Australian Paramedic report 87 percent of paramedics surveyed in NSW regularly missed over half of their scheduled work breaks per month and 80 percent said they felt too fatigued to drive home at some point in the same period.

Governments intend to respond to growing demands for better working conditions by resorting to authoritarian measures. Already in Western Australia, the McGowan Labor government is attempting to destroy the right to strike by imposing massive Industrial Relations Commission fines on nurses for taking one-day strike action last November.