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Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence.A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders.Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2–22.2, P < 0.001). Females reported increased odds of patient-initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8–10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94–2.85). Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention.Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention. Am. J. Ind. Med. 59:150–163, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.