Bullying and harassment is deeply entwined in Ambulance Victoria's culture, with employees raped, driven to self harm and feeling "doomed" if they dared lodge a complaint.
In a first-volume, 500-page report released on Tuesday, the Victorian Equal Opportunity and Human Rights Commission found more than half of 2163 survey respondents were bullied and 47 per cent were discriminated against.
The commission found "certain behaviours, particularly everyday forms of disrespect, have seeped into the fabric of the organisation" and existing efforts to prevent harmful behaviour "have so far been ineffective".
Overwhelmingly, staff told the inquiry Ambulance Victoria was "a safe place if you are a white male", but for women and those who are LGBTIQ+, have a disability and are from a racial or other minority group, there is a fear of being seen as out of place.
There were 330 respondents who told of unwanted sexual behaviour, among them 33 who reported requests or pressure for sexual interactions and 12 reported rape or attempted rape.
Sixteen people reported ongoing sexual harassment when they completed the survey and 97 were harassed within the previous year.
Paramedics reported being bullied by colleagues on jobs, with some fearful of being humiliated in front of patients.
When a new manager tried to tell superiors about bullying from a paramedic, he was told it was just one man and to "put your big boy pants on, go and sort it out yourself".
Another employee said they were "doomed from the start from that minute that I put that complaint in for the sexual harassment, I was gone."
People reported attempting suicide or developing suicidal ideation because of their experiences.
The commission found main drivers of the destructive behaviour included a power imbalance due to a historically male-dominated workforce and a higher focus on operational performance.
"Often things like this happen behind doors, but in Ambulance Victoria we heard very often it happens out in the workplace," Commissioner Ro Allen told reporters.
"Over time it's developed a culture that this is just how it is around here, and that's where the line has to be drawn and people have to not walk past that behaviour."
The service's leadership on Tuesday unreservedly apologised to their staff for the harm caused and vowed to do better, accepting all 24 recommendations to improve.
Ambulance Victoria chief executive Tony Walker said they were unaware of the extent of the problem because people were not reporting incidents and acknowledged the bravery of people coming forward.
"Things must change. Experiences of bullying, discrimination, victimisation and sexual harassment are deeply confronting," he said.
"As the commission rightly highlights some of these behaviours aren't just harmful, these behaviours are unlawful."
Among its new measures, Ambulance Victoria will create a dedicated division to drive workplace equality and reform and redesign its reporting and complaints system.
Ambulance Employees Australia Victorian secretary Brett Adie said perpetrators "must be removed from the organisation for there to be any hope of transformational change".
The commission was called in by Ambulance Victoria in October 2020 and the final report is due in March 2022.
Tuesday's report follows similar reviews of Victoria Police and the state's fire services, however the fire report has been blocked from release by the United Firefighters Union through the courts.
Opposition Leader Matthew Guy on Tuesday urged the government to release the fire services report, but Premier Daniel Andrews said the government does not have a copy of it and even if it did, it was prevented from releasing it due to the court ruling.
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Australian Associated Press