Critical incident experiences, related stress and support among Finnish paramedics: A cross-sectional survey study

Further definition of critical incidents in paramedics' work

INTRODUCTION

Paramedics operate in unpredictable, fast-paced, and high-risk environments, yet their profession is profoundly centered on human interaction. This study aimed to define, through a unifying analysis, the critical incidents in paramedic work.

METHODS

This qualitative study utilized three previously published listings of critical incidents among paramedics from the United States, Germany, and Denmark and e-survey data of Finnish paramedics. A directed content analysis was applied.

RESULTS

The previously identified critical incidents formed two main categories. The first, 'Challenging situations or circumstances faced during Emergency Medical Service (EMS) missions', had five categories: 'Accidents, threats, and violence targeting EMS personnel'; 'Mistakes'; 'EMS missions identified within one's own personal life'; 'Psychologically challenging interaction situations'; and 'Working conditions that involve experiences of failure or unreasonableness'. The second main category, 'Ethically burdensome and professionally demanding patient outcomes', also had five categories: 'Facing mutilated bodies and death'; 'Children and youth as victims of illness, severe accidents, or crimes'; 'Tragic patient outcomes involving injustice and misfortune'; 'Mass casualty incidents'; and 'Situations caused by intentional acts of others'. The unifying analysis proposed 34 critical incidents. The largest number of different critical incidents was identified in categories of 'Accidents, threats, and violence targeting EMS personnel' (7), 'Psychologically challenging interaction situations' (6), and 'Children and youth as victims of illness, severe accidents, or crimes' (6).

CONCLUSIONS

The unified listing should be tested in various countries to assess its comprehensiveness and, if necessary, refine and supplement the critical incidents in paramedic work.

The recovery processes among paramedics who encountered violence during work-a narrative interview study

BACKGROUND

Almost all paramedics encounter workplace violence (WPV) during their careers. The most common form of WPV is verbal, and the perpetrator is usually the patient. It is known that paramedics suffer from post-traumatic stress disorder and other mental health problems, and WPV is one of the reasons behind that. Nevertheless, little is known about the recovery processes paramedics have had after encountering WPV. The research question was: What kind of recovery processes have paramedics had after encountering WPV?

METHODS

A qualitative, narrative interview study was done. Data was collected in individual interviews with Finnish paramedics (n = 18). Paramedics were from different parts of Finland, and their ages varied from 24 to 49 years. They had been working in EMS for an average of 10.5 years (range 1.5 to 25 years). Interviews were conducted with a narrative approach, which enabled paramedics to narrate their experiences and speak on their own terms about the subject to the extent of their choosing. The data was analyzed using thematic analysis.

RESULTS

Ten recovery process themes were identified: Strong psychological and physical reactions in a short time frame, Questioning one's profession and actions, Various support structures aided in recovery, Dysfunctional processes hindered recovery, Personal resources provided support, The support of the workcommunity as a lifeline, Left to cope alone, Permanent changes to work routines, Resulting in professional growth and Eternal crack in the shell.

CONCLUSIONS

Many internal and external factors affect paramedics' recovery processes. While some receive adequate help, others struggle to get appropriate support, especially from their organization and supervisors. The findings of this study suggest that clear protocols should be established to help paramedics recover after encountering WPV and that an individual aspect should be kept in mind, as not everybody reacts in the same way.