Paramedics' experiences and coping strategies when encountering critical incidents

Brief Report: An Examination of Curvilinear Relations Between Perceived Mother-Child Closeness and Maternal Hair Cortisol

Interpersonal closeness has important health benefits; however, recent work suggests that in certain contexts, closeness can come at a cost. In the current study, curvilinear relations between mother-child closeness and health (e.g., depressive and anxiety symptoms and hair cortisol concentrations [HCC]) were tested. Our sample consisted of 117 mother (Mage = 36.86) and child (Mage = 73.07 months, 50.86% male) dyads. A quadratic relationship between maternal perceived closeness with their child and self-reported depressive and anxiety symptoms, along with overall hair cortisol output, was hypothesized. Path analysis suggested that the quadratic term was predictive of maternal cortisol (β = 0.28, p = 0.001) and depression (β = 0.23, p = 0.014), such that both high and low perceived closeness predict greater maternal depressive symptoms and HCCs as compared to moderate levels of closeness. Results are discussed in terms of parenting support and burnout.

Negotiating grey areas: an interview-based analysis of paramedic uncertainty and decision-making in cardiac arrest events

BACKGROUND

Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate their decision-making. Within the United Kingdom (UK), there is little evidence on how and why paramedics make their decisions at actual OHCA events.

METHODS

We explored the experiences of UK paramedics using individually recalled OHCA events as catalysts for discussion. Pen portraits developed from semi-structured interviews with 31 paramedics across two UK ambulance services were thematically analysed, enabling cross-participant comparisons whilst retaining depth and context.

RESULTS

We identified four themes: uncertainties encountered in resuscitation guidelines, influences on decision-making, holistic perspectives, and indirect moderators. We found that paramedics experienced uncertainty at all stages of the resuscitation process. Uncertainties arose from indeterminate, ambiguous or complex information and were described as having both clinical and ethical dimensions. Whilst guidelines drove paramedics' decisions, non-clinical personal, practical and relational factors moderated their assessments of survivability and decision-making, with attitudes to interactions between patient age, frailty and quality of life playing a substantial role. Coping strategies such as uncertainty reduction, assumption-based reasoning and weighing pros and cons were evident from interviews.

CONCLUSIONS

The complexity of interactions between clinical and non-clinical factors points to an element of variability in paramedics' responses to uncertainty. Exploring UK paramedics' uncertainties and decision-making during specific OHCA events can help acknowledge and address uncertainties in resuscitation guidelines and paramedic training, providing paramedics with the tools to manage uncertainty in a consistent and transparent way.

Prehospital emergency care family satisfaction scale for care provided by emergency medical technicians: Scale development and validation

RATIONALE

To date, family satisfaction with emergency medical technicians (EMTs) has only been reported through narrative statements in subjective evaluations. Although a quantitative assessment of healthcare professional satisfaction is desirable, no specific measures have been devised to assess family satisfaction with the healthcare and care provided by EMTs.

AIMS AND OBJECTIVES

This study aimed to develop and validate an EMT care family satisfaction scale to measure patient satisfaction with prehospital emergency care.

METHODS

The study population comprised 216 family members (N = 216) of patients who used ambulances between November 2020 and May 2021 in a single region in Japan. Questionnaires were distributed to the participants who provided informed consent. An exploratory factor analysis of construct validity was performed to validate the Family Satisfaction Scale. The Cronbach's alpha was used to validate the internal consistency reliability of the scale.

RESULTS

The exploratory factor analysis results revealed a four-factor structure: 'explanation and communication,' 'physical treatment,' 'psychological support,' and 'environment in the ambulance.' The Cronbach's range (0.80-0.93) for the total score for each of these four factors and the overall total score confirmed favorable internal reliability of this study.

CONCLUSIONS

The family satisfaction scale developed in this study was constructed and validated to highlight the role of EMTs and needs of the families in the prehospital care settings. Moreover, this scale can be applied in the evaluation and consideration of interventions to improve family satisfaction with EMTs.

How prehospital emergency personnel manage ethical challenges: the importance of confidence, trust, and safety

BACKGROUND

Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine.

METHODS

We explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach.

RESULTS

We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope.

CONCLUSION

Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout.

Exploring factors associated with paramedic work-related psychological injury through data linkage

INTRODUCTION

In comparison to the general population and other emergency services workers, paramedics experience high rates of work-related psychological injury. However, there is limited understanding of the case and practitioner-related factors that increase the risk of psychological injury among these workers. This paper aims to identify case and practitioner-related factors associated with paramedic work-related psychological injury in Victoria, Australia, through data linkage.

METHODS

Data linkage of 7,223 paramedic injury reports with electronic patient care records, and paramedic demographic data from the single state-wide ambulance service in Victoria, Australia - Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Factors associated with paramedic psychological injury were assessed using multivariable logistic regression analysis.

RESULTS

A total of 4,641 (64%) injury reports were successfully linked, of which, 244 (5%) were psychological injuries. Shift hours between 0401 and 0800 (AOR 1.83; 95%CI: 1.12-2.97), cardiac arrest or deceased patient attendances (AOR 2.15; 95%CI: 1.06-4.34), hospital or medical center case locations (AOR 2.44; 95%CI: 1.22-4.91), and Priority 0 (AOR 2.27; 95%CI: 1.26-4.09), Priority 2 (AOR 1.56; 95%CI: 1.04-2.33), and Priority 3 (AOR 1.95; 95%CI: 1.15-3.32) dispatch codes were associated with increased odds of psychological injury. Increasing patient age (AOR 0.98; 95%CI: 0.97-0.99), and the absence of other emergency services on scene (AOR 0.50; 95%CI: 0.34-0.72) were associated with decreased odds of paramedic psychological injury.

CONCLUSIONS

This is the first study to collectively examine and identify EMS case and practitioner-related characteristics associated with paramedic psychological injury through data linkage of EMS agency-level data sources.

PRACTICAL APPLICATION

The findings of this study highlight the dispatch case characteristics that may increase the risk of a paramedic sustaining a work-related psychological injury, and consequently facilitate the early identification, intervention, and support of the individuals most at risk.

Exploring coping strategies of emergency medical technicians against COVID-19 stress: a qualitative study

Introduction

The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, the psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. This qualitative study aimed to explore the coping strategies used by EMTs to manage stress during the pandemic.

Methods

The research was designed as a qualitative study, utilizing a thematic analysis framework. Semi-structured interviews were conducted with 15 EMTs from a single geographic area between September 2022 and December 2022. The data were analyzed using Braun and Clarke analytic techniques, and this study used Lincoln and Guba's to assess the reliability of the data.

Results

Four main coping strategies emerged from the data: seeking social support, practicing self-care, utilizing coping mechanisms, and finding meaning and purpose in work. EMTs sought support from both professional and personal sources, engaged in physical and emotional self-care, used humor and distraction as coping mechanisms, and found meaning and purpose in helping others and growing as professionals.

Conclusion

Based on the extracted results from the study on EMTs in Iran, it can be concluded that the importance of social support cannot be overstated, as it serves as a crucial buffer against the negative effects of stress and trauma. The findings suggest that addressing the social and emotional needs of EMTs is important for promoting their mental health and well-being during the pandemic.

Wellbeing of Helicopter Emergency Medical Services Personnel in a Challenging Work Context: A Qualitative Study

BACKGROUND

Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. Work in the HEMS setting is characterized by frequent exposure to critical incidents and other stressors. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing to inform organizations regarding workplace interventions that can be implemented to support employees.

METHOD

We conducted 16 semi-structured interviews with HEMS personnel from a university hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding.

RESULTS

The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. Various factors are important to their wellbeing, such as working together with colleagues and social support. Participants reported that HEMS work can have an emotional impact on wellbeing, yet they use multiple strategies to cope with various stressors. The perceived need for organizational support and follow-up care is low among participants.

CONCLUSION

This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. Findings from this study may benefit employers by shedding much-needed light on factors that HEMS personnel feel affect wellbeing.

Evaluation of the CARES Skills Framework as a Peer Support Model in the Paramedic Undergraduate Curriculum: Facilitating Challenging Discussions in a Safe Environment

OBJECTIVE

Infant or child death is reported as being the most distressing type of case paramedics attend. Student paramedics also identify supporting bereaved families as an area associated with low confidence. This study evaluated the CARES skills framework (Connect to emotion, Attention training, Reflective listening, Empathy, Support help seeking) as a peer support model to encourage student paramedics to talk about grief and death related to infants and children.

METHOD

A convenience sample of first-year paramedic students (target n = 154) was recruited from a single Australian regional university. A modified nominal group technique method was used following a student debriefing session designed to identify problems, generate solutions, and make decisions regarding the efficacy of the CARES skills framework.

RESULTS

Of 154 eligible participants, 141 participated (92% response rate). Peer social support normalized students' emotions related to death and dying. Although naming emotions was challenging, students reported that the CARES model facilitated a safe environment to talk about death and dying. Students reported feeling heard and connected to their peers during the exercise and an enhanced sense of belonging after the exercise.

CONCLUSIONS

Findings contribute to evidence that suggests the CARES model is a useful mechanism to enhance peer social support in paramedic students.

Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event

Health professionals require support and recognition to help manage the well-known impact of critical or sentinel events relating to patient care. The potential distress can be magnified or mitigated by the response of the organization and colleagues. However, strategies that are accessible, relevant, and effective in the aftermath of a poor outcome are not well established. Using an action research methodology, a support tool was collaboratively designed, developed, and evaluated in a maternity service of one organization and adapted to the mental health and addiction service in another. Four principles that are intrinsic to the establishment of support tools became apparent across the two settings. Through applying these criteria to the customization of the support tool, it became relevant within the new service setting, and an implementation guide for other organizations was created. Although undertaken pre-pandemic, insights derived from this study may benefit post-pandemic situations where the need for health professional support is even greater.

A qualitative, cross-cultural investigation into the impact of potentially traumatic work events on Saudi and UK ambulance personnel and how they cope

Background

Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to investigate the lived experience of potentially traumatic work events between Saudi and UK ambulance personnel.

Methods

Semi-structured interviews with 16 ambulance workers from Saudi Arabia and the United Kingdom (8 participants from each country) were conducted to explore their lived experiences of potentially traumatic events at work. Data were analyzed using thematic analysis.

Results

Four key themes were identified from interviews: (1) some events are inherently more stressful than others; (2) pressure of organizational and interpersonal stressors; (3) convergence and divergence in cross-cultural coping strategies; and (4) preferring formal and confidential support.

Conclusions

There were differences in the nature of traumatic events and the ways of coping between the two cultures, but paramedics in both cultures had an agreement about their preference for individual and formal support. The results of this study may help inform the development of interventions and PTSD prevention programs for ambulance personnel.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00666-w.

How do paramedics and student paramedics cope? A cross-sectional study

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality.

Emergency Nursing-Care Patient Satisfaction Scale (Enpss): Development and Validation of a Patient Satisfaction Scale with Emergency Room Nursing

This study aimed to develop and validate an emergency nursing-care patient satisfaction scale to measure patient satisfaction with emergency room (ER) nursing. Patient satisfaction scales for ER nursing have been validated without considering the perspectives of the healthcare system or cultural background of the country. Moreover, although nursing care is changing with COVID-19, no scale has been specifically designed to assess patient satisfaction with ER nursing. The study population included patients who visited five ERs in Japan (March to December 2021) (n = 135). The rating scales were provided to patients who visited the ER and gave consent, and the patients were asked to reply. In the process of validating the scale, exploratory and confirmatory factor analyses of the construct and criterion validity were conducted. The confirmatory factor analysis results showed a factorial structure consisting of four factors. The domain and summary scores demonstrated good-to-excellent internal reliability (Cronbach’s range = 0.81–0.89). This patient satisfaction scale was designed and validated from the perspective of the Japanese healthcare system and cultural backgrounds. This scale may be useful for developing assessments and interventions to improve patient satisfaction with ER nursing.

How do paramedics cope? A scoping review

Exposure to repeated trauma is an inherent component of paramedicine. Additionally, paramedics are exposed to threats that can undermine healthy workplaces, social connectedness, and health behaviour, predisposing them to overwhelming distress and unhealthy coping, including suicidality and psychiatric disorders. This scoping review aimed to identify how paramedics cope. PubMed, PsycINFO and CINAHL were searched between January 1, 2010, to April 21, 2021. Studies were included if they used any research design to identify specific coping strategies used by paramedics. Three studies met the inclusion criteria-two qualitative and one cross-sectional survey design. There was a high risk of bias across all studies. Studies were conducted in Israel, Poland, and the UK, primarily with males. Two studies only identified healthy coping strategies-self-soothing and social and professional support. Unhealthy strategies identified in the third study were limited to negative self-talk and alcohol use, with no mention of other harmful behaviours, social withdrawal, or suicidality. There is limited research describing how paramedics cope, and in particular, how female paramedics cope. Further research exploring the breadth of coping strategies used by paramedics is needed to understand the impact of the work paramedics undertake on coping and inform prevention and support activities.

'We Ought to Be Professionals': Strategies of Intrapersonal and Interpersonal Emotion Regulation of Emergency Medical Services Professionals in Confrontation With the Death of a Newborn in Simulated Task

Managing one's own and others' emotions is a necessary part of emergency medical services (EMS) professionals' work. For that reason, we explored their emotion regulation strategies in a simulated task which focused these skills. Short semistructured interviews were conducted with 48 EMS professionals immediately after completing the task. They described their experience during this task as distressing on a manageable level. Emergent emotion regulation strategies are largely in line with established theoretical frameworks, but their specification is unique and offers new insights. Focusing on the task along with emotional distancing is a crucial combination employed by many EMS professionals. Pre-existing cognitive frames also help with processing of emotional stimuli. Among interpersonal strategies, allowing the relatives of a deceased child to cope with their grief was the most typical reaction. However, attempts to distract them or positively reframe their situation were also present, along with few other strategies.

Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies

BACKGROUND

Ambulance care professionals are regularly confronted with critical incidents that increase risks for mental health disorders. To minimize these risks, it is important that ambulance care professionals adequately cope with critical incidents. Especially from the perspective of starting ambulance care professionals it is unknown which coping styles they use when experiencing a critical incident and how they are trained to cope with critical incidents. The aim of this study was to gain insight in (a) what starting ambulance care professionals describe as critical incidents, (b) how they experience these critical incidents and their consequences, (c) how they cope with these incidents, and (d) how they are trained and guided to cope with these incidents.

METHODS

A qualitative design with individual, semi-structured interviews was used. The data was analyzed by using inductive thematic analysis.

RESULTS

Twenty-two starting ambulance care professionals were interviewed of which, 11 were male. The age ranged from 23 to 31 years, with 11 participants being 27 years or younger. Three key-themes emerged that make an incident critical: (1) emotional connection versus emotional detachment, (2) feeling loss of control, and (3) incomprehension. All participants experienced several short to middle term physical, psychological and social consequences after encountering a critical incident. Starting ambulance care professionals applied different coping strategies during different phases of the ambulance care process: a mix of depersonification, focus on the medical task, support from colleagues and their own network, seeking confirmation, and distraction. Most starting ambulance care professionals don't actively remember they received education about coping with critical incidents during their initial educational program. During and after traineeships, the workplace preceptor has a crucial role for starting ambulance care professionals to learn them how to cope with critical incidents.

CONCLUSIONS

Three key-themes interact to make an incident more critical for starting ambulance care professionals. To cope with these critical incidents, starting ambulance care professionals use a variety of coping strategies. These results can be used to develop training and coaching for starting ambulance care professionals so they can adequately cope with critical incidents.

The Effect of Psychological Hotwash on Resilience of Emergency Medical Services Personnel

Introduction

Emergency medical services (EMS) personnel are exposed to stress. Job stress in EMS personnel can reduce their resilience and have adverse effects on their clinical performance and mental health, thus reducing the quality of their work. The present research was performed to determine the effect of psychological hotwash on resilience of emergency medical services personnel.

Methods

This study was a quasiexperimental. Sixty-four EMS personnel were randomly divided into two groups of hotwash and control. The psychological hotwash program was performed in the intervention group for a month based on the protocol; however, the control group continued their usual work and received no intervention. A day and six weeks after the psychological hotwash in the intervention group, the resilience of the EMS personnel was remeasured in both groups.

Results

Before the intervention, the participants' mean resilience score was 138.37 ± 7.04 in the intervention group and 137.34 ± 8.48 in the control group. There was a statistically significant difference between the mean scores of resilience in the intervention and control groups a day after the intervention (P=0.003). There was no statistically significant difference between the mean scores of resilience in the intervention and control groups 6 weeks after the intervention (P=0.102).

Conclusion

The EMS personnel's attendance at psychological hotwash sessions could increase their resilience. Nevertheless, the sessions should not be interrupted because the 6-week interruption of the sessions caused the nonsignificant scores of resilience in the hotwash and control groups. Hence, it is recommended to continue the investigation of the effects of hotwash on resilience, stress reduction, and job burnout reduction in EMS personnel by other researchers in different settings.

Emotionen im Rettungsdienst

Hintergrund

Rettungskräfte müssen im Notfalleinsatz häufig mit emotional belastenden Situationen und ihren eigenen Reaktionen auf menschliches Leid umgehen. Wir untersuchten Rettungskräfte hinsichtlich ihrer Empathie und emotionalen Reaktivität sowie Strategien zur Emotionsregulation und Bewältigung schwieriger Situationen und stellten Zusammenhänge zum chronischen Stresserleben her. Zum Vergleich diente eine studentische Vergleichsstichprobe, welche keine medizinischen Berufserfahrungen vorwies.

Methode

Stress, Empathie, Emotionsregulation und Bewältigungsstrategien wurden mittels einer Fragebogenbatterie erfasst. Emotionale Reaktivität wurde experimentell mit normiertem Bildmaterial zur Erzeugung von Ekel, Trauer, Angst und Freude untersucht, welches auf einer mehrstufigen Skala von angenehm bis unangenehm beurteilt wurde.

Ergebnisse

Rettungskräfte (n = 161) erlebten weniger Stress, waren weniger empathisch und machten seltener oder ähnlichen Gebrauch von Strategien zur Emotionsregulation und Bewältigung wie Studierende (n = 56). Sie empfanden zudem ekel- und trauerauslösende Bilder weniger unangenehm. Mehr Reaktivität auf Ekelbilder, mehr Empathie, Emotionsunterdrückung und vermeidende Bewältigungsstrategien waren mit mehr Stress assoziiert.

Konklusion

Eine verminderte, jedoch nicht niedrige Empathie könnte im Einsatz hilfreich zur emotionalen Abschirmung sein, während nach dem Einsatz eine aktive Auseinandersetzung mit eigenen Emotionen und erlebten kritischen Situationen adaptiv zum Schutz vor Stress erscheint.

Does a peer social support group intervention using the cares skills framework improve emotional expression and emotion-focused coping in paramedic students?

There is growing concern for the health and wellbeing of paramedic students who are required to undertake work integrated learning (WIL) in the ambulance setting to become a registered paramedic. Paramedic culture, barriers to help seeking, and difficulty in accessing peer support is limiting their ability to express emotions and cope with workplace stress. This study aimed to examine whether participation in a peer social support group, using the CARES skills framework, changed paramedic students' emotional expression and emotion-focused coping. A convenience sample of seventy-eight participants were recruited from a paramedic program at a single regional university in Australia. Due to small participant numbers third year students were assigned to the intervention group (n = 44) and second year students were assigned to the control group (n = 34). The intervention group received training on how to undertake a peer social support group using the skills embedded in the CARES framework and were encouraged to meet every two weeks over a twelve-week period. All participants completed online surveys consisting of the DASS-21 stress subscale, General Help Seeking Questionnaire, Emotional Approach Coping Scale, Emotional Expressivity Scale and Multidimensional Scale of Perceived Social Support in week 1 and in week 12. Findings suggest that peer social support participation significantly increased emotional expression and emotion-focused coping when compared to the control group. Furthermore, this intervention significantly reduced participants' reliance upon help seeking without a significant increase in external social support. This is the first known study to investigate the role of peer social support amongst paramedic students, and the findings provide new information on how to help individuals cope with the stressors of working in the ambulance setting. Future studies should investigate whether the positive effects of peer social support are consistent over time and focus on minimising sampling issues.

Paramedic students' experiences of stress whilst undertaking ambulance placements - An integrative review

Work integrated learning (WIL) in the ambulance setting is an essential part of the paramedic curriculum. However, qualified ambulance personnel are reported to experience higher suicide rates and mental stress disorders due to high pressure work environments, and there is growing concern for the wellbeing of students entering this setting. The aim of this integrative review was to explore how studies have reported paramedic students' experience of stress whilst undertaking WIL. Five studies met the inclusion criteria and were evaluated for quality according to validated tools from the Critical Appraisal Skills Program, then ranked on the level of evidence used. Data was summarised in a comprehensive research paper matrix, and findings were categorised into levels and sources of stress. Levels of stress were measured by the percentage of paramedic students who developed post-traumatic stress disorder. The primary sources of stress were experiencing death and fear of making clinical mistakes. Students also identified emotional expression as a negative attribute. Future research should prioritise identifying the levels and sources of stress students face in each year of their academic program when undertaking WIL to provide a direction for preparatory activities that may mitigate the negative effects of stress.

Chronic and Traumatic Stress Among Emergency Medical Services Personnel

Abstract. Background: Emergency medical services (EMS) personnel are frequently confronted with multiple stressful and potentially traumatic events as well as adverse working conditions. Objective: This narrative review provides an overview of the impact of adverse mission experiences and working conditions on the mental and physical health of EMS personnel. Methods: We summarize the empirical findings on prevalence rates as well as individual vulnerability factors and resilience. Results: EMS personnel show the highest prevalence rates of stress-related health problems among first responders. The article outlines prevention and intervention approaches that contribute to maintaining and improving the mental and physical health of EMS personnel. Conclusion: In the future, further evidence-based intervention measures should be developed to adequately support this professional group.

Archetypal meanings of being a paramedic: A hermeneutic review

BACKGROUND

Interpretations of being a paramedic are normally unspoken in the literature and easily overlooked in the busyness of everyday work. The premise of this study was to explicate historical and cultural archetypes of the paramedic from within relevant literature.

METHODS

A hermeneutic review was conducted to explore meanings associated with being a paramedic. This was a novel approach to exploring meanings of being and provided a rich depiction of the cultural and historical nuances inherent in paramedic work.

RESULTS

Six paramedic archetypes were identified and related broadly to the principles of service, care and stoicism. These archetypes provided glimpses of how the paramedic is theorised both within and external to the profession, as well as gaps related to how the phenomenon of being a paramedic is experienced amid everyday practice situations.

CONCLUSION

Historical archetypes of the paramedic need to be recognised by paramedics as important in shaping the inherited cultural meanings of the work they do. However, due to the limited ability of fixed archetypes to capture the dynamic meanings of being a paramedic further research is required to understand how paramedics experience their caring work as meaningful across diverse contexts.

The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research

BACKGROUND

High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce.

METHODS

This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being.

RESULTS

Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.

CONCLUSIONS

Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.

Burnout and Coping Methods among Emergency Medical Services Professionals

Purpose

To determine levels of burnout among emergency medical services (EMS) professionals and the coping strategies they use to alleviate burnout and measure the association between burnout vs sociodemographic and work-related characteristics and coping strategies of EMS professionals.

Methods

This was a cross-sectional survey study conducted among 270 active-duty EMS professionals. The Maslach Burnout Inventory (MBI) — Health Services Survey was used to assess burnout. There are three scales of burnout: depersonalization, emotional exhaustion, and personal achievement. Coping Methods Checklist (CMC) was used to assess coping strategies. Univariate descriptive statistics were used to explore sociodemographic characteristics of participants, level of burnout, and coping strategies. Primary bivariate analyses were used to determine variables significantly correlated with each of the three MBI scores. Multiple linear regression models were used to explore correlation between variables measured in the survey with each of the three MBI scales (emotional exhaustion, depersonalization, and personal accomplishment).

Results

EMS professionals perceived high levels of emotional exhaustion and depersonalization and low levels of personal achievement. The most frequently used coping strategies were talking with colleagues (87.4%), looking forward to being off duty (82.6%), and thinking about the positive benefits of work (81.1%). CMC7 (thinking about the positive benefits of work) contributed most to variations in emotional exhaustion, depersonalization, and personal achievement. Saudis had lower emotional exhaustion and depersonalization.

Conclusion

This study might provide evidence to formulate comprehensive training on how EMS workers can cope with burnout.

Working in prehospital emergency contexts

Purpose

Ambulance personnel face a diversity of stressful events that could be potentially traumatic, putting their health and well-being at risk. The purpose of this paper is to explore, from this group perspective, sources of stress, coping strategies and support measures.

Design/methodology/approach

The authors interviewed 14 ambulance workers of Portuguese Red Cross local structures from the north of Portugal. Data were analyzed according to thematic analysis procedures.

Findings

The authors identified three themes: operational and organizational factors, control and predictability; anticipating scenarios, focusing on procedures and dealing with reactions; and from undervalued support to support as routine. Dealing with human lives, the unpredictability of calls and working under pressure are the main sources of stress, causing, in some of them, insomnia, fatigue, anxiety and intrusive thoughts. Road accidents, situations involving children and cardiac arrest are the most distressing events. During events, they cope focusing on technical procedures, but after them they prefer to talk with colleagues and seek support from family and friends. All participants emphasize the inexistence of structured support measures.

Practical implications

It is important to develop support measures tailored to ambulance personnel’s needs, leading to enhancements of theirs work performance, health and well-being.

Originality/value

Contrarily to most of the studies that explore mostly PTSD and/or burnout, the authors explored, from the perspective of professionals, other dimensions such as sources of stress, coping strategies and support measures, adopting a qualitative approach, which has been rarely used.

Deconstructing Traumatic Mission Experiences: Identifying Critical Incidents and Their Relevance for the Mental and Physical Health Among Emergency Medical Service Personnel

Emergency medical service (EMS) personnel frequently encounter emotionally stressful or even traumatic incidents in their line of duty. In this study, a checklist of emotionally stressful events for the German EMS was introduced. A mixed-method approach was used to identify mission events that were critical for the development of mental and physical stress symptoms. Data were collected in a cross-sectional sample of 102 EMS employees. A quantitative content analysis of the participants' worst experiences on duty indicated, traumatic missions to be a concatenation of two to five emotionally stressful events. Rescue missions were experienced as traumatic if (i) EMS personnel became victims of attacks or threats; (ii) certain circumstances caused them to give up their professional detachment from patients; (iii) EMS personnel perceived the overall mission as exceptionally tragic. In subsequent correlation analyses, the corresponding checklist items showed consistent positive associations with the post-traumatic, depressive and physical stress symptoms among the study cohort. Within the exploratory regressions, the sum score of critical on-duty exposures contributed incrementally to the prediction of mental and physical stress symptoms when non-work-related trauma exposure and perceived social support were also considered. Findings point toward the importance of considering the cumulative burden of critical incidents for the long-term health of EMS personnel. Future research is needed to investigate, how on-duty trauma affects the social support EMS personnel received from their work and personal relationships.

Stress coping styles among anaesthesiology and intensive care unit personnel - links to the work environment and personal characteristics: a multicentre survey study

BACKGROUND

High levels of stress among anaesthesiology and intensive care unit workers are commonly reported. Personnel in these units are prone to stress because of specific characteristics of their work. Their development of skills to cope with stress may affect their psychophysical condition and, consequently, patient safety.

OBJECTIVES

The aim of this study was to define the coping styles of anaesthesiology and intensive care unit personnel and to evaluate the connections between the work environment as well as personal characteristics and the dominant coping styles.

METHODS

Anaesthesiology and intensive care unit personnel from 15 selected Polish hospitals were surveyed using the Coping Inventory for Stressful Situations, which examines task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The Perceived Stress Scale was used to assess stress levels.

RESULTS

The analysis included 425 successfully completed surveys. The examined population was divided into two groups: Group N comprised 311 nurses (73.18%) and group P comprised 114 physicians (26.82%). For 167 participants (39.29%), the dominant coping style was defined. The most common style was the task-oriented coping style; it was dominant in 96 participants (22.58% of the entire examined population). This style was significantly predominant among men. The domination of some coping styles coexisted with marital status, number of children and financial situation. The occurrence of different coping styles did not significantly differ among workers at different-sized hospitals, with different job seniority or with different living locations. Perceived stress was correlated with all coping styles.

CONCLUSIONS

Work-related stress among anaesthesiology and intensive care unit workers is an important problem. Further investigations of stress levels and the causes and effects of stress in this population are necessary.

Higher sense of coherence is associated with better mental and physical health in emergency medical services: results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers

As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset - called sense of coherence - may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)_age = 26.0 (8.5), age range: 18-61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (β = -.31, p = .009), depressive (β = -.44, p < .001), and somatic symptoms (β = -.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R's factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R's convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.

Fatores associados ao uso de medicamentos ansiolíticos entre bombeiros militares

RESUMO: Introdução: O uso de ansiolíticos é uma opção no tratamento de sintomas psíquicos. Contudo, ainda que o uso seja controlado há riscos de dependência, intoxicação e alterações cognitivas. O uso não controlado entre trabalhadores agrava tais problemas. Objetivos: Identificar a prevalência do uso de ansiolíticos e conhecer os fatores associados ao consumo em bombeiros militares. Método: Pesquisa transversal de base censitária investigou 711 bombeiros de Belo Horizonte, Minas Gerais, por meio de autorrelato. Regressão logística multinomial foi utilizada para verificar associação entre características sociodemográficas, condições de vida, trabalho e saúde e consumo de ansiolíticos de modo controlado ou não. Resultados: A prevalência do uso de ansiolíticos foi 9,9%. Para 7,5% dos bombeiros o consumo ocorreu sem indicação e/ou controle terapêutico especializado. O uso controlado foi associado ao relato compatível com Transtorno Mental Comum (OR = 23,6; IC95% 6,54 - 85,11). O uso não controlado foi associado ao tempo de serviço (OR = 2,57; IC95% 1,03 - 6,40), ao tabagismo (OR = 3,22; IC95% 1,50 - 6,91) e ao Transtorno Mental Comum (OR = 4,02; IC95% 2,17 - 7,45). Conclusão: A alta prevalência de consumo indica alerta para as ações dos programas de saúde ocupacional.

Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group training. Conclusions: There appears to be both a need and an opportunity for education initiatives regarding paediatric traumatic stress in the pre-hospital context.