Posttraumatic stress disorder among paramedics: exploring a new solution with occupational health nurses using the Ottawa Charter as a framework

Paramedic attitudes and experiences working as a community paramedic: a qualitative survey

BACKGROUND

Community paramedicine (CP) is an extension of the traditional paramedic role, where paramedics provide non-acute care to patients in non-emergent conditions. Due to its success in reducing burden on hospital systems and improving patient outcomes, this type of paramedic role is being increasingly implemented within communities and health systems across Ontario. Previous literature has focused on the patient experience with CP programs, but there is lack of research on the paramedic perspective in this role. This paper aims to understand the perspectives and experiences, both positive and negative, of paramedics working in a CP program towards the community paramedic role.

METHODS

An online survey was distributed through multiple communication channels (e.g. professional organizations, paramedic services, social media) and convenience sampling was used. Five open-ended questions asked paramedics about their perceptions and experiences with the CP role; the survey also collected demographic data. While the full survey was open to all paramedics, only those who had experience in a CP role were included in the current study. The data was qualitatively analyzed using a comparative thematic analysis.

RESULTS

Data was collected from 79 respondents who had worked in a CP program. Three overarching themes, with multiple sub-themes, were identified. The first theme was that CP programs fill important gaps in the healthcare system. The second was that they provide paramedics with an opportunity for lateral career movement in a role where they can have deeper patient connections. The third was that CP has created a paradigm shift within paramedicine, extending the traditional scope of the practice. While paramedics largely reported positive experiences, there were some negative perceptions regarding the slower pace of work and the "soft skills" required in the role that vary from the traditional paramedic identity.

CONCLUSIONS

CP programs utilize paramedic skills to fill a gap in the healthcare system, can improve paramedic mental health, and also provide a new pathway for paramedic careers. As a new role, there are some challenges that CP program planners should take into consideration, such as additional training needs and the varying perceptions of CP.

How does the use of humour in the UK ambulance service affect a clinician's well-being?

Introduction:

Paramedics and ambulance staff face many different stresses in today’s UK ambulance service, with many having reported an effect on their well-being and mental health. Humour is widely used by staff as a coping mechanism, but little is known about this topic. This literature review aims to find out how humour is used and how it can affect clinicians’ well-being.

Methods:

A total of nine medical databases were searched for relevant literature – Cochrane, Scopus, CINAHL Complete, Science Direct, Medline Complete, Complementary Index, Academic Search Complete, Emerald Insight and Supplemental Index. Articles were included if they were published in 2005 or after, if they were a UK-based original study and if they studied humour in relation to paramedics’ well-being.

Results:

After limiters were applied, a total of 26 articles were found. Only four articles met all the inclusion and exclusion criteria. Two of the articles studied humour directly, whereas two found humour as a result of studying the resilience and strategies used to cope with the stresses of ambulance work. Four key themes were identified: different types of humour, the source and boundaries of humour, offloading and camaraderie.

Conclusion:

This review of the literature found that many in the ambulance community view their use and expression of humour as a positive coping strategy that helps them to relieve the stresses of the job. Further research is needed to investigate any negative effects that humour has on a clinician’s well-being and larger studies are needed to give a better representation of the ambulance community.

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

Introduction

Very little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession.

Methods

We administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service. We defined the presence of burnout as a high score on either the emotional exhaustion or depersonalization subscales of the MBI.

Results

Survey respondents who provided regular 911 response at the time of the survey and completed the MBI portion of the survey were included in our analysis (190 paramedics/EMTs, 19 dispatchers; 54% response). The overall prevalence of burnout was 18%, with prevalence reaching 32% among dispatchers. The seven pediatric critical incident types presented in the survey accounted for seven of the top eight rated most difficult to cope with, and severity ratings for pediatric critical incidents did not differ by parental status (all p>0.30). A significant number of respondents reported that they had been threatened with a gun/weapon (43%) or assaulted by a patient (68%) at least once while on duty. Being over the age of 50, a parent, or in a committed relationship was associated with reduced odds of burnout in unadjusted models; however, these associations did not remain statistically significant in multivariate analysis. Increasing tertile of career exposure to critical incidents was not associated with burnout.

Conclusion

Medical dispatchers may be an EMS subgroup particularly susceptible to burnout. These data also demonstrate quantitatively that in this EMS agency, responders find pediatric critical incidents especially distressing and that violence against responders is commonplace. In this study, a simple measure of career exposure to potentially critical incidents was not associated with burnout; however, individual reactions to incidents are heterogeneous, and assessment tools that more accurately enumerate encounters that result in distress are needed.