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Karnick A, Caulfield NM, Buerke M, Stanley I, Capron D, Vujanovic A. Clinical and psychological implications of post-traumatic stress in firefighters: a moderated network study. Cogn Behav Ther 2024; 53:171-189. [PMID: 37960947 DOI: 10.1080/16506073.2023.2282374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of post-traumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of symptom severity and emergency work-related trauma on symptom networks. The present study probed the network structure of post-traumatic stress symptoms in trauma-exposed firefighters (N = 871) to model the dynamic interactions of psychological symptoms. We developed a network of post-traumatic stress symptoms and a network of post-traumatic stress with clinical covariates and used moderated network modelling to assess the effects of having PTSD and experiencing work-related trauma on the networks. We identified high edge correlations between several nodes (e.g. startle/hypervigilance, internal/external cue avoidance, detachment/lack of interest) and high centrality of detachment, external cue avoidance, and flashbacks. Additionally, having PTSD moderated positive network associations between risk-taking and suicidality and between distorted blame and post-traumatic cognitions. Work-related trauma moderated negative associations between appetite gain and loss and appetite loss and suicidality. Findings suggest that targeting specific symptoms of detachment, external cue avoidance, and flashbacks could allow for the development of effective trauma-informed interventions for these populations.
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Affiliation(s)
- Aleksandr Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Ian Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Anka Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA
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Martínez-Caballero CM, Matellán-Hernández MP, Polo-Portes CE, Reques-Marugán AM, Soto-Cámara R, Cardaba-García RM, Thuissard IJ, Navalpotro-Pascual S. Exploring Disparities in Self-Reported Mental Health Symptoms Across Professional Categories in Spain's Emergency Medical Services: A Nationwide Cross-Sectional Study. Disaster Med Public Health Prep 2023; 17:e518. [PMID: 37872714 DOI: 10.1017/dmp.2023.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021. METHODS A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions. RESULTS The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20]. CONCLUSIONS Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.
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Affiliation(s)
| | | | | | | | - Raúl Soto-Cámara
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | | | - Israel John Thuissard
- Facultad de CC Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Susana Navalpotro-Pascual
- Emergency Medical Service of Madrid- SUMMA 112, Madrid, Spain
- Department of Health Sciences, Autonomous University of Madrid, Madrid, Spain
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Torres-McGehee TM, Emerson DM, Flanscha-Jacobson A, Uriegas NA, Moore EM, Smith AB. Energy Availability, Mental Health, and Sleep Patterns of Athletic Trainers. J Athl Train 2023; 58:788-795. [PMID: 36913639 PMCID: PMC11215732 DOI: 10.4085/1062-6050-0547.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CONTEXT Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs). OBJECTIVE To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional). DESIGN Cross-sectional study. SETTING Free living in occupational settings. PATIENTS OR OTHER PARTICIPANTS A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States. MAIN OUTCOME MEASURE(S) Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality. RESULTS Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances. CONCLUSIONS Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care.
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Carson LM, Marsh SM, Brown MM, Elkins KL, Tiesman HM. An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015-2017. JOURNAL OF SAFETY RESEARCH 2023; 85:361-370. [PMID: 37330885 PMCID: PMC11284622 DOI: 10.1016/j.jsr.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/06/2022] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection. METHODS Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders. RESULTS First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts. CONCLUSIONS While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions. PRACTICAL APPLICATION Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.
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Affiliation(s)
- Leslie M Carson
- National Highway Traffic Safety Administration, Office of Impaired Driving and Occupant Protection, Impaired Driving Division, Washington, DC, USA
| | - Suzanne M Marsh
- National Institute for Occupational Safety and Health, Division of Safety Research, Surveillance and Field Investigations Branch, Morgantown, WV, USA.
| | - Margaret M Brown
- National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA, USA
| | - Katherine L Elkins
- National Highway Traffic Safety Administration, Office of Emergency Medical Services, EMS and National 911 Programs, Washington, DC, USA
| | - Hope M Tiesman
- National Institute for Occupational Safety and Health, Division of Safety Research, Analysis and Field Evaluations Branch, Morgantown, WV, USA
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Melnyk H, Di Tosto G, Powell J, Panchal AR, McAlearney AS. Conflict in the EMS Workforce: An Analysis of an Open-Ended Survey Question Reveals a Complex Assemblage of Stress, Burnout, and Pandemic-Related Factors Influencing Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105861. [PMID: 37239587 DOI: 10.3390/ijerph20105861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Emergency Medical Services (EMS) clinicians provide patient care within a high-stakes, unpredictable, and complex work environment in which conflict is inevitable. Our objective was to explore the extent to which added stressors of the pandemic exacerbated EMS workplace conflict. We administered our survey to a sample of U.S. nationally certified EMS clinicians during the COVID-19 pandemic in April 2022. Out of 1881 respondents, 46% (n = 857) experienced conflict and 79% (n = 674) provided free-text descriptions of their experience. The responses were analyzed for themes using qualitative content analysis, and they were then sorted into codes using word unit sets. Code counts, frequencies, and rankings were tabulated, enabling quantitative comparisons of the codes. Of the fifteen codes to emerge, stress (a precursor of burnout) and burnout-related fatigue were the key factors contributing to EMS workplace conflict. We mapped our codes to a conceptual model guided by the National Academies of Sciences, Engineering, and Medicine (NASEM) report on using a systems approach to address clinician burnout and professional well-being to explore implications for addressing conflict within that framework. Factors attributed to conflict mapped to all levels of the NASEM model, lending empirical legitimacy to a broad systems approach to fostering worker well-being. Our findings lead us to propose that active surveillance (enhanced management information and feedback systems) of frontline clinicians' experiences during public health emergencies could increase the effectiveness of regulations and policies across the healthcare system. Ideally, the contributions of the occupational health discipline would become a mainstay of a sustained response to promote ongoing worker well-being. The maintenance of a robust EMS workforce, and by extension the health professionals in its operational sphere, is unquestionably essential to our preparedness for the likelihood that pandemic threats may become more commonplace.
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Affiliation(s)
- Halia Melnyk
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, Ohio State University, Columbus, OH 43202, USA
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, Ohio State University, Columbus, OH 43202, USA
| | - Jonathan Powell
- National Registry of Emergency Medical Technicians, Columbus, OH 43223, USA
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 43210, USA
| | - Ashish R Panchal
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, Ohio State University, Columbus, OH 43202, USA
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 43210, USA
- Department of Emergency Medicine, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, Ohio State University, Columbus, OH 43202, USA
- Department of Family and Community Medicine, College of Medicine, Ohio State University, Columbus, OH 43210, USA
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Al-Wathinani AM, Almusallam MA, Albaqami NA, Aljuaid M, Alghamdi AA, Alhallaf MA, Goniewicz K. Enhancing Psychological Resilience: Examining the Impact of Managerial Support on Mental Health Outcomes for Saudi Ambulance Personnel. Healthcare (Basel) 2023; 11:healthcare11091277. [PMID: 37174818 PMCID: PMC10178426 DOI: 10.3390/healthcare11091277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Ambulance personnel are among the groups with high mental health risks. This study aims to investigate the role of managerial support in determining the mental well-being of ambulance personnel, a group at high risk for mental health issues. A descriptive, cross-sectional survey design was conducted in Riyadh, Saudi Arabia, in February 2022, involving a convenience sample of 354 ambulance personnel. An online survey was distributed via social media platforms. Manager behavior and mental well-being were assessed using the Manager Behavior Questionnaire (MBQ) and the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). The participants represented nearly equal-sized groups from different agencies, with 50.3% residing in the Riyadh Region and 67.5% aged between 25 and 34. The mean score for manager behavior was 2.92 ± 1.124, while the mental well-being scale's mean score was 3.398 ± 0.8219. Variance analyses revealed statistically significant differences in manager behavior concerning gender, age, residence, and years of experience (p < 0.05), as well as in the mental well-being of ambulance personnel. Generalized linear regression analysis demonstrated a statistically significant relationship between manager behavior and mental well-being (p < 0.01). Focusing on improving organizational management behaviors is a promising strategy for enhancing mental health interventions among ambulance personnel. Further research is recommended to monitor the mental health of these professionals and develop evidence-based interventions to support their well-being.
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Affiliation(s)
- Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohannad A Almusallam
- National Guard Health Affairs, King Abdulaziz Medical City, Dirab Primary Health Center Riyadh, Riyadh 14972, Saudi Arabia
| | - Nawaf A Albaqami
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah A Alghamdi
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad A Alhallaf
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Dęblin, Poland
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Ebrahimian A, Keshavarz‐Tork A, Akbari‐Shahrestanaki Y, Tourdeh M, Fakhr‐Movahedi A. Changes in the prehospital emergency technician's resilience during the COVID-19 pandemic: A web-based cross-sectional study. Health Sci Rep 2023; 6:e1223. [PMID: 37091356 PMCID: PMC10113882 DOI: 10.1002/hsr2.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Aims Resilience is a process that enables people to control the stressors of their lives. During the COVID-19 crisis, work stress increased among prehospital emergency technicians. So, it was possible to reduce their resilience. This study aimed to investigate the changes in the prehospital emergency technicians' resilience during the pandemic of COVID-19. Methods A cross-sectional study was conducted at the prehospital emergency department in Qazvin province. For 6 months, 234 emergency technicians participated in this study. Data collection tools included a demographic questionnaire and the emergency medical services resilience scale (EMSRS). Results The Friedman test indicated no significant difference between the mean scores of EMS employees' resilience during 6 months (p > 0.05). However, the correlation matrix between the scores of EMSRS during 6 months indicated that the resilience scores of EMS employees were positively correlated during the study (p < 0.01). Conclusions The EMS technicians' resilience was almost constant and moderate during the 6 months of care for patients with COVID-19 and their transfer to the hospital, indicating that the COVID-19 crisis could suppress the emergency medical technicians ability to increase resilience.
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Affiliation(s)
- Abbasali Ebrahimian
- Health in Emergencies and Disasters Group, Faculty of ParamedicalQom University of Medical SciencesQomIran
- Nursing Care Research CenterSemnan University of Medical SciencesSemnanIran
| | | | - Yousof Akbari‐Shahrestanaki
- Department of Prehospital Emergency Medical Care, School of Paramedical SciencesQazvin University of Medical SciencesQazvinIran
| | - Maedeh Tourdeh
- Anesthesia Department, Faculty of ParamedicalQom University of Medical SciencesQomIran
| | - Ali Fakhr‐Movahedi
- Nursing Care Research CenterSemnan University of Medical SciencesSemnanIran
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Obuobi-Donkor G, Shalaby R, Eboreime E, Agyapong B, Phung N, Eyben S, Wells K, Hilario C, Dias RDL, Jones C, Brémault-Phillips S, Zhang Y, Greenshaw AJ, Agyapong VIO. Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4215. [PMID: 36901235 PMCID: PMC10001524 DOI: 10.3390/ijerph20054215] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Public safety personnel experience various mental health conditions due to their work's complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel. OBJECTIVE The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention. METHODS Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment. RESULTS One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (-35.3%, X2 (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02). CONCLUSIONS The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.
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Affiliation(s)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Natalie Phung
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Scarlett Eyben
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Kristopher Wells
- Department of Child and Youth Care, Faculty of Health and Community Studies, MacEwan University, Edmonton, AB T5J 4S2, Canada
| | - Carla Hilario
- School of Nursing, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Chelsea Jones
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Andrew J. Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Allison P, Tiesman HM, Wong IS, Bernzweig D, James L, James SM, Navarro KM, Patterson PD. Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research. Am J Ind Med 2022; 65:878-897. [PMID: 35711032 PMCID: PMC9851314 DOI: 10.1002/ajim.23407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers. METHODS We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue. RESULTS Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs. CONCLUSIONS In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.
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Affiliation(s)
- Penelope Allison
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Hope M. Tiesman
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Imelda S. Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David Bernzweig
- Ohio Association of Professional Fire Fighters, Columbus, Ohio, USA
| | - Lois James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Stephen M. James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Kathleen M. Navarro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rudman JS, Farcas A, Salazar GA, Hoff JJ, Crowe RP, Whitten-Chung K, Torres G, Pereira C, Hill E, Jafri S, Page DI, von Isenburg M, Haamid A, Joiner AP. Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review. PREHOSP EMERG CARE 2022; 27:385-397. [PMID: 36190493 DOI: 10.1080/10903127.2022.2130485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS. METHODS Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively. RESULTS We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes. CONCLUSIONS Existing EMS workforce research demonstrates continued underrepresentation of women and non-White personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.
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Affiliation(s)
- Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andra Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Gilberto A Salazar
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - J J Hoff
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | | | | | | | | | - Eric Hill
- Department of Emergency Medicine, Medical Center of Aurora, Aurora, CO
| | | | - David I Page
- Prehospital Care Research Forum, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | | | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago Medicine, Chicago, IL
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
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The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis. PLoS One 2022; 17:e0272732. [PMID: 36001612 PMCID: PMC9401173 DOI: 10.1371/journal.pone.0272732] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. Methods Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. Results 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. Conclusions Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.
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12
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Hoff JJ, Zimmerman A, Tupetz A, Van Vleet L, Staton C, Joiner A. Shame and Guilt in EMS: A Qualitative Analysis of Culture and Attitudes in Prehospital Emergency Care. PREHOSP EMERG CARE 2022; 27:418-426. [PMID: 35522078 DOI: 10.1080/10903127.2022.2074178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study ObjectivesThe shame reaction is a highly negative emotional reaction shown to have long-term deleterious effects on the mental health of clinicians. Prior studies have focused on in-hospital personnel, but very little is known about what drives shame reactions in emergency medical services (EMS), a field with very high rates of post-traumatic stress disorder, burnout, anxiety, and depression. The objective of this study was to describe emotions, processes, and resilience associated with self-identified adverse events in the work of prehospital clinicians.MethodsWe conducted a qualitative study using a modified critical incident technique. Participants were recruited from two EMS agencies in North Carolina: one urban and one rural. They provided an open-ended, written reflection in which they were asked to self-identify particular events in their EMS careers that felt emotionally difficult. In-person or video in-depth interviews about these events were then conducted in a semi-structured fashion using an iterative interview guide. The codebook was developed through a mix of inductive and deductive analysis strategies and discussed within the research team and a content expert for validation. Interviews were transcribed and data were analyzed following a thematic content analysis approach for types of cases identified as emotionally difficult, common emotional responses and coping mechanisms, and the lingering effects of these experiences on study subjects.ResultsEight interviews were conducted with EMS personnel: five from an urban agency and three from a rural agency. Participants commonly identified complex medical cases as being emotionally difficult, which led to the most robust shame reactions. Shame reactions were more common when EMS clinicians committed self-perceived errors in patient care, whereas guilt reactions were more common when patient outcomes seemed "inevitable" despite any intervention. Common themes related to coping mechanisms included both personal mechanisms, which tended to be less successful compared to interpersonal mechanisms, particularly when emotions were shared with colleagues. This reflected a perceived culture change within EMS in which sharing emotions with colleagues was seen as a departure from the "old school" where emotions tended to be kept to oneself. Feelings of inadequacy, low self-worth, and being "not good enough" were frequently identified as lingering emotions after difficult cases that were hard to move on from, corresponding to longstanding shame in these clinicians. Recovery and resilience varied but tended to be positively associated with a culture in which sharing with colleagues was encouraged, along with personal introspection on root causes for the sentinel event.ConclusionEMS clinicians often identify complex patient cases as those leading to emotions such as shame and guilt, with shame reactions being more common when a perceived error was committed. Coping mechanisms were varied, but individuals often relied on their co-workers in a sharing environment to adequately process their negative feelings, which was seen as a departure from past practices in EMS personnel. Our hope is that future studies will be able to use these findings to identify targets for intervention on negative mental health outcomes in EMS personnel.
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Affiliation(s)
- J J Hoff
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Department of Emergency Medicine, East Carolina University, Greenville, NC
| | - Armand Zimmerman
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lee Van Vleet
- Duke Global Health Institute, Durham, NC.,Durham County Emergency Medical Services, Durham, NC
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
| | - Anjni Joiner
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
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Dodd N, Warren-James M, Stallman HM. How do paramedics and student paramedics cope? A cross-sectional study. Australas Emerg Care 2022; 25:321-326. [PMID: 35525725 DOI: 10.1016/j.auec.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Natalie Dodd
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Qld, Australia.
| | - Matthew Warren-James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Qld, Australia
| | - Helen M Stallman
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Birtinya, Qld, Australia
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Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084879. [PMID: 35457746 PMCID: PMC9030944 DOI: 10.3390/ijerph19084879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.
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15
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COVID-19 induced PTSD: Stressors for trauma and acute care surgeons. Am J Surg 2022; 224:843-848. [PMID: 35277241 PMCID: PMC8896861 DOI: 10.1016/j.amjsurg.2022.02.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/23/2022]
Abstract
Background At the peak of the pandemic, acute care surgeons at many hospitals were reassigned to treat COVID-19 patients. However, the effect of the pandemic on this population who are well versed in stressful practice has not been fully explored. Methods A web-based survey was distributed to the members of the Eastern Association for the Surgery of Trauma (EAST). PTSD and the personal and professional impact of the pandemic were assessed. A positive screen was defined as a severity score of ≥14 or a symptomatic response to at least 5 of the 6 questions on the screen. Results A total of 393 (17.8%) participants responded to the survey. The median age was 43 (IQR: 38-52) and 238 (60.6%) were male. The majority of participants were surgeons (351, 89.3%), specializing in general surgery/trauma (379, 96.4%). The main practice type and setting were hospital-based (350, 89%) and university hospital (238, 60.6%), respectively. The incidence of PTSD was 16.3% when a threshold severity score of ≥14 was used and 5.6% when symptomatic responses were assessed. Risk factors for a positive PTSD screen included being single/unmarried (p = 0.02), having others close to you contract COVID-19 (p = 0.02), having family issues due to COVID-19 (p = 0.0004), rural (p = 0.005) and suburban (p = 0.047) practice settings, a fear of going to work (p = 0.001), and not having mental health resources provided at work (p = 0.03). Conclusion The COVID-19 pandemic had a psychological impact on surgeons. Although acute care surgeons are well versed in stressful practice, the pandemic nevertheless induced PTSD symptoms in this population, suggesting the need for mental health resources.
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Perceived Symptoms of Depression, Anxiety and Stress amongst Staff in a Malaysian Public University: A Workers Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211874. [PMID: 34831628 PMCID: PMC8623520 DOI: 10.3390/ijerph182211874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
Mental health conditions are a major part of workers’ health that predisposes to poor self-motivation for sustaining productivity. This study was aimed to determine the prevalence of depression, anxiety, and stress among staff in a Malaysian public university and its associated factors. A cross-sectional study was conducted among 459 staff from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A questionnaire that consisted of items on socio-demographic and socioeconomic characteristics, employment description, lifestyle risk behaviors, personal medical history, and symptoms of depression, anxiety, and stress was administered to participants. Descriptive and inferential statistics were conducted using SPSS version 22.0. The prevalence of perceived symptoms of depression, anxiety, and stress among the respondents was 28.7%, 50.1%, and 14.8%, respectively. Over one-quarter (26.5%) of the participants presented symptoms of two or more mental disorders. Women, those aged less than 40 years old, and non-academic professionals were more likely to exhibit depressive symptoms, while those with medical conditions that required hospitalizations sustained anxiety symptoms. Perceived stress was more likely to be prevalent among staff with secondary education or less and smokers. Proactive support for staff needs to be offered in sustaining their emotional well-being.
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Martínez-Caballero CM, Cárdaba-García RM, Varas-Manovel R, García-Sanz LM, Martínez-Piedra J, Fernández-Carbajo JJ, Pérez-Pérez L, Madrigal-Fernández MA, Barba-Pérez MÁ, Olea E, Durantez-Fernández C, Herrero-Frutos MT. Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179132. [PMID: 34501726 PMCID: PMC8431006 DOI: 10.3390/ijerph18179132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022]
Abstract
The early stages of the COVID-19 pandemic presented the characteristics of a traumatic event that could trigger post-traumatic stress disorder. Emergency Medical Services workers are already a high-risk group due to their professional development. The research project aimed to analyse the impact of the COVID-19 pandemic on EMS professionals in terms of their mental health. For this purpose, we present a descriptive crosssectional study with survey methodology. A total of 317 EMS workers (doctors, nurses, and emergency medical technicians) were recruited voluntarily. Psychological distress, post-traumatic stress disorder, and insomnia were assessed. The instruments were the General Health Questionnaire-12 (GHQ-12), the Davidson Trauma Scale (DTS-8), and the Athens Insomnia Scale (AIS-8). We found that 36% of respondents had psychological distress, 30.9% potentially had PTSD, and 60.9% experienced insomnia. Years of work experience were found to be positively correlated, albeit with low effect, with the PTSD score (r = 0.133). Finally, it can be stated that the COVID-19 pandemic has been a traumatic event for EMS workers. The number of professionals presenting psychological distress, possible PTSD, or insomnia increased dramatically during the early phases of the pandemic. This study highlights the need for mental health disorder prevention programmes for EMS workers in the face of a pandemic.
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Affiliation(s)
- Carmen M. Martínez-Caballero
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
| | - Rosa M. Cárdaba-García
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain or (L.P.-P.); or (M.A.M.-F.); (M.Á.B.-P.); (E.O.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
| | - Rocío Varas-Manovel
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
| | - Laura M. García-Sanz
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
| | | | - Juan J. Fernández-Carbajo
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
| | - Lucía Pérez-Pérez
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain or (L.P.-P.); or (M.A.M.-F.); (M.Á.B.-P.); (E.O.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
- Primary Care Management Valladolid West (SACYL), 47012 Valladolid, Spain
| | - Miguel A. Madrigal-Fernández
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain or (L.P.-P.); or (M.A.M.-F.); (M.Á.B.-P.); (E.O.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
- University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
| | - M. Ángeles Barba-Pérez
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain or (L.P.-P.); or (M.A.M.-F.); (M.Á.B.-P.); (E.O.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
- University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
| | - Elena Olea
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain or (L.P.-P.); or (M.A.M.-F.); (M.Á.B.-P.); (E.O.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
- Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid-CSIC, 47005 Valladolid, Spain
| | | | - M. Teresa Herrero-Frutos
- Emergencies Management (SACYL), 40002 Segovia, Spain; (C.M.M.-C.); (R.M.C.-G.); (R.V.-M.); (L.M.G.-S.); (J.J.F.-C.)
- Correspondence: or
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Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review. Prehosp Disaster Med 2021; 36:475-480. [PMID: 33928892 DOI: 10.1017/s1049023x21000431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career. METHODS A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. RESULTS A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. CONCLUSION Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.
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Awais SB, Martins RS, Khan MS. Paramedics in pandemics: protecting the mental wellness of those behind enemy lines. Br J Psychiatry 2021; 218:75-76. [PMID: 33092658 DOI: 10.1192/bjp.2020.193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.
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Coto J, Restrepo A, Cejas I, Prentiss S. The impact of COVID-19 on allied health professions. PLoS One 2020; 15:e0241328. [PMID: 33125385 PMCID: PMC7598457 DOI: 10.1371/journal.pone.0241328] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
The purpose of the current study was to examine the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19) on allied health professionals work environment, access to personal protective equipment (PPE) and COVID-19 testing, and mental health. A 34-question survey was developed and distributed electronically to allied health professionals through listservs of professional organizations and social media groups. A total of 921 responses from allied health professionals in a variety of work settings were analyzed. The majority of allied health professionals had access to medical-grade PPE and agreed with their clinics decisions to stay open or closed. Private practices appeared to be the most negatively impacted with regards to employment in the form of pay reductions, furloughs, lay-offs, or the requirement of using paid time off. Importantly, 86% of all respondents, irrespective of employment status, reported feeling stressed with regards to changes in their work environment and transmission of the virus. However, levels of stress were dependent upon access to PPE and mental health resources. Specifically, those with access to mental health support reported lower stress levels than those without such access. These results highlight the need for continuous monitoring of mental health for allied health professionals in order to inform clinic and hospital policies for PPE and the development of brief interventions to mitigate adverse long-term mental health outcomes.
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Affiliation(s)
- Jennifer Coto
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Alicia Restrepo
- Department of Otolaryngology Ear Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Ivette Cejas
- Department of Otolaryngology Ear Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Sandra Prentiss
- Department of Otolaryngology Ear Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
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Hichisson AD, Corkery JM. Alcohol/substance use and occupational/post-traumatic stress in paramedics. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/jpar.2020.12.10.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Paramedics work in high-pressure environments and experience traumatic events, which contribute to high levels of occupational and post-traumatic stress. Such stress can result in alcohol and substance misuse in other health professionals, but this relationship has not been examined in paramedics. This review is the first exploration of the literature on this. Methods: A systematic literature review was conducted using PRISMA guidelines, with databases searched using terms relevant to paramedics and alcohol/substance use. Studies were analysed using descriptive statistics for quantitative data and thematic analysis for qualitative information. Findings: Eleven studies were identified. Nine studies examined alcohol use; seven examined substance use; five examined both. Alcohol and smoking may be linked to occupational stress. Conclusions: The nature and extent of alcohol and substance use in relation to occupational and post-traumatic stress among paramedics need further investigation to facilitate advice and support.
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Affiliation(s)
- Andrew David Hichisson
- Advanced Paramedic Practitioner (Urgent Care), Medical Directorate, London Ambulance Service NHS Trust
| | - John Martin Corkery
- Senior Lecturer in Pharmacy Practice and Module Lead for Online Masters in Public Health, University of Hertfordshire, Hatfield
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22
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Stevelink SAM, Pernet D, Dregan A, Davis K, Walker-Bone K, Fear NT, Hotopf M. The mental health of emergency services personnel in the UK Biobank: a comparison with the working population. Eur J Psychotraumatol 2020; 11:1799477. [PMID: 33062207 PMCID: PMC7534319 DOI: 10.1080/20008198.2020.1799477] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is evidence that mental disorders are more frequently reported among emergency services personnel due to the stressful nature of the job in combination with a high exposure to traumatic events. However, most of this research is based on occupational surveys that may lead to a contextual bias in the prevalence estimates or lack an adequate comparison group. Objectives: To investigate mental health outcomes and associations with individual, job and trauma related characteristics among emergency services personnel compared to other workers. Method: Participants were identified from the UK Biobank, a large study that collected a variety of genetic, physical and health data on individuals from across the UK. UK Biobank participants were aged between 40-69 years at recruitment. Those employed in the emergency services were identified based on job titles. A comparison sample of other workers was selected and matched to the gender composition of emergency services personnel. Results: 5052 participants were included, and 842 were currently working in the emergency services. The majority were male (77.4%) and the mean age at Biobank enrolment was 52.5 years. Alcohol misuse was reported in 32.8% of emergency services personnel compared to 29.2% in non-emergency services personnel, followed by PTSD (9.2% vs 6.0%), depression (6.8% vs 5.1%) and anxiety (3.9% vs 3.6%). An increased risk of PTSD was found among emergency services personnel compared to other workers (odds ratio 1.58, 95% confidence interval 1.21-2.06), but this association was no longer significant after adjustment for exposure to traumatic events and job characteristics. Conclusions: The substantial levels of alcohol misuse and increased risk of PTSD, possibly as a result of traumatic exposures in the line of duty in combination with job stressors such as shift work, call for continued monitoring of the health and wellbeing of emergency services personnel.
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Affiliation(s)
- Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK
- Arthritis Research UK/MRC Centre for Musculoskeletal Work and Health, Southampton General Hospital, Southampton, Hampshire, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Sampson S, Mazur J, Israel G, Galindo S, Ward C. Competing Roles and Expectations: Preliminary Data from an Agricultural Extension Survey on COVID-19 Impacts. J Agromedicine 2020; 25:396-401. [PMID: 32945240 DOI: 10.1080/1059924x.2020.1815619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Agricultural Extension professionals play a critical role in outreach and translation of research to practice. Extension has not only been an audience for Agricultural Safety and Health Center work, but also an essential partner in promoting evidence-based farm health and safety in communities. This commentary stems from a collaborative effort among Center leaders across the nation who developed a set of surveys to explore the ways COVID-19 has affected Extension professionals. Preliminary data gathered from across the nation suggest that while many Extension professionals feel prepared to address challenges from the pandemic and are well supported by their State and Center's resources, over half also reported moderate to great difficulty in balancing personal and professional needs and, to a lesser extent, balancing remote work and family needs. Because Extension professionals act as connectors between Agricultural Safety and Health Centers and farmers and their families, they serve in a role similar to first-responders. COVID-19 has exacerbated the potential for anxiety, stress, and other mental health concerns among this group. With COVID-19 numbers rising at an especially fast rate among agricultural workers, it is important to attend to the wellbeing of the professionals who work with them.
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Affiliation(s)
- Shannon Sampson
- College of Education Evaluation Center, University of Kentucky , Lexington, Kentucky, USA
| | - Joan Mazur
- Southeast Center for Agricultural Safety Health and Injury Prevention**, University of Kentucky , Lexington, Kentucky, USA
| | - Glenn Israel
- Southeastern Coastal Center for Agricultural Health and Safety***, University of Florida , Gainesville, Florida, USA
| | - Sebastian Galindo
- Southeastern Coastal Center for Agricultural Health and Safety, University of Florida , Gainesville, Florida, USA
| | - Cassandra Ward
- Southeastern Coastal Center for Agricultural Health and Safety, University of Florida , Gainesville, Florida, USA
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Khan WAA, Conduit R, Kennedy GA, Abdullah Alslamah A, Ahmad Alsuwayeh M, Jackson ML. Sleep and Mental Health among Paramedics from Australia and Saudi Arabia: A Comparison Study. Clocks Sleep 2020; 2:246-257. [PMID: 33089203 PMCID: PMC7445850 DOI: 10.3390/clockssleep2020019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Paramedics face many challenges while on duty, one of which is working different types of shifts. Shift work has been linked to a number of health issues such as insomnia, depression, and anxiety. Besides shift work, Saudi paramedics, a group that has not been investigated for sleep or mental health issues previously, may be facing more demands than Australian paramedics due to lower numbers of paramedics in comparison to the general population. The aim of this study was to investigate the prevalence of sleep and mental health disorders among paramedics in Saudi Arabia and Australia. Paramedics were invited to complete a survey to assess stress, post-traumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift work disorder, obstructive sleep apnoea, fatigue, and general health. A total of 104 males Saudi paramedics (M age = 32.5 ± 6.1 years) and 83 males paramedics from Australia (M age = 44.1 ± 12.1 years) responded to the survey. Significantly higher rates of depression, PTSD, insomnia, and fatigue, along with significantly poorer physical functioning were observed among Saudi paramedics in comparison with Australian paramedics. However, Australian paramedics reported significantly poorer sleep quality and general health in comparison to Saudi paramedics. After removing the effect of driving and working durations, outcomes were no longer significant. The higher burden of depression and PTSD among Saudi paramedics may be explained by longer hours spent driving and longer work durations reported by this group. Taking into consideration the outcomes reported in this study, more investigations are needed to study their possible effects on paramedics' cognition, performance, and safety.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, P.O. Box 715, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
| | - Gerard A Kennedy
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Psychology, Federation University Australia, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC 3084, Australia;
| | - Ahmed Abdullah Alslamah
- General Supervisor of Emergency Medical Services Affairs, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Mohammad Ahmad Alsuwayeh
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Melinda L Jackson
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
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Almutairi I, Al-Rashdi M, Almutairi A. Prevalence and Predictors of Depression, Anxiety and Stress Symptoms in Paramedics at Saudi Red Crescent Authority. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:105-111. [PMID: 32587491 PMCID: PMC7305676 DOI: 10.4103/sjmms.sjmms_227_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/12/2019] [Accepted: 11/17/2019] [Indexed: 01/09/2023]
Abstract
Background: Emergency medical professionals often encounter situations when dealing with patients that can affect their mental health. In Saudi Arabia, there is paucity of data regarding the mental health of paramedics involved in prehospital care. Objectives: To determine the prevalence and predictors of stress, anxiety and depression symptoms among paramedics working at Saudi Red Crescent Authority (SRCA) stations in Riyadh, Saudi Arabia. Methods: This cross-sectional, questionnaire study included all paramedics working in the prehospital medical services of 21 SRCA stations in Riyadh (N = 300) between March and June 2017. Sociodemographic data were collected using a self-reporting questionnaire, and the Arabic version of the Depression Anxiety and Stress Scale-21 was used to identify the states of stress, anxiety and depression. Bivariate analysis using chi-square test and multivariate logistic regression analysis were performed to determine the association between sociodemographic factors and mental health. Results: In total, 240 emergency medical professionals responded (response rate = 80%). Of these, 30.5% had stress, 40% had anxiety and 26.7% had depression. All cases of stress were of mild-to-moderate level, while 5.1% of the respondents had severe-to-extremely severe anxiety and 1.3% had severe depression; there were no cases of extremely severe depression. Number of mission calls was identified as a predictor for stress and anxiety; intake of medications for noncommunicable diseases as a predictor for stress and depression; hours of sleep/day for anxiety and depression and use of stimulant beverages other than tea, coffee and energy drinks as predictors for anxiety. Conclusion: This study demonstrates that stress, anxiety and depressive symptoms are relatively common in paramedics working at SRCA stations in Riyadh. The authors suggest that the above-mentioned predictors should be monitored in paramedics and interventions should be made when necessary.
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Affiliation(s)
- Ibrahim Almutairi
- College of Medicine, Majma'ah University, Al Majma'ah, Kingdom of Saudi Arabia
| | - Meshal Al-Rashdi
- Family Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Khan WAA, Conduit R, Kennedy GA, Jackson ML. The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health 2020; 6:330-337. [PMID: 32223969 DOI: 10.1016/j.sleh.2019.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of sleep and mental health issues, the role of chronotype, and the relationship between these variables in Australian paramedics. DESIGN A cross-sectional study. SETTINGS Cross-sectional survey. MEASUREMENTS Paramedics were invited to complete an online survey to assess stress, posttraumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift-work disorder, bruxism, obstructive sleep apnea, narcolepsy, chronotype, fatigue, and well-being. PARTICIPANTS A total of 136 paramedics responded to the survey (age, 39.1 ± 12.1 years; 45.8% men and 54.2% women; 85.4% rotating shift-workers, 7% rural shift-workers, and 7.6% fixed rosters). RESULTS Paramedics reported significantly higher levels of depression symptoms, anxiety symptoms, fatigue, PTSD symptoms, insomnia symptoms, narcolepsy, and significantly poorer sleep quality and general well-being than norms from the general population of Australia and Western countries (all p < .05). From regression analyses, insomnia explained the greatest amount of variance in depression and anxiety scores, followed by fatigue and PTSD (adjusted R-squared for depression and anxiety models = .58 and = .44, respectively, p < .001). The majority of participants were intermediate chronotype (57%), followed by morning (32%) and evening type (11%). Evening chronotypes showed significantly higher depression scores (p < .001), anxiety (p < .05), PTSD symptoms (p < .05), poorer sleep quality (p < .05), and general well-being (p < .001) compared with morning types. CONCLUSION Addressing sleep issues and matching chronotype to shift preference in paramedics may help to reduce depression, anxiety, and improve well-being.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia; Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Gerard A Kennedy
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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ALmutairi MN, El Mahalli AA. Burnout and Coping Methods among Emergency Medical Services Professionals. J Multidiscip Healthc 2020; 13:271-279. [PMID: 32214822 PMCID: PMC7083646 DOI: 10.2147/jmdh.s244303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/04/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
| | - Azza Ali El Mahalli
- Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ducar DM, Penberthy JK, Schorling JB, Leavell VA, Calland JF. Mindfulness for healthcare providers fosters professional quality of life and mindful attention among emergency medical technicians. Explore (NY) 2020; 16:61-68. [DOI: 10.1016/j.explore.2019.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 11/17/2022]
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Ma IC, Chang WH, Wu CL, Lin CH. Risks of post-traumatic stress disorder among emergency medical technicians who responded to the 2016 Taiwan earthquake. J Formos Med Assoc 2019; 119:1360-1371. [PMID: 31839523 DOI: 10.1016/j.jfma.2019.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Few studies have explored the field experiences and risk factors related to post-traumatic stress disorder (PTSD) among disaster rescue workers. METHODS A 6.4-magnitude earthquake struck southern Taiwan on February 6, 2016. A standardized, paper-based, self-administered survey questionnaire including demographic information, field experiences and the Post-Traumatic Stress Disorder Checklist (PCL) was conducted among emergency medical technicians (EMTs) one month after the earthquake. A multivariate regression model was used to analyze the associations between risk factors and the PCL. A two-sided p value less than 0.05 was considered statistically significant. RESULTS The survey response rate was 86.1% (447/519). The respondents who exceeded the cut-off points for the re-experience, avoidance, or hyperarousal domains were 11.8%, 2.7%, or 4.7%, respectively. A proportion of 12.7% of respondents met partial PTSD. The personality characteristics of anxiety (p < 0.001), perfectionism (p = 0.023) and introvert tendency (p = 0.002) were significantly correlated with partial PTSD. Emergency medical services (EMS) were significantly associated with partial PTSD than other main tasks (p < 0.001). The prevalence of partial PTSD was higher but was not significantly different in the groups of lower educational level, longer EMT careers, earlier arrival date, fewer field working hours, or managing dead people. Both univariate and multivariate logistic regression analyses showed that an anxious personality and EMS as the main task during the missions were significantly associated with PTSD risk. CONCLUSION Not only personality characteristics but also the task components could alter the PTSD risks in disasters. A broad realization of these risks may improve the mental outcomes of disaster rescuers.
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Affiliation(s)
- I Chun Ma
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Long Wu
- Department of Occupational and Environmental Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Exploring the Physical and Mental Health Challenges Associated with Emergency Service Call-Taking and Dispatching: A Review of the Literature. Prehosp Disaster Med 2019; 34:619-624. [PMID: 31637995 DOI: 10.1017/s1049023x19004990] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Emergency service (ambulance, police, fire) call-takers and dispatchers are often exposed to duty-related trauma, placing them at increased risk for developing mental health challenges like stress, anxiety, depression, and posttraumatic stress disorder (PTSD). Their unique working environment also puts them at-risk for physical health issues like obesity, headache, backache, and insomnia. Along with the stress associated with being on the receiving end of difficult calls, call-takers and dispatchers also deal with the pressure and demand of following protocol despite dealing with the variability of complex and stressful situations. METHODS A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases. RESULTS A total of 25 publications were retrieved by the search strategy. The majority of studies (n = 13; 52%) reported a quantitative methodology, while nine (36%) reported the use of a qualitative research methodology. One study reported a mixed-methods methodology, one reported an evaluability assessment with semi-structured interviews, one reported on a case study, and one was a systematic review with a narrative synthesis. DISCUSSION Challenges to physical health included: shift-work leading to lack of physical activity, poor nutrition, and obesity; outdated and ergonomically ill-fitted equipment, and physically confining and isolating work spaces leading to physical injuries; inadequate breaks leading to fatigue; and high noise levels and poor lighting being correlated with higher cortisol levels. Challenges to mental health included: being exposed to traumatic calls; working in high-pressure environments with little downtime in between stressful calls; inadequate debriefing after stressful calls; inappropriate training for mental-health-related calls; and being exposed to verbally aggressive callers. Lack of support from leadership was an additional source of stress. CONCLUSION Emergency service call-takers and dispatchers experience both physical and mental health challenges as a result of their work, which appears to be related to a range of both operational and support-based issues. Future research should explore the long-term effects of these physical and mental health challenges.
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Florio G, Bergman JR. The Mental Health of Disaster Responders. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lessons in Post-Disaster Self-Care From 9/11 Paramedics and Emergency Medical Technicians. Prehosp Disaster Med 2019; 34:335-339. [DOI: 10.1017/s1049023x19004382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The objective of this study was to explore preferred self-care practices among paramedics and emergency medical technicians (EMTs) who responded to the September 11, 2001 terrorist attack (9/11) in New York City (New York USA).Design, Setting, and Participants:Qualitative research methodology with convenience and subsequent snowball sampling was utilized. Participants were adult (at least 18 years of age) paramedics or EMTs who self-reported as responding to the 9/11 terrorist attack in New York City.Main Outcome Measures:Preferred self-care practices; participant characteristics; indications and patterns of self-care use; perceived benefits and harms; and views on appropriate availability of support and self-care services were the main outcome measures.Results:The 9/11 paramedic and EMT participants reported a delay in recognizing the need for self-care. Preferred physical self-care practices included exercise, good nutrition, getting enough sleep, and sticking to routine. Preferred psychosocial self-care practices included spending time with family and friends, participating in peer-support programs and online support forums, and routinely seeing a mental health professional. Self-care was important for younger paramedics and EMTs who reported having less-developed supportive infrastructure around them, as well as for retiring paramedics and EMTs who often felt left behind by a system they had dedicated their lives to. Access to cooking classes and subsidized gym memberships were viewed as favorable, as was the ability to include family members in self-care practices.Conclusion(s):A range of physical and psychosocial self-care practices should be encouraged among paramedic students and implemented by Australian ambulance services to ensure the health and well-being of paramedics throughout their career and into retirement.
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Differences in Cardiovascular Health Metrics in Emergency Medical Technicians Compared to Paramedics: A Cross-Sectional Study of Emergency Medical Services Professionals. Prehosp Disaster Med 2019; 34:288-296. [DOI: 10.1017/s1049023x19004254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Emergency Medical Services (EMS) professionals face high physical demands in high-stress settings; however, the prevalence of cardiovascular health (CVH) risk factors in this health care workforce has not been explored. The primary objective of this study was to compare the distribution of CVH and its individual components between a sample of emergency medical technicians (EMTs) and paramedics. The secondary objective was to identify associations between demographic and employment characteristics with ideal CVH in EMS professionals.Methods:A cross-sectional survey based on the American Heart Association’s (AHA; Dallas, Texas USA) Life’s Simple 7 (LS7) was administered to nationally-certified EMTs and paramedics. The LS7 components were scored according to previously described cut points (ideal = 2; intermediate = 1; poor = 0). A composite CVH score (0-10) was calculated from the component scores, excluding cholesterol and blood glucose due to missing data. Multivariable logistic regression was used to estimate odds ratios (OR; 95% CI) for demographic and employment characteristics associated with optimal CVH (≥7 points).Results:There were 24,708 respondents that were currently practicing and included. More EMTs achieved optimal CVH (n = 4,889; 48.8%) compared to paramedics (n = 4,338; 40.6%). Factors associated with higher odds of optimal CVH included: higher education level (eg, college graduate or more: OR = 2.26; 95% CI, 1.97-2.59); higher personal income (OR = 1.26; 95% CI, 1.17-1.37); and working in an urban versus rural area (OR = 1.31; 95% CI, 1.23-1.40). Paramedic certification level (OR = 0.84; 95% CI, 0.78-0.91), older age (eg, 50 years or older: OR = 0.65; 95% CI, 0.58-0.73), male sex (OR = 0.54; 95% CI, 0.50-0.56), working for a non-fire-based agency (eg, private service: OR = 0.68; 95% CI, 0.62-0.74), and providing medical transport service (OR = 0.81; 95% CI, 0.69-0.94) were associated with lower odds of optimal CVH.Conclusions:Several EMS-related characteristics were associated with lower odds of optimal CVH. Future studies should focus on better understanding the CVH and metabolic risk profiles for EMS professionals and their association with incident cardiovascular disease (CVD), major cardiac events, and occupational mortality.Cash RE, Crowe RP, Bower JK, Foraker RE, Panchal AR. Differences in cardiovascular health metrics in emergency medical technicians compared to paramedics: a crosssectional study of Emergency Medical Services professionals.Prehosp Disaster Med.2019;34(3):288–296.
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Abstract
OBJECTIVES Because of the high prevalence of Autism Spectrum Disorder (ASD) and wandering behavior, emergency medical responders (EMRs) will likely encounter children and adolescents with ASD. The objectives were to describe interactions between EMRs and children and adolescents with ASD, to evaluate EMRs' ability to recognize ASD in a simulated trauma setting, and to determine if EMRs' demographic characteristics affected their interactions with ASD youth. METHODS A study of 75 videos of a simulated school bus crash was performed. The simulation included an adolescent with ASD portrayed by an actor. Videos were coded based on 5 domains: (1) reassurance attempts by the EMR, (2) quality of the EMR's interactions, (3) EMR's elicitation of information, (4) EMR's interactions with others, and (5) EMR's recognition of a disability. Two clinicians coded the videos independently, and consensus was reached for any areas of disagreement. RESULTS Of 75 interactions, 27% provided reassurance to the adolescent with ASD, 1% elicited information, 11% asked bystanders for information or assistance, and 35% suggested a disability with 13% considering ASD. No differences across domains were found based on the EMR's sex. Emergency medical responders with greater than or equal to 5 years of experience were significantly more likely to elicit information than those with less than 5 years of experience, and paramedics had significantly higher total performance scores than paramedic students or those with EMT-Basic. CONCLUSIONS Few EMRs in this study optimally interacted with adolescents with ASD or recognized a disability. These findings suggest a strong need for targeted educational interventions.
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Alfuqaha OA, Alkawareek MY, Alsharah HS. Self-evaluation and professional status as predictors of burnout among nurses in Jordan. PLoS One 2019; 14:e0213935. [PMID: 30901363 PMCID: PMC6430417 DOI: 10.1371/journal.pone.0213935] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to evaluate the contribution of self-evaluation, professional status and several demographic factors in predicting burnout among nurses in Jordan. This study was performed on a stratified convenience sample of 350 nurses from 6 hospitals. Modified versions of burnout inventory, self-evaluation scale, and professional status scale were developed, validated and used in this study. Burnout, self-evaluation, and professional status are all found to be at moderate levels. Furthermore, self-evaluation and professional status are found to be important predictors of burnout. On the other hand, although type of hospital and educational level are found to be associated with the level of burnout, overall none of the studied demographic factors was found to be a significant predictor of burnout among nurses in Jordan.
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Affiliation(s)
- Othman A. Alfuqaha
- School of Educational Sciences, The University of Jordan, Amman, Jordan
- Jordan University Hospital, Amman, Jordan
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Tran TTT, Nguyen NB, Luong MA, Bui THA, Phan TD, Tran VO, Ngo TH, Minas H, Nguyen TQ. Stress, anxiety and depression in clinical nurses in Vietnam: a cross-sectional survey and cluster analysis. Int J Ment Health Syst 2019; 13:3. [PMID: 30622629 PMCID: PMC6317201 DOI: 10.1186/s13033-018-0257-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/13/2018] [Indexed: 02/14/2023] Open
Abstract
Background Hospital nurses are exposed to various work-related factors that may be associated with increased risk of developing different mental disorders. Empirical evidence on the prevalence and correlates of individual mental health problems such as stress, anxiety and depression is widely reported, while a combined pattern of these conditions is unknown. This study aims to examine the co-occurrence of stress, anxiety and depression among clinical nurses, and to explore socio-demographic characteristics of, and working conditions experienced by, nurses that may be associated with these three mental health conditions. Methods A cross-sectional study was implemented in one tertiary hospital in Hanoi city, Vietnam, from May to September 2015. A self-reported questionnaire including a short version of the Depression, Anxiety and Stress scale 21 items and questions on demographic and work-related characteristics was delivered to 787 registered nurses. 600 completed questionnaires was used in the final analysis (76.2% response rate). The two-step clustering analysis was performed to identify sub groups. Chi square test and post hoc ANOVA analysis with Bonferroni correction were used to examine differences in psychological status, demographic characteristics and working conditions among the clusters (two-tailed p < 0.05). Results The prevalence of self-reported stress, anxiety and depression were 18.5%, 39.8% and 13.2%, respectively. 45.3% participants reported symptoms of at least one mental disorder, 7.3% had all three. Nurses in the first cluster (high prevalence of mental disorders), had high task demand and conflict at work with low job control and reward. The second cluster nurses (moderate percentage of mental strain) were significantly older and in marital relationship, high task demand and job control, and presence of chronic diseases. The lowest proportion of self-perceived mental disorders were observed in the cluster three who were younger and had fewer years of services, moderate task demand and low job control and better physical health in comparison with those in the other two clusters (p < 0.05). Conclusions Stress, anxiety and depression were prevalent among clinical nurses. Heterogeneity in demographic characteristics and working conditions were observed across clusters with different patterns of mental disorders. Institutional effort should be emphasized to support nurses in their career development to reduce psychological strains. Electronic supplementary material The online version of this article (10.1186/s13033-018-0257-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thi Thu Thuy Tran
- 1Faculty of Environmental and Occupational Health, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Ngoc Bich Nguyen
- 1Faculty of Environmental and Occupational Health, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Mai Anh Luong
- 2Health and Environment Management Agency, Ministry of Health, Line 8, Ton That Thuyet Street, My Dinh 2, Nam Tu Liem District, Hanoi, Vietnam
| | - Thi Hai Anh Bui
- 3National Institute of Hygiene and Epidemiology, 1 Yecxanh Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Thi Dung Phan
- Nursing Office, Viet Duc University Hospital, 40 Trang Thi Street, Hanoi, Vietnam
| | - Van Oanh Tran
- Nursing Office, Viet Duc University Hospital, 40 Trang Thi Street, Hanoi, Vietnam
| | - Thi Huyen Ngo
- Nursing Office, Viet Duc University Hospital, 40 Trang Thi Street, Hanoi, Vietnam
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, 235 Bouverie Street, Carlton, VIC 3053 Australia
| | - Thuy Quynh Nguyen
- 1Faculty of Environmental and Occupational Health, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
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Petrie K, Milligan-Saville J, Gayed A, Deady M, Phelps A, Dell L, Forbes D, Bryant RA, Calvo RA, Glozier N, Harvey SB. Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2018; 53:897-909. [PMID: 29869691 DOI: 10.1007/s00127-018-1539-5] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/28/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide. METHODS A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity. RESULTS In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity. CONCLUSION Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.
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Affiliation(s)
- Katherine Petrie
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Josie Milligan-Saville
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Aimée Gayed
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Andrea Phelps
- Phoenix Australia, Centre for Posttraumatic Mental Health, Carlton, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Lisa Dell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Carlton, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Carlton, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Rafael A Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Glozier
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia.
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
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Cash RE, White-Mills K, Crowe RP, Rivard MK, Panchal AR. Workplace Incivility Among Nationally Certified EMS Professionals and Associations with Workforce-Reducing Factors and Organizational Culture. PREHOSP EMERG CARE 2018; 23:346-355. [DOI: 10.1080/10903127.2018.1502383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gouweloos-Trines J, Tyler MP, Giummarra MJ, Kassam-Adams N, Landolt MA, Kleber RJ, Alisic E. Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers. Emerg Med J 2017; 34:816-822. [PMID: 29055892 DOI: 10.1136/emermed-2017-206584] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support. METHODS This cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis. RESULTS Of the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=-0.01, 95% CI -0.01 to 0.00), having enough time to recover after critical incidents (b=-0.07, 95% CI -0.09 to -0.04) and perceived colleague support (b=-0.01, 95% CI -0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=-0.04, 95% CI -0.02 to -0.01). CONCLUSIONS Prehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design.
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Affiliation(s)
- Juul Gouweloos-Trines
- Impact, National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Mark P Tyler
- School of Psychological Science and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia.,School of Psychology and Public Health, Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Melita J Giummarra
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Eva Alisic
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Monash University Accident Research Centre, Monash University, Clayton, Australia
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Crowe RP, Bower JK, Cash RE, Panchal AR, Rodriguez SA, Olivo-Marston SE. Association of Burnout with Workforce-Reducing Factors among EMS Professionals. PREHOSP EMERG CARE 2017; 22:229-236. [PMID: 28841102 DOI: 10.1080/10903127.2017.1356411] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Emergency medical services (EMS) professionals often work long hours at multiple jobs and endure frequent exposure to traumatic events. The stressors inherent to the prehospital setting may increase the likelihood of experiencing burnout and lead providers to exit the profession, representing a serious workforce and public health concern. Our objectives were to estimate the prevalence of burnout, identify characteristics associated with experiencing burnout, and quantify its relationship with factors that negatively impact EMS workforce stability, namely sickness absence and turnover intentions. METHODS A random sample of 10,620 emergency medical technicians (EMTs) and 10,540 paramedics was selected from the National EMS Certification database to receive an electronic questionnaire between October, 2015 and November, 2015. Using the validated Copenhagen Burnout Inventory (CBI), we assessed burnout across three dimensions: personal, work-related, and patient-related. We used multivariable logistic regression modeling to identify burnout predictors and quantify the association between burnout and our workforce-related outcomes: reporting ten or more days of work absence due to personal illness in the past 12 months, and intending to leave an EMS job or the profession within the next 12 months. RESULTS Burnout was more prevalent among paramedics than EMTs (personal: 38.3% vs. 24.9%, work-related: 30.1% vs. 19.1%, and patient-related: 14.4% vs. 5.5%). Variables associated with increased burnout in all dimensions included certification at the paramedic level, having between five and 15 years of EMS experience, and increased weekly call volume. After adjustment, burnout was associated with over a two-fold increase in odds of reporting ten or more days of sickness absence in the past year. Burnout was associated with greater odds of intending to leave an EMS job (personal OR:2.45, 95% CI:1.95-3.06, work-related OR:3.37, 95% CI:2.67-4.26, patient-related OR: 2.38, 95% CI:1.74-3.26) or the EMS profession (personal OR:2.70, 95% CI:1.94-3.74, work-related OR:3.43, 95% CI:2.47-4.75, patient-related OR:3.69, 95% CI:2.42-5.63). CONCLUSIONS The high estimated prevalence of burnout among EMS professionals represents a significant concern for the physical and mental well-being of this critical healthcare workforce. Further, the strong association between burnout and variables that negatively impact the number of available EMS professionals signals an important workforce concern that warrants further prospective investigation.
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Jones S. Describing the Mental Health Profile of First Responders: A Systematic Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2017; 23:200-214. [PMID: 28445653 DOI: 10.1177/1078390317695266] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND First responders (FRs) are responsible for providing multiple services during various critical events. Considering the frequency, nature, and intensity of duty-related traumatic exposures, the cumulative impact on FRs' mental health is of paramount importance. OBJECTIVES The purpose of this systematic review was to describe how duty-related trauma exposure can affect the comprehensive mental health profile of FRs, including firefighters, emergency medical technicians, and paramedics. DESIGN Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted using keywords related to FRs and mental health. RESULTS Twenty-seven data-based articles met eligibility criteria and were included in this systematic review. Studies explored various mental health concerns, including posttraumatic stress disorder, depression, suicidality, anxiety, alcohol use, and sleep disturbances. CONCLUSIONS Findings pose significant implications for psychiatric nurses in practice and research, including the need for tailored strategies to meet the mental health needs of this at-risk population.
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Affiliation(s)
- Sara Jones
- 1 Sara Jones, PhD, APRN, PMHNP-BC, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Steeps RJ, Wilfong DA, Hubble MW, Bercher DL. Emergency Medical Services Professionals' Attitudes About Community Paramedic Programs. West J Emerg Med 2017; 18:630-639. [PMID: 28611884 PMCID: PMC5468069 DOI: 10.5811/westjem.2017.3.32591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/21/2016] [Accepted: 03/02/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. Methods We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma) were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05. Results Of the 350 EMS professionals receiving an invitation, 283 (81%) participated. Of those participants, 165 (70%) indicated that they understood what a CP program entails. One hundred thirty-five (58%) stated they were likely to attend additional education in order to become a CP, 152 (66%) were willing to perform CP duties, and 175 (75%) felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03) and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p < 0.001). Conclusion The majority of EMS professionals in this study believe they understand CP programs and perceive that their communities want them to provide CP-level care. While fewer in number, most are willing to attend additional CP education and/or are willing to perform CP duties.
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Affiliation(s)
- Robert J Steeps
- Northwest Arkansas Community College, Division of Health Professions, Emergency Medical Sciences Program, Bentonville, Arkansas
| | - Denise A Wilfong
- Western Carolina University, School of Health Sciences, Emergency Medical Care Program, Cullowhee, North Carolina
| | - Michael W Hubble
- Western Carolina University, School of Health Sciences, Emergency Medical Care Program, Cullowhee, North Carolina
| | - Daniel L Bercher
- University of Arkansas for Medical Sciences, College of Health Related Professions, Department of Emergency Medical Services, Little Rock, Arkansas
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Sriram VM, Gururaj G, Hyder AA. Public-private implementation of integrated emergency response services: Case study of GVK Emergency Management and Research Institute in Karnataka, India. Surgery 2017; 162:S63-S76. [PMID: 28433250 DOI: 10.1016/j.surg.2017.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emergency medical services are important to the functioning of health systems, but these services tend to be neglected in low- and middle-income countries, such as India. In recent years, several models of pre-hospital emergency medical services have emerged in India. Research on these models holds important lessons for existing and future emergency medical service programs in low- and middle-income countries. Our objective was to provide a comprehensive description of the organizational structure and service delivery model of a public-private partnership in the southern Indian state of Karnataka, GVK Emergency Management and Research Institute, with a particular focus on its operations in Bengaluru. METHODS A case study methodology was used to explore systematically the organizational model of GVK Emergency Management and Research Institute in Karnataka. Qualitative data were collected through an in-person site visit to GVK Emergency Management and Research Institute headquarters in Bengaluru in July 2013. Three sources were used: in-depth, semistructured interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. RESULTS The organization follows a standardized model across the states and union territories where they have contractual arrangements, including Karnataka. Processes for fleet maintenance, information systems/information technology and training, and deployment were well structured at the organizational level. The public-private partnership appears pro-poor in orientation; however, further demand-side research is required on the perspective of patients. CONCLUSION Our study reveals a functional structure at the organizational level, which provides a key service at no cost to users. Detailed analyses of this nature can help inform global efforts for the development and strengthening of emergency medical services systems.
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Affiliation(s)
- Veena M Sriram
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Gopalkrishna Gururaj
- Department of Epidemiology and Centre for Public Health, World Health Organization CC for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Wu AC, Donnelly-McLay D, Weisskopf MG, McNeely E, Betancourt TS, Allen JG. Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey. Environ Health 2016; 15:121. [PMID: 27974043 PMCID: PMC5157081 DOI: 10.1186/s12940-016-0200-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/24/2016] [Indexed: 05/11/2023]
Abstract
BACKGROUND The Germanwings Flight 9525 crash has brought the sensitive subject of airline pilot mental health to the forefront in aviation. Globally, 350 million people suffer from depression-a common mental disorder. This study provides further information on this important topic regarding mental health especially among female airline pilots. This is the first study to describe airline pilot mental health-with a focus on depression and suicidal thoughts-outside of the information derived from aircraft accident investigations, regulated health examinations, or identifiable self-reports, which are records protected by civil aviation authorities and airline companies. METHODS This is a descriptive cross-sectional study via an anonymous web-based survey administered between April and December 2015. Pilots were recruited from unions, airline companies, and airports via convenience sampling. Data analysis included calculating absolute number and prevalence of health characteristics and depression scores. RESULTS One thousand eight hundred thirty seven (52.7%) of the 3485 surveyed pilots completed the survey, with 1866 (53.5%) completing at least half of the survey. 233 (12.6%) of 1848 airline pilots responding to the Patient Health Questionnaire 9 (PHQ-9), and 193 (13.5%) of 1430 pilots who reported working as an airline pilot in the last seven days at time of survey, met depression threshold-PHQ-9 total score ≥ 10. Seventy-five participants (4.1%) reported having suicidal thoughts within the past two weeks. We found a significant trend in proportions of depression at higher levels of use of sleep-aid medication (trend test z = 6.74, p < 0.001) and among those experiencing sexual harassment (z = 3.18, p = 0.001) or verbal harassment (z = 6.13, p < 0.001). CONCLUSION Hundreds of pilots currently flying are managing depressive symptoms perhaps without the possibility of treatment due to the fear of negative career impacts. This study found 233 (12.6%) airline pilots meeting depression threshold and 75 (4.1%) pilots reporting having suicidal thoughts. Although results have limited generalizability, there are a significant number of active pilots suffering from depressive symptoms. We recommend airline organizations increase support for preventative mental health treatment. Future research will evaluate additional risk factors of depression such as sleep and circadian rhythm disturbances.
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Affiliation(s)
- Alexander C. Wu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA 02115 USA
| | - Deborah Donnelly-McLay
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA 02115 USA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA 02115 USA
| | - Eileen McNeely
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA 02115 USA
| | - Theresa S. Betancourt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1104, Boston, MA 02115 USA
| | - Joseph G. Allen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA 02115 USA
- Harvard T.H. Chan School of Public Health, 401 Park Drive, Landmark Center, 404-L, Boston, MA 02215 USA
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Schooley B, Hikmet N, Tarcan M, Yorgancioglu G. Comparing Burnout Across Emergency Physicians, Nurses, Technicians, and Health Information Technicians Working for the Same Organization. Medicine (Baltimore) 2016; 95:e2856. [PMID: 26962780 PMCID: PMC4998861 DOI: 10.1097/md.0000000000002856] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies on the topic of burnout measure the effects of emotional exhaustion (EE), depersonalization (DP) (negative or cynical attitudes toward work), and reduced sense of personal accomplishment (PA). While the prevalence of burnout in practicing emergency medicine (EM) professionals has been studied, little is known of the prevalence and factors across physicians, nurses, technicians, and health information technicians working for the same institution. The aim of this study was to assess burnout differences across EM professional types.The total population of 250 EM professionals at 2 public urban hospitals in Turkey were surveyed using the Maslach Burnout Inventory and basic social- and work-related demographics. Descriptive statistics, ANOVA, and additional post hoc tests were computed.Findings show that EE and DP scores were high across all occupational groups, while scores on PA were low. There was a statistically significant difference between nurses and medical technicians (P < 0.05) for EE; and between physicians and both nurses and medical technicians (P < 0.05) for PA; while no group differences were found for DP. Age, gender, economic well-being, and income level were all significant; while patient load and marital status showed no significance.Burnout can be high across occupational groups in the emergency department. Burnout is important for EM administrators to assess across human resources. Statistically significant differences across socio-demographic groups vary across occupational groups. However, differences between occupational groups may not be explained effectively by the demographic factors assessed in this or other prior studies. Rather, the factors associated with burnout are incomplete and require further institutional, cultural, and organizational analyses including differentiating between job tasks carried out by each EM job type.
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Affiliation(s)
- Benjamin Schooley
- From the Health Information Technology Program and Arnold School of Public Health, University of South Carolina, Columbia, SC (BS, NH); Department of Health Care Management, Eskişehir Osmangazi University School of Health, Eskişehir, Turkey (MT); and Department of Health Care Management, Hacettepe University, Ankara, Turkey (GY)
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Patterson PD, Klapec SE, Weaver MD, Guyette FX, Platt TE, Buysse DJ. Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report. PREHOSP EMERG CARE 2015; 20:132-6. [PMID: 25978152 DOI: 10.3109/10903127.2015.1025158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.
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Oglesbee S, Riss D, Ernst AA, Weiss SJ, Brady WH, Brady NW, Otero SL. A program to improve health among prehospital providers. Am J Emerg Med 2015; 33:590-2. [DOI: 10.1016/j.ajem.2015.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/25/2022] Open
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Donnelly EA, Siebert D, Siebert C. Development of the Emergency Medical Services Role Identity Scale (EMS-RIS). SOCIAL WORK IN HEALTH CARE 2015; 54:212-233. [PMID: 25760489 DOI: 10.1080/00981389.2014.999979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article describes the development and validation of the theoretically grounded Emergency Medical Services Role Identity Scale (EMS-RIS), which measures four domains of EMS role identity. The EMS-RIS was developed using a mixed methods approach. Key informants informed item development and the scale was validated using a representative probability sample of EMS personnel. Factor analyses revealed a conceptually consistent, four-factor solution with sound psychometric properties as well as evidence of convergent and discriminant validities. Social workers work with EMS professionals in crisis settings and as their counselors when they are distressed. The EMS-RIS provides useful information for the assessment of and intervention with distressed EMS professionals, as well as how role identity may influence occupational stress.
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Rice V, Glass N, Ogle K, Parsian N. Exploring physical health perceptions, fatigue and stress among health care professionals. J Multidiscip Healthc 2014; 7:155-61. [PMID: 24729714 PMCID: PMC3979795 DOI: 10.2147/jmdh.s59462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Nurses, midwives, and paramedics are exposed to high degrees of job demand, which impacts health status and job satisfaction. The aim of this study was to explore the experiences and perceptions of health with a group of nurses, midwives and paramedics in Australia. Specifically, this paper reveals the findings related to the dataset on physical health. In this regard, the researchers sought to explore the relationship between physical health and job satisfaction, and the relationship between health status and stress levels. The study adopted a mixed methodology and used two methods for data collection: one-on-one interviews exploring the relationship between physical health and job satisfaction, and a survey questionnaire focusing on self-rated stress management. The individual interviews were conducted for further exploration of the participants’ responses to the survey. There were 24 health care participants who were drawn from metropolitan and regional Australia. The findings revealed participants: had a desire to increase their physical activity levels; had different perspectives of physical health from those recommended by government guidelines; and viewed physical health as important to job satisfaction, yet related to stress and fatigue.
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Affiliation(s)
- Vanessa Rice
- School of Exercise Science, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Nel Glass
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Kr Ogle
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Nasrin Parsian
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
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Macdonald AB, Rossiter MD, Jensen JL. Nutrition and shiftwork: evaluation of new paramedics' knowledge and attitudes. CAN J DIET PRACT RES 2014; 74:198-201. [PMID: 24472169 DOI: 10.3148/74.4.2013.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The effect of an oral education intervention on nutrition knowledge was evaluated in new paramedic employees. The evaluation involved measuring knowledge of and attitudes toward nutrition and shiftwork before and after the directed intervention. METHODS A convenience sample of 30 new paramedic shiftworkers attended a 15-minute education session focused on nutrition management strategies. This matched cohort study included three self-administered surveys. Survey 1 was completed before education, survey 2 immediately after education, and survey 3 after one month of concurrent post-education and employment experience. Knowledge and attitude scores were analyzed for differences between all surveys. RESULTS Participants were primary care paramedics, 59% of whom were male. They reported that previously they had not received this type of information or had received only a brief lecture. Mean knowledge scores increased significantly from survey 1 to survey 2; knowledge retention was identified in survey 3. A significant difference was found between surveys 2 and 3 for attitudes toward meal timing; no other significant differences were found between attitude response scores. CONCLUSIONS The education session was successful in improving shiftwork nutrition knowledge among paramedics. Paramedics' attitudes toward proper nutrition practices were positive before the education intervention.
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