Assessing the Perceptions and Impact of Critical Incident Stress Management Peer Support among Firefighters and Paramedics in Canada

Impacts of Post Critical Incident Seminar on emergency service personnel: The critical incident-related experiences and psychological state

INTRODUCTION

Post Critical Incident Seminar (PCIS) is an intervention originally developed by the Federal Bureau of Investigation (FBI) for supporting law enforcement officers who have faced critical incidents (CIs) at work. In Finland, police forces have arranged modified PCIS regularly since 2012, but the first PCIS for emergency service personnel was organized in 2020. PCIS consists of psychoeducation, peer support, and mental health professional support/Eye Movement Desensitization and Reprocessing (EMDR). Previous international studies of PCIS are scarce. Our research question was this: After 6 months, how do emergency service personnel who have participated in the PCIS describe the impacts of PCIS on experiences and psychological state evoked by the CI that was the reason to apply for it?

METHODS

The data consisted of individual interviews 6 months after attending the PCIS. The number of participants in this study was 15 (94%). The data was analyzed qualitatively with inductive content analysis.

RESULTS

The impacts of PCIS on incident-related experiences and state 6 months afterward were divided into five main categories: social changes, new perspectives and sensations, incident-related components, future-oriented processes, and new abilities and actions.

CONCLUSIONS

PCIS can have multilevel impacts on the experiences and psychological state caused by a CI. These impacts are reflected, for example, in their inner experience, choices, emotions, actions, and relationships with others in different areas of life. As a result of PCIS, the emergency service personnel's relationship with CIs in the past and the ability to function in the future can change. Further study is needed to investigate the long-term impacts of the PCIS.

Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance

Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.

Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis

BACKGROUND

Research supports that public safety personnel (PSP) are regularly exposed to potentially psychologically traumatic events and occupational stress, which can compromise their well-being. To help address PSP well-being and mental health, peer support is increasingly being adopted (and developed) in PSP organizations. Peer support apps have been developed to connect the peer and peer supporter anonymously and confidentially, but little is known about their effectiveness, utility, and uptake.

OBJECTIVE

We designed this study to evaluate the functionality and use of the PeerConnect app, which is a vehicle for receiving and administering peer support. The app connects peers but also provides information (eg, mental health screening tools, newsfeed) to users; thus, we wanted to understand why PSP adopted or did not adopt the app and the app's perceived utility. Our intention was to determine if the app served the purpose of connectivity for PSP organizations implementing peer support.

METHODS

A sample of PSP (N=23) participated in an interview about why they used or did not use the app. We first surveyed participants across PSP organizations in Ontario, Canada, and at the end of the survey invited participants to participate in a follow-up interview. Of the 23 PSP interviewed, 16 were PeerConnect users and 7 were nonusers. After transcribing all audio recordings of the interviews, we used an emergent theme approach to analyze themes within and across responses.

RESULTS

PSP largely viewed PeerConnect positively, with the Connect feature being most popular (this feature facilitated peer support), followed by the Newsfeed and Resources. App users appreciated the convenience of the app and felt the app helped reduce the stigma around peer support use and pressure on peer supporters while raising awareness of wellness. PSP who did not use the app attributed their nonuse to disinterest or uncertainty about the need for a peer support app and the web-based nature of the app. To increase app adoption, participants recommended increased communication and promotion of the app by the services and continued efforts to combat mental health stigma.

CONCLUSIONS

We provide contextual information about a peer support app's functionality and use. Our findings demonstrate that PSP are open to the use of mental health and peer support apps, but more education is required to reduce mental health stigma. Future research should continue to evaluate peer support apps for PSP to inform their design and ensure they are fulfilling their purpose.

Paramedic To Provider Consultation Challenges in the Emergency Department in Kazakhstan: An Online Survey

Objective

Consultation is an important and necessary aspect of patient care in the emergency department. We prospectively examined difficulties during the consultation process between paramedics and providers in emergency departments in Kazakhstan.

Methods

The paramedics were interviewed using various platforms and face-to-face meetings. Questionnaires were administered to paramedics to gather feedback on the current consultation process. In our survey, 202 paramedics of ambulance from the cities of Semey, Pavlodar, and Ust-Kamenogorsk, located in the North and East of Kazakhstan took part.

Results

Serious barriers to effective consultation were identified during consultations with cardiologists, pediatricians, and traumatologists. Weekends, as well as nighttime, are associated with more consultation difficulties. The most common problems for paramedics are non-attendance of the consultant, refusal of hospitalization by the consultant, and referral to other specialists and departments. More than 40% of the respondents noted the desire to share responsibility for the patient with medical consultants, which indicates uncertainty in their own knowledge due to the limited work experience of the majority of respondents.

Conclusion

Barriers that arise during the consultation process of patients with emergency conditions can lead to unfavorable outcomes. Strategies to address these barriers are needed to improve the quality of patient care. This review aims to understand and evaluate the issues that arise during the consultation process.

Examining mental health knowledge, stigma, and service use intentions among Royal Canadian Mounted Police cadets

Background

Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP.

Methods

Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions.

Results

RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions.

Conclusion

The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Mental Health Training, Attitudes toward Support, and Screening Positive for Mental Disorders among Canadian Coast Guard and Conservation and Protection Officers

Public Safety Personnel (PSP) including members of the Canadian Coast Guard (CCG) and Conservation and Protection (C&P) officers, are regularly exposed to potentially psychologically traumatic events (PPTEs) and other occupational stressors. Several mental health training programs (e.g., critical incident stress management [CISM], critical incident stress debriefing [CISD], peer support, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures. To help inform on the impact of several categories of mental health training programs (i.e., CISM, CISD, mental health first aid, Peer Support, R2MR) for improving attitudes toward support and willingness to access supports among CCG and C&P officers, the current study assessed CCG and C&P Officers perceptions of access to professional (i.e., physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e., spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants (n = 341; 58.4% male) completed an online survey assessing perceptions of support, experience with mental health training and symptoms of mental health disorders. CCG and C&P Officers reported access to professional and non-professional support; however, most indicated they would first access a spouse (73.8%), a friend (64.7%), or a physician (52.9%). Many participants would never, or only as a last resort, access other professional supports (24.0% to 47.9%), a CCG or C&P colleague (67.5%), or their leadership (75.7%). Participants who received any mental health training reported a lower prevalence of positive screens for all mental health disorders compared to those who did not received training; but no statistically significant associations were observed between mental health training categories and decreased odds for screening positive for mental disorders. The current results suggest that the mental health training categories yield comparable results; nevertheless, further research is needed to assess the shared and unique content across each training program. The results highlight the need to increase willingness to access professional and non-professional support among CCG and C&P Officers. Revisions to training programs for leadership and colleagues to reduce stigma around mental health challenges and support for PSP spouses, friends, and physicians may be beneficial.