Article

Living in critical times: The impact of critical incidents on frontline ambulance personnel--a qualitative perspective

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Abstract

Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.

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... 51 In such circumstances, paramedics reported difficulty giving their full attention to the next call, limiting their ability to provide life-saving care. 64 Contrary to the above findings, one ambulance worker preferred to be dispatched to another call immediately following a stressful call, due to the distraction this provided. 53 ...
... 66 69 Discussing stress in this culture was described as 'taboo'. 64 ESWs often avoided talking to their colleagues about their emotions following traumatic calls. 60 62 Police officers described how 'tough' colleagues working in such a culture have died by suicide. ...
... 66 Concerns about confidentiality were also raised by firefighters, who, therefore, requested preference for an anonymous counselling service outside of the brigade. 70 In the EMSs, emergency medical technicians (EMTs) expressed concerns about loss of confidentiality through the organisation-provided peer support network 64 ; similar concerns were expressed by EMTs towards CISD. 65 There are also perceived risks of confidentiality breaches in informal settings as described by one paramedic: I think that the stigma is you have to be very careful who you tell that it bothered you or you might get judged as weak or you might get fired. ...
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Objectives To identify factors and contexts that may contribute to mental health and recovery from psychological difficulties for emergency service workers (ESWs) exposed to occupational trauma, and barriers and facilitators to help-seeking behaviour among trauma-exposed ESWs. Background ESWs are at greater risk of stressor-related psychopathology than the general population. Exposure to occupational stressors and trauma contribute to the observed rates of post-trauma psychopathology in this occupational group with implications for workforce sustainability. Types of organisational interventions offered to trauma-exposed ESWs are inconsistent across the UK, with uncertainty around how to engage staff. Design Four databases (OVID MEDLINE, EMBASE, PsycINFO and SCOPUS) were systematically searched from 1 January 1980 to March 2020, with citation tracking and reference chaining. A modified Critical Appraisal Skills Programme tool and quality appraisal prompts were used to identify fatally flawed studies. Qualitative studies of trauma-exposure in front-line ESWs were included, and data were extracted using a customised extraction table. Included studies were analysed using thematic synthesis. Results A qualitative evidence synthesis was conducted with 24 qualitative studies meeting inclusion criteria, as defined by the PerSPEcTiF framework. Fourteen descriptive themes emerged from this review, categorised into two overarching constructs: (1) factors contributing to mental health (such as the need for downtime, peer support and reassurance) and (2) factors influencing help-seeking behaviour (such as stigma, the content/form/mandatory nature of interventions, and mental health literacy issues including emotional awareness and education). Conclusion ESWs reported disconnect between the organisations’ cultural positioning on trauma-related mental health, the reality of undertaking the role and the perceived applicability and usefulness of trauma interventions. Following traumatic exposure, ESWs identify benefitting from recovery time and informal support from trusted colleagues. A culture which encourages help seeking and open dialogue around mental health may reduce stigma and improve recovery from mental ill health associated with trauma exposure.
... Populations studied included call-takers and dispatchers across different emergency services; seven studied police, 3,5-10 one studied fire, 11 nine studied ambulance, [12][13][14][15][16][17][18][19][20] and two studied emergency nurse services. 21,22 In one study, call-takers and dispatchers managed calls for both fire and ambulance, 23 and in two studies, they managed calls for fire, police, and ambulance. ...
... 3 Calls relating to vehicle accidents, incidents involving children or vulnerable adults, domestic violence, and suicides were commonly cited as the most distressing types of call. 3,6,7,12,16,24 Police dispatchers reported concern about handling fluid situations, such as robberies-in-progress or suicidal callers, in case they did not make the correct decisions. 6 Emergency service call-takers and dispatchers reported higher levels of traumatic distress compared to police officers, and this level of distress experienced during and immediately after a traumatic call positively correlated with PTSD symptoms and burnout. ...
... 3 Veteran dispatchers had the highest rate of PTSD, 27 and exposure to traumatic calls resulted in difficulties sleeping, nightmares, flashbacks, and increases in alcohol consumption. 16,18 Managing traumatic and abusive calls was also associated with a higher desire to leave the occupation and greater levels of emotional exhaustion. 15 Call-takers and dispatchers dealt with abuse from callers, 6,12,15 as well as from fellow professionals. ...
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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.
... Många olika faktorer påverkar arbetet och den enskildes psykiska och fysiska hälsa [13,15,21]. ...
... viktökning, ryggproblem och aptitlöshet. Vidare finns det rapporterade problem med magbesvär, sömnproblem och nackbesvär [13,20,21]. Det finns risk för sjukdomar relaterade till ett ökat tobaksanvändande av rökning [20]. ...
... När samma studier förekom i de olika sökordskombinationerna och inga nya studier tillkom ansågs sökningen avslutad. Det framkommer tydligt i artiklarna vilka specifika stressorer som finns inom ambulanssjukvården och bland dessa är det traumatiska incidenter med barn som är den mest betydande stressoren [13,[16][17][18][19][20][21]. Det finns inte beskrivit i några artiklar varför det är barn som är den mest betydande stressoren. ...
... 52,56, 60,61 Of the primary research studies, the most common data collection method was semi-structured interviews conducted either face-to-face or via telephone or Skype (n=11). 34,35,[49][50][51][53][54][55]58,59,63 Four studies used a combination of semi-structured interviews and focus groups, 29,43,44,64 while another four utilised questionnaires with at least one open-ended question. 27,37,38,46 Six studies used a mixed methods approach, combining qualitative and quantitative approaches. ...
... There was also an increase in vigilance and fear of doing the required role, unwanted and unpredictable flashbacks or intrusive thoughts, triggers as part of their ongoing role, fatigue, stress, high rates of sickness and days absent, and difficulty switching off. 28,31,32,35,40,43,45,48,55,59,61 The high and increasing rates of depression and anxiety, and the associated development of posttraumatic stress and suicidal ideation [26][27][28]30,31,33,43,49,50,56,61,62 were clearly oultined as current and systemic issues faced by paramedics and call-takers, with rates estimated as being twice as high as other health professionals. 32,33,36,39,45,48,55,56 The nature of the work, including the routine 'everyday' call-outs, and those that generated associated secondary or vicarious trauma, have a cumulative effect on paramedics, ambulance officers, ambulance volunteers, and call-takers. ...
... Paramedics also find themselves being hyper-alert and overprotective of family and friends because they know and see worst-case scenarios as part of their everyday work. 34,43,59,63 The effects of shift work adds to the psychological stress due to the continuous negotiation between their role and identity at work and their personal life. Shift work specifically reduces the time for recovery and quality individual and family time with limits on their social life. ...
Research
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The scoping literature review of peer-reviewed and grey qualitative literature addressed the psychological, physical, and social well-being of paramedics, ambulance officers, ambulance volunteers and call-takers.
... The remaining 92 full texts were reviewed, with 39 articles deemed to meet the eligibility criteria (see Table 2 and Fig. 1). The studies were conducted in a range of countries including the United States of America (n = 9) [9,[19][20][21][22][23][24][25][26], Australia (n = 8) [10,[27][28][29][30][31][32][33], Canada (n = 6) [34][35][36][37][38][39], Sweden (n = 5) [40][41][42][43][44], the England (n = 4) [44][45][46][47][48], Ireland (n = 2) [49,50], Norway (n = 2) [11,51], Saudi Arabia (n = 1) [52], and Israel (n = 1) [53]. Another study was conducted in both Australia and the United Kingdom [54]. ...
... These responses included angry outbursts and changes in tolerance to everyday interactions, sleep disturbances and deficits, irritability, decreased social life, and an increased sense of isolation. An increase in vigilance and fear of doing the required role, and recognition of associated triggers, unwanted and unpredictable flashbacks or intrusive thoughts, fatigue, stress, high rates of sickness and days absent, and difficulty switching off were significant [9,11,24,25,27,31,34,36,39,46,50]. The high and increasing rates of depression and anxiety, and associated development of PTS and suicidal ideation [9,11,19,20,22,23,25,34,40,41,47,52] were clearly outlined as current and systemic issues faced by paramedics and calltakers, with rates estimated as being twice as high as other health professionals [24,25,28,30,36,39,46,47]. The nature of the work, including routine 'everyday' call-outs, and those that generated associated secondary or vicarious trauma, had a cumulative effect on ambulance personnel. ...
... This enabled them to distance themselves from their negative emotions and alleviate their emotional distress. Paramedics also found themselves being hyper-alert and over-protective of family and friends because they knew and saw worst-case scenarios as part of their everyday work [26,34,50,53]. ...
Article
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Background: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. Methods: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. Results: Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports. Conclusions: Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
... Peer-reviewed studies were limited to four countries: Australia (5), Ireland (6), the United Kingdom (7,8) (8). The three research studies employed semi-structured interviews as the data collection method (5,6,8). The grey literature comprised four submissions to the Australian Senate Inquiry into the role of Commonwealth, state and territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers (10)(11)(12)(13); and five newspaper articles, four from Australia (14)(15)(16)(17) and one from the US (18). ...
... Call-takers perceived managers to lack understanding or the capacity to deal with the stress experienced by call-takers (5,6). They were mindful of the stigma associated with mental illness or to admiting the work was stressful and for this reason were reticent to seek help from their organisation when they experienced feelings of anger, guilt and helplessness (6,16). They believed management did not view their role as important, saw it as less valuable than on-road staff, and failed to acknowledge that part of the stress that arose from dealing with human trauma. ...
... They felt managers assumed they could get over any tense or traumatic event, despite the fact that in some instances they were required to stay online until a paramedic arrived at the scene (5). Much of their stress was compounded by the fact that they often worked alone at night or on weekends and reported that it was very difficult to take breaks, had to manage shift work across a 24/7 roster, and had to deal with considerable anger from on-road staff (6,8). The pace of work meant that at times calls were missed, putting patients' lives at risk (17). ...
Article
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h2>Background Over the past decade there has been significant focus on the mental health and wellbeing of emergency service workers in Australia, evidenced by the 2018 Senate Inquiry into the role of Commonwealth, state and territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers. Call-takers as an occupational group within this domain are at risk of cumulative and vicarious trauma, yet there is little research on their work-related mental illness. This systematic thematic narative literature review of qualitative articles reports on the mental health and wellbeing of emergency call-takers. Methods Both published peer review (2000–2018) and grey literature (2009–2018) that examined the impact of emergency work on call-takers was retrieved. Papers that focussed on call-takers’ psychological and psychosocial health were selected. Databases included Ovid Medline, CINAHL, Ovid EMcare, PsychInfo, Scopus as well as Google Scholar. Results Fourteen articles met the eligibility criteria; five peer review and nine grey literature studies. Thematic analysis identified issues around surveillance versus lack of supervision; role denial versus advocacy; and failure to acknowledge vicarious trauma. Suggestions for improvement required recognition of the stressful nature of the work, improvements in workplace culture and the provision of support and counselling services. Conclusion Workplace stressors for call-takers arise from their work in dealing with trauma related communication with the public as well workplace culture, particularly the response of management to issues such as shift work, poorly managed rosters and long hours of work with little time for recovery. Compounding these issues is the invisibility of call-taker work. </p
... 52,56, 60,61 Of the primary research studies, the most common data collection method was semi-structured interviews conducted either face-to-face or via telephone or Skype (n=11). 34,35,[49][50][51][53][54][55]58,59,63 Four studies used a combination of semi-structured interviews and focus groups, 29,43,44,64 while another four utilised questionnaires with at least one open-ended question. 27,37,38,46 Six studies used a mixed methods approach, combining qualitative and quantitative approaches. ...
... There was also an increase in vigilance and fear of doing the required role, unwanted and unpredictable flashbacks or intrusive thoughts, triggers as part of their ongoing role, fatigue, stress, high rates of sickness and days absent, and difficulty switching off. 28,31,32,35,40,43,45,48,55,59,61 The high and increasing rates of depression and anxiety, and the associated development of posttraumatic stress and suicidal ideation [26][27][28]30,31,33,43,49,50,56,61,62 were clearly oultined as current and systemic issues faced by paramedics and call-takers, with rates estimated as being twice as high as other health professionals. 32,33,36,39,45,48,55,56 The nature of the work, including the routine 'everyday' call-outs, and those that generated associated secondary or vicarious trauma, have a cumulative effect on paramedics, ambulance officers, ambulance volunteers, and call-takers. ...
... Paramedics also find themselves being hyper-alert and overprotective of family and friends because they know and see worst-case scenarios as part of their everyday work. 34,43,59,63 The effects of shift work adds to the psychological stress due to the continuous negotiation between their role and identity at work and their personal life. Shift work specifically reduces the time for recovery and quality individual and family time with limits on their social life. ...
Research
Full-text available
The scoping literature review of peer-reviewed and grey qualitative literature addressed the psychological, physical, and social well-being of paramedics, ambulance officers, ambulance volunteers and call-takers.
... A number of well-known self-report measures were used to assess: (1) symptoms of Posttraumatic Stress Disorder (PTSD); (2) burn- out; (3) physical and mental health status; and (4) disposi- tional optimism. One-to-one interviews were also conducted with all participants, but these are reported elsewhere (Gallagher & McGilloway, 2007). ...
... Van der Ploeg and Kleber (2003) outline a number of work- related stressors which may significantly affect stress levels in ambulance personnel including: poor communication; lack of support from colleagues/supervisors; insufficient finan- cial reward; high emotional demands; lack of information; physical strain; and lack of job autonomy. Indeed, some of these emerged in the one-to-one interviews that were con- ducted as part of the larger study (Gallagher & McGilloway, 2007). All of these findings support our second hypothesis and point toward an urgent need to provide appropriate and timely psychological support for frontline ambulance staff. ...
This two-stage study was undertaken to assess the extent and nature of Critical Incident Stress (CIS) amongst frontline staff in a large ambulance service in Ireland. In Stage One, 63% (112/180) of participants completed a Screening Questionnaire and the GHQ-12. In Stage Two, 27 participants, who had experienced a critical incident (CI) during the previous year completed several measures to assess PTSD symptomatology, burnout, health-related Quality of Life, and dispositional optimism. Eighty-one per cent (80/94) of the Stage One group reported that their health had been affected by a CI; 42% (44/106) were identified as 'cases' on the GHQ-12. Stage Two results indicated that 12 participants had PTSD symptoms while this entire group showed moderate levels of emotional exhaustion and depersonalization, despite experiencing high levels of personal accomplishment and optimism. The findings suggest a high prevalence of CIS among ambulance personnel in Ireland and a significant impact on overall health and wellbeing. This has important implications for the effective management of CIS and suggests an important role for occupational health and organizational psychologists in providing routine support to ambulance service staff andpossibly other emergency services personnel.
... Az e témában készült különböző tanulmányok rávilágítanak arra, hogy a mentődolgozók sokkal inkább kitettek egészségi problémáknak, mint az átlagpopuláció vagy más egészségügyi ellátást végzők. Ez önmagában is további vizsgálatok elvégzését indokolta a mentődolgozók körében [5,6,7,8]. Néhány kutató a mentődolgozókkal kapcsolatosan olyan kérdéseket fogalmazott meg, amelyek az egészségi állapotot, a fi zikai állapotot és a személyiségváltozásokra gyakorolt károsító faktorokat helyezték a kutatások középpontjába, összehasonlításokat végezve más munkakörökkel is [9,10]. ...
... Többváltozós logisztikus regressziós elemzés a mentődolgozók észlelt egészségi állapotáról A klaszterváltozó és a fentebb említett egészségi állapot jellemzők (páronként elemezve) meglehetősen erős kapcsolatot mutatnak. Azok a mentődolgozók, akik kevesebb pszichoszomatikus panaszt jelöltek meg (első klaszter) az egészségi állapot önértékelésében 1,7-szer (95% CI: 1,2-3,3), a fi zikai fi ttség megítélésében 2, 9szer (95% CI: 1,[4][5]8) és a mindennapi tevékenység egészségi problémák miatti korlátozottságában 2,1-szer (95% CI: 1,2-4,1) kedvezőbb képet mutatnak, mint azok, akik a második klaszterhez tartoznak. ...
Article
Unlabelled: Health status of ambulance personnel has an important impact on the quality of patient care. Surveys in some smaller regions of Hungary have been conducted on health behavior of ambulance personnel; however they do not mirror the complexity of multidimensional health status in this respect. The aim of the present study is to examine the self-perceived health status of ambulance personnel (AP) and its most salient work related and individual factors. Methods: A quantitative cross-sectional survey was carried out among AP of the Hungarian National Ambulance and Emergency Service in 2008. The survey covered all the regions and sample taking ensured the study to be of representative value. Anonymously 364 individuals gave their answers that could be evaluated. After data procession and coding, records were statistically analyzed by SPSS 15.0. Spearman correlation, chi-square test and multivariable logistic regression analyses were applied to measure the significance of variables. The survey was conducted with a self-fill-in questionnaire measuring the following dimensions of self-perceived health: self-rated health, self-rated physical fitness and limitation in daily activities by health problems. Results: The results revealed that self-perceived general health status of ambulance personnel does not differ significantly among the emergency units in many terms. However, there are significant differences regarding the complexity of the duties what they have to deal. In their self rated health 1.9 times (95% CI:1.2-2.8), in their self rated physical fitness 2.0 times (95% CI:1.3-3) and in the limitation of daily activities by health problems 1.9 times (95% CI:1.2-3.1) those ambulance personnel feel more favorable who do any kind of sports activity. Generally they experience serious stress; they have not enough leisure time and hardly do sport. Due to their bad lifestyle all fifth ambulance personnel suffer from serious obesity. Conclusion: Physical activity may enhance self perceived health even though if the person delivers physical symptoms. Regular training to increase the physical fitness should be implemented for ambulance personnel that could well contribute to copying with psychological trauma.
... About 10% of ambulance workers met criteria for clinical levels of depression, whereas 22% reported high levels of anxiety (Bennett et al., 2004). Finally, rescuing children involved in accidents, victims of suicide, or people with limb mutilation expose ambulance personnel to high levels of stress, frequently associated with behavioral problems (angry outbursts, irritability) and feelings of alienation (Gallagher & McGilloway, 2007). ...
... Concerning physical health, hypertension and musculoskeletal problems were more frequently detected among ambulance workers than in the general population (Jonsson et al., 2005;Okada, Ishii, Nakata, & Nakayama, 2005). Sleeping difficulties were observed among a wide range of ambulance workers (Aasa, Brulin,Ängquist, & Barnekow-Bergkvist, 2005;Gallagher & McGilloway, 2007). A study on early retirement among health professionals showed that ambulance personnel were more likely to retire than were hospital staff because of circulatory and mental problems (Rodgers, 1998). ...
Article
While several studies have highlighted the negative consequences of trauma exposure on rescuers' health, the psychological factors promoting rescuers' well-being have rarely been investigated. The present study aimed at analyzing the quality of rescuing experience among professionals and volunteers of the Italian Red Cross. The experiences of 14 professional and 11 volunteer ambulance rescuers were examined through the repeated assessment of their subjective evaluations of daily activities and contexts in real time. Their experience fluctuation pattern was analyzed based on the levels of environmental challenges and personal skills perceived during daily activities. Both professionals and volunteers reported frequent exposure to highly challenging situations while rescuing and associated this activity with high concentration, involvement, and control. Perceptions of anxiety were significantly more frequent among volunteers. For both groups, first-aid activities were reported to provide optimal experience, a complex and rewarding condition characterized by the perception of high challenges matched with adequate skills. Results suggested that working as rescuers can promote well-being through optimal experiences. The potential for skill refinement and individual development embedded in rescuing activities, together with individual characteristics, should be taken into account in designing training programs for professionals and volunteers.
... Rivard et al. (2002), examining the prevalence of acute traumatic dissociative responses in law enforcement officers involved in critical incidents, concluded that 90% of these officers experienced a dissociative response during the critical incident, 30% met the criterion of acute stress disorder, and 19% reported memory impairment for details of the incident . Gallagher and McGilloway (2007), who studied the impact of critical incidents on ambulance personnel found that exposure to these kinds of incidents has a significant impact on the health and well-being of the workers. Study participants reported a wide range of mental health problems such as sleeping difficulties, outbursts of anger, irrationality and feelings of alienation. ...
... In a study, ambulance personnel identified the following incidents as the most disturbing: situations where children or people known to them are involved; situations involving severe injuries and death; situations in which ambulance staff experience helplessness; where support from colleagues is needed but lacking; and where information is incorrect or imprecise about the needs of the victim/s, details at the scene or the conditions under which the accident occurred (Alexander & Klein, 2001;Haslam & Mallon, 2003). According to Gallagher and McGilloway (2007), incidents that involve children, suicides, or grotesque mutilation are the most distressing for ambulance personnel. Furthermore, physical proximity to the incident is a major contributory factor to psychological effects on the emergency workers (Adams, Figley, & Boscarino, 2008;Shiri et al., 2008;White, 2001). ...
... Moreover, they considered a time out as an important procedure. In Ireland, Gallagher and McGilloway (2008) interviewed ambulance personnel not only to assess the nature and the impact of critical incidents on their health and well-being, but also to understand their attitudes toward the support system and to explore the barriers to its accessibility. The findings suggested a high prevalence of critical incident stress among ambulance personnel and a significant impact on overall health and well-being. ...
... However, participants also reported the lack of desire to be with others and avoiding thinking about the situation, which can make the process of recovering from critical incidents very difficult (Kirby et al., 2011). Sleep disturbance is one of the consequences of confrontation with stressful emergency situations, which has been noted in other studies (Aasa et al., 2005;Gallagher and McGilloway, 2008). Recurrent and intrusive images and thoughts were also recognized as consequences of these events, also identified by Regehr et al. (2002). ...
Article
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Purpose – Ambulance personnel face a diversity of stressful events that could be potentially traumatic, putting their health and well-being at risk. The purpose of this paper is to explore, from this group perspective, sources of stress, coping strategies and support measures. Design/methodology/approach – The authors interviewed 14 ambulance workers of Portuguese Red Cross local structures from the north of Portugal. Data were analyzed according to thematic analysis procedures. Findings – The authors identified three themes: operational and organizational factors, control and predictability; anticipating scenarios, focusing on procedures and dealing with reactions; and from undervalued support to support as routine. Dealing with human lives, the unpredictability of calls and working under pressure are the main sources of stress, causing, in some of them, insomnia, fatigue, anxiety and intrusive thoughts. Road accidents, situations involving children and cardiac arrest are the most distressing events. During events, they cope focusing on technical procedures, but after them they prefer to talk with colleagues and seek support from family and friends. All participants emphasize the inexistence of structured support measures. Practical implications – It is important to develop support measures tailored to ambulance personnel’s needs, leading to enhancements of theirs work performance, health and well-being. Originality/value – Contrarily to most of the studies that explore mostly PTSD and/or burnout, the authors explored, from the perspective of professionals, other dimensions such as sources of stress, coping strategies and support measures, adopting a qualitative approach, which has been rarely used. Keywords Coping, Stress, Support, Ambulance personnel
... As características inerentes ao trabalho em contexto pré-hospitalar faz com que estes profissionais estejam sujeitos a níveis de stresse mais elevados comparativamente a outros profissionais de saúde (8,(12)(13)(14)(15), podendo manifestar-se num maior risco de desenvolver problemas de saúde física e mental (4,14,(16)(17)(18). A maior parte dos estudos aponta no sentido de as mulheres reportarem mais problemas de saúde mental em geral (13,16,(19)(20)(21). ...
... As características inerentes ao trabalho em contexto pré-hospitalar faz com que estes profissionais estejam sujeitos a níveis de stresse mais elevados comparativamente a outros profissionais de saúde (8,(12)(13)(14)(15), podendo manifestar-se num maior risco de desenvolver problemas de saúde física e mental (4,14,(16)(17)(18). A maior parte dos estudos aponta no sentido de as mulheres reportarem mais problemas de saúde mental em geral (13,16,(19)(20)(21). ...
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Introdução e objetivos Em Portugal, uma das entidades que opera no contexto de emergência pré-hospitalar é a Cruz Vermelha Portuguesa. Trabalhar a este nível é considerado uma atividade de risco, entre eles a exposição a níveis elevados de stresse, que pode originar o desenvolvimento de problemas de saúde. Os principais objetivos deste estudo foram descrever o perfil destes operacionais considerando variáveis de saúde, trabalho, coping e suporte social, explorar diferenças de idade/género, bem como a relação entre estas variáveis. Metodologia Realizou-se um estudo transversal e recorreu-se aos seguintes instrumentos: General Health Questionnaire– 28, Posttraumatic Stress Disorder Checklist 5, Warr’s Job-Related Affective Well-Being Scale, Brief COPE e o Survey of Perceived Organizational Support. Resultados e Conclusões Os resultados mostraram níveis satisfatórios de saúde em geral e bem-estar psicológico, bons níveis de satisfação com o trabalho e níveis moderados de suporte social percebido. As estratégias de coping mais utilizadas por estes socorristas foram o coping focado na emoção. As diferenças encontradas e as relações entre variáveis identificadas constituem pistas importantes a ter em conta no planeamento e execução de ações e intervenções com estes operacionais. Otimizar as condições de trabalho dos socorristas, disponibilizar apoio e promover o desenvolvimento de competências, serão contributos cruciais para a sua saúde e bem-estar psicológico, refletindo-se na qualidade do apoio que prestam à população. Palavras-chave: socorristas, saúde ocupacional, trabalho, coping, suporte social, psicologia do trabalho ou das organizações.
... PTSD is an anxiety disorder that can develop after exposure to a terrifying event or situation outside the normal range of human experience (APA: American Psychiatric Association 1994 ). In acute care medicine, experiences such as major disasters, severe polytrauma with dismemberment, suicide bombing, severely burned patients, death after prolonged resuscitation, and providing care to a patient who is a relative or close friend who is dying are likely PTSD trigger events (Gallagher and McGilloway 2007 ;Laposa and Alden 2003 ;McCammon et al. 1988 ; Van der Ploeg and Kleber 2003 ). Around 25-30 % of people experiencing a traumatic event may go on to develop PTSD. ...
Chapter
An emergency dispatch center notifies a local emergency department about a child who has fallen from a third-story window. About 15 min later, the ambulance team arrives in the resuscitation bay with a 15-month-old male. Complete spine immobilization is in place and the patient is receiving oxygen via a non-rebreathing mask. A trauma team composed of an emergency medicine (EM) resident, a surgical resident, a neurosurgical resident, an X-ray technician, and two nurses assumes care of the child. Due to an emergent situation on the ward, the anesthesiologist is unavailable to join the team. As per hospital policy for trauma codes, the EM resident assumes the role of trauma team leader. Unfortunately, both surgery and EM residents have had limited experience with pediatric trauma patients. The primary survey reveals an unresponsive patient with severe head and facial injuries. The patient is tachypneic and has weak central pulses and sluggishly reactive pupils. The paramedic reports that the child was briefly unsupervised and had fallen from a third floor window. While the surgery resident performs bag-mask ventilation, one of the nurses attempts to place a peripheral IV line, but her efforts are unsuccessful. During this period, the ECG shows two episodes of bradycardia. It is not until the second nurse suggests an intraosseous needle that the EM resident considers changing his plan.
... Although this conceptualization gives a sense of what might constitute a critical incident, it is difficult to identify or quantify incidents that "surpass normal coping methods" or cases that are "charged with emotion." Subsequent research efforts have attempted to identify other events that might be considered critical, including cases that involve injury and death of children (Clohessy & Ehlers, 1999;Gallagher & McGilloway, 2008;Haslam & Mallon, 2003;Regehr, Goldberg, & Hughes, 2002), response to acutely ill or seriously injured people (Alexander & Klein, 2001;Beaton, Murphy, Johnson, Pike, & Corneil, 1998;Clohessy & Ehlers, 1999), being threatened or assaulted (Mock, Wrenn, Wright, Eustis, & Slovis, 1999;Pozzi, 1998;Suserud, Blomquist, & Johansson, 2002), treating family, friends, or those known to the individual (Alexander & Klein, 2001;Haslam & Mallon, 2003;Jonsson, Segesten, & Mattsson, 2003), or having to deal with dead bodies (Bennett et al., 2005;Clohessy & Ehlers, 1999). The conceptualization of critical incident exposure includes primary and secondary traumatization; responders may develop pathological reactions to having either their personal safety directly threatened, or from secondary exposure as witness to another's tragedy or trauma. ...
Article
In this study, a mixed-methods approach was used to develop an inventory of critical incidents for emergency medical service (EMS) personnel. Data were collected from a probabilistic sample of EMS personnel (N = 1,633) via an online survey. Quantitative responses captured the frequency of exposure to 29 critical events, self-reported stress related to exposure, demographic characteristics, and posttraumatic stress symptomatology (PTSS). Respondents reported exposure to all of the stressors in the inventory. Critical incident exposure and the resultant stress were significantly (p
... These included, but were not limited to, headaches, back pains, insomnia, stiff or sore muscles, itchy eyes or skin, and heartburn (Lily et al., 2016). Similarly, research has also identified that exposure to traumatic calls can result in increased levels of aggression and alcohol use (Adams, Shakespeare-Finch, & Armstrong, 2015;Gallagher & McGilloway, 2008). While many of these findings may appear generalizable with those of police officers as well, scholars should seek to examine these exact health issues further. ...
Chapter
Policing is often understood as a dangerous occupation. Subsequently, much research has examined police officer victimization. Scholarship is relatively scant, however, when focused on police dispatcher victimization. This gap in empirical discourse is concerning as these individuals serve an integral function for police and other emergency responders. Likewise, the actions taken by dispatchers impact the needs of citizens (e.g., crime victims, missing persons, etc.) and the actions taken by emergency services. Thus, the purpose of this chapter is focused on illustrating what is known about dispatcher victimization and how these occurrences impact these public servants both professionally and personally. Also discussed in the text are areas that need to be further explored by researchers and practitioners.
... These included, but were not limited to, headaches, back pains, insomnia, stiff or sore muscles, itchy eyes or skin, and heartburn (Lily et al., 2016). Similarly, research has also identified that exposure to traumatic calls can result in increased levels of aggression and alcohol use (Adams, Shakespeare-Finch, & Armstrong, 2015;Gallagher & McGilloway, 2008). While many of these findings may appear generalizable with those of police officers as well, scholars should seek to examine these exact health issues further. ...
Chapter
Policing is often understood as a dangerous occupation. Subsequently, much research has examined police officer victimization. Scholarship is relatively scant, however, when focused on police dispatcher victimization. This gap in empirical discourse is concerning as these individuals serve an integral function for police and other emergency responders. Likewise, the actions taken by dispatchers impact the needs of citizens (e.g., crime victims, missing persons, etc.) and the actions taken by emergency services. Thus, the purpose of this chapter is focused on illustrating what is known about dispatcher victimization and how these occurrences impact these public servants both professionally and personally. Also discussed in the text are areas that need to be further explored by researchers and practitioners.
... Because military service can acutely threaten service member sleep (e.g., Adler et al., 2009;Gallagher & McGilloway, 2007;Neylan et al., 1998;Neylan et al., 2002;Su et al., 2007), and sleep problems are interlinked with psychological and organizational problems ( Seelig et al., 2010;Wesenten, Belenky, & Balkin, 2006), we targeted the domain of sleep. Deployment conditions are not typically conducive to sleep, but rather involve prolonged stress, shift work, and environmental exposure ( Peterson et al., 2008). ...
Article
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Individuals in high-risk occupations (e.g., military service) often report physical, psychological, and organizational problems. Although leaders can partially buffer their subordinates against these problems, the impact of established leadership skills appears limited, especially in high-risk occupations. Thus, building on recent theories of domain-specific leadership, we examined whether leadership focused on the specific domain of sleep might be negatively associated with some specific problems facing individuals in high-risk occupations, beyond their relationship with general leadership. Studying military personnel on peacekeeping and combat deployments, we predicted that "sleep leadership" would be negatively associated with sleep problems (physical), depressive symptoms (psychological), and negative climate (organizational), and that sleep would mediate the relationship between sleep leadership and the psychological and organizational problems. Results were generally supportive, contributing to theories of domain-specific leadership by showing that sleep-focused leader behaviors may go beyond general leadership behaviors, relating directly to the problems facing individuals in high-risk occupations.
... Increasing evidence suggests that ambulance workers experience more health problems than the general working population and other groups of health care workers (Sterud, Ekeberg, & Hem, 2006). Frontline ambulance personnel are highly vulnerable to critical incident stress, which manifests as a wide range of physical and mental health problems (Gallagher, & McGilloway, 2007;Neely & Spitzer, 1997). Work-related stressors such as the work environment, job conditions, cognitive demands, and lack of support from colleagues and supervisors pose significant risks to mental health (Aasa, Brulin, Angquist, & Barnekow-Bergkvist, 2005;Revicki & Gershon, 1996;van der Ploeg & Kleber, 2003). ...
Article
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This study investigated the impact of working for public versus private ambulance services in Turkey and elaborated on predictors of mental, physical, and emotional well-being in emergency medical technicians (EMT-Bs). In this observational cross-sectional study, an 81-question self-report survey was used to gather data about employee demographics, socioeconomic status, educational background, working conditions, and occupational health and workplace safety (OHS), followed by the 12-item General Health Questionnaire (GHQ-12), the Work-Related Strain Inventory (WRSI), and the Maslach Burnout Inventory (MBI) with three subscales: Emotional Exhaustion (MBI-EE), Depersonalization (MBI-DP), and Diminished Personal Accomplishment (MBI-PA). In 2011, 1,038 EMT-Bs worked for publicly operated and 483 EMT-Bs worked for privately owned ambulance services in Istanbul, Turkey, of which 606 (58.4%) and 236 (48.9%) participated in the study (overall participation rate = 55.4%), respectively. On all scales, differences between total mean scores in both sectors were statistically insignificant (p > .05). In the public sector, work locations, false accusations, occupational injuries and diseases, work-related permanent disabilities, and organizational support were found to significantly influence self-reported perceptions of well-being (p < .05). In the private sector, commute time to and from work (p < .05), false accusations (p < .05), vocational training and education (p < .05), informed career choices (p < .05), and work-related permanent disabilities (p < .05) were found to significantly influence self-reported perceptions of well-being. EMT-Bs were asked about aspects of their working lives that need improvement; priority expectations in the public and private sectors were higher earnings (17.5%; 16.7%) and better social opportunities (17.4%; 16.8%). Working conditions, vocational training, and OHS emerged as topics that merit priority attention.
... They found that incidents involving children, suicides, and grotesque mutilation were the most distressing for these personnel. 38 A study on emergency medical responders (EMRs) found that serious operational and physical demands were the most common severe stressors. Dealing with traumatic events, serious accidents, and young victims were found to be the common acute stressors. ...
Article
Introduction Medical responders are at-risk of experiencing a wide range of negative psychological health conditions following a disaster. Aim Published literature was reviewed on the adverse psychological health outcomes in medical responders to various disasters and mass casualties in order to: (1) assess the psychological impact of disasters on medical responders; and (2) identify the possible risk factors associated with psychological impacts on medical responders. Methods A literature search of PubMed, Discovery Service, Science Direct, Google Scholar, and Cochrane databases for studies on the prevalence/risk factors of posttraumatic stress disorder (PTSD) and other mental disorders in medical responders of disasters and mass casualties was carried out using pre-determined keywords. Two reviewers screened the 3,545 abstracts and 28 full-length articles which were included for final review. Results Depression and PTSD were the most studied outcomes in medical responders. Nurses reported higher levels of adverse outcomes than physicians. Lack of social support and communication, maladaptive coping, and lack of training were important risk factors for developing negative psychological outcomes across all types of disasters. Conclusions Disasters have significant adverse effects on the mental well-being of medical responders. The prevalence rates and presumptive risk factors varied among three different types of disasters. There are certain high-risk, vulnerable groups among medical responders, as well as certain risk factors for adverse psychological outcomes. Adapting preventive measures and mitigation strategies aimed at high-risk groups would be beneficial in decreasing negative outcomes.
... Our current study is unique in exploring perceptions and procedures around retirement in a sample of emergency service personnel, but the fi ndings are also applicable to other high-risk occupations, such as police offi cers and emergency room nurses. The study is timely and topical in view of the increasing recognition of the important role of emergency service personnel and the potential impact of trauma exposure on their overall quality of life and well-being (e.g., Gallagher & McGilloway, 2007Mitani et al., 2006 ). The sample was relatively small, but suffi ciently diverse to represent the perspectives of each organization and a mix of personnel therein while also yielding useful and important insights which would not have emerged from, for example, a larger postal survey. ...
Article
RÉSUMÉ L’objectif principal de cette étude a été d’examiner les politiques et les procédures pour soutenir les employés prenant leur retraite de leur travail aux services d’urgence. On a mené des entrevues avec les participants qui connaissaient bien les politiques et les procédures actuelles d’un grand ambulance ( n = 8) et le service d’incendie ( n = 6) en Irlande. Quatre thèmes principaux ont été révelés: (1) «Je ne pense pas que ce soit un bon travail d’etre ambulancier d’urgence quand on a 65 ans»; (2) “ils se sentent véritablement un tout petit peu isolé”; (3) l’amélioration du «choc culturel»; et (4) «Je continue a m’avancer en espérant que tout aille pour le mieux. » Les conclusions indiquent que la retraite est un changement majeur de la vie, et mettent en évidence la nécessité pour une préparation de pré-retraite plus structurée et efficace. Les éléments uniques au personnel des services d’urgence comprennent: le stress physique et émotionnel intense impliqué dans les services d’urgence; une forte identification avec ce service; et un manque de clarté sur les règles et les droits, exigeant meilleure renseignements et préparation pour prendre sa retraite.
... The literature suggests some gender differences in the transition to retirement more generally (e.g. Pinquart and Schindler, 2007) but in the context of the emergency services, where the vast majority of employees are male, our previous research uncovered a culture characterised by high levels of machismo (Gallagher and McGilloway, 2007) which may compound any negative perceptions and beliefs/expectations around retirement for this occupational group. Indeed, this unique occupational culture and environment emerged as an important sub-theme (see below). ...
Article
Purpose Much has been written about the impact of emergency service work on personnel, but very little is known about the lives of personnel once they have retired. The purpose of this paper is to explore the experiences and assess the quality of life (QoL) of emergency service retirees (ESRs) and to ascertain the possible longer term effects of emergency service work. Design/methodology/approach A series of one-to-one interviews was conducted with ESRs (n=10). These were then transcribed and analysed using interpretative phenomenological analysis. Findings A number of key emergent themes and associated sub-themes were identified from the analysis including: retirement as a major life change; potential impact of working role and unique aspects of emergency service work; trauma; and health and ageing more generally. Overall, the findings highlight the unique experiences of ESRs and the potential longer term impact of emergency service work on QoL in retirement. Originality/value In an under-researched area, the findings point towards a need to improve the transition to retirement for ESRs and, in particular, to enhance available supports, information and guidance for retirees, both prior to and following retirement.
... Finally, sleep may also be affected by the psychological stress of public safety work. 20 Sleep disturbance or deprivation has been associated with insulin resistance, weight gain, hypertension, and CVD. [21][22][23][24][25][26][27][28] ...
Article
Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45% of on-duty fatalities) and a major cause of morbidity. CVD in the fire service also has adverse public safety implications as well as significant cost impacts on government agencies. Over the last decade, our understanding of CVD among firefighters has significantly improved and provides insight into potential preventive strategies. The physiology of cardiovascular arousal and other changes that occur in association with acute firefighting activities have been well-characterized. However, despite the strenuous nature of emergency duty, firefighters' prevalence of low fitness, obesity, and other CVD risk factors are high. Unique statistical approaches have documented that on-duty CVD events do not occur at random in the fire service. They are more frequent at certain times of day, certain periods of the year, and are overwhelmingly more frequent during strenuous duties compared with nonemergency situations. Moreover, as expected on-duty CVD events occur almost exclusively among susceptible firefighters with underlying CVD. These findings suggest that preventive measures with proven benefits be applied aggressively to firefighters. Furthermore, all fire departments should have entry-level medical evaluations, institute periodic medical and fitness evaluations, and require rigorous return to work evaluations after any significant illness. Finally, on the basis of the overwhelming evidence supporting markedly higher relative risks of on-duty death and disability among firefighters with established coronary heart disease, most firefighters with clinically significant coronary heart disease should be restricted from participating in strenuous emergency duties.
... Existing papers on the mental health of emergency operators have many limitations, and the results they provide seem inconsistent. On the one hand, the burdens and negative consequences for mental health resulting from contact with traumatic events are highlighted in research [29]. In particular, the impact of operators' work on the development of secondary traumatic stress disorders [11]. ...
Article
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Aim: The main purpose of this research was to investigate the relationship between alexithymia, stress at work, and post-traumatic stress disorder (PTSD) in impact emergency call center operators working in Poland (province of Greater Poland). The risk of exposure to critical life events was also considered. Methods: Data were collected using self-report questionnaires administered after dispatchers' shifts. The emergency call center operators (N = 66) completed the Impact of Event Scale-Revised, 20-item Toronto Alexithymia Scale, Workplace Perceived Stress Questionnaire, and a questionnaire measuring the frequency and intensity of potentially traumatic events faced by emergency operators (a questionnaire developed by the authors). Results: Twenty of the most frequent events (e.g., child sexual harassment, rape, etc.) were identified. Results indicated that post-traumatic stress positively correlated with (a) work-related stress and (b) one aspect of alexithymia: difficulty expressing feelings. Additionally, work-related stress was identified as a mediator for the relation between alexithymia and the intensity of post-traumatic stress. Conclusions: The results of this study confirm that emergency operators are a high-risk group for the development of PTSD. The study results suggest that performing the work of an emergency dispatcher is not only demanding but also inherently involves participation in potentially traumatic events (as encountered through emergency calls).
... Social withdrawal and signs and symptomatic symptoms described above produced an atmosphere that adversely impacted personal interactions and intensified the feeling of alienation and withdrawal (24). To handle this, paramedics specifically had challenges and blame others such as their close friends (25)(26). ...
Article
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Introduction Our research sought to assess the psychological and social wellbeing of paramedics in Riyadh City in Saudi Arabia during the COVID 19 pandemic. It also aimed to assess the therapeutic assistance provided to pre-hospital care givers during the pandemic. Methods In this quantitative cross-sectional analysis an assessment of 106 paramedics was undertaken from data obtained from 28 September to 10 November 2020. The authenticity and durability of Pilot and the Cronbach have been added. Results Of the 106 paramedics surveyed, 60 (56.6%) were 30–39 years of age; 101 were male (95.3%). The mean average psychological wellbeing of the paramedics was 6.41 with the standard deviation of 2.42. Family and friends’ average social support score was 9.2 in norm 2.6 deviation. Conclusion Our study showed that during the COVID-19 pandemic paramedics suffered from social and psychological depression. Paramedics must be protected from the socioeconomic and psychological difficulties they face every day in order to combat the COVID-19 pandemic.
... A modicum of research is available concerning the physical and mental health-related conditions that co-occur with PTSD in dispatchers. Exposure to potentially traumatic calls has been shown to increase anger outbursts (Gallagher & McGilloway, 2008), nightmares, flashbacks, alcohol use (Adams, Shakespeare-Finch, & Armstrong, 2015) and burnout (Roberg, Hayhurst, & Allen, 1988) in dispatchers. For example, Roberg et al. (1988) compared 62 law enforcement dispatchers with 115 police officers on the Maslach Burnout Inventory. ...
Article
Posttraumatic stress disorder (PTSD) may develop after exposure to an event in which death, severe physical harm, or violence occurred or was threatened. First responders, including police, fire rescue personnel, and emergency dispatchers, have been viewed as populations at high risk for developing PTSD symptoms. Indeed, over 80% of first responders report experiencing traumatic events on the job, and it is estimated that 10–15% have been diagnosed with PTSD. However, to date, limited research has reviewed the impact and services available following these traumatic events across first responders. This review examines research regarding PTSD in police officers, firefighters, and emergency dispatchers with particular attention to the prevalence, comorbid diagnoses, risk and protective factors, and resources available to each group. A discussion of limitations of the available research in this area, and suggestions for directions that future work might take, are offered.
... In addition, communication specialists must navigate the challenges of a high volume of calls, shiftwork, communication difficulties, and ambiguous information, all with little access to learning the outcome for a given caller (Forslund et al., 2004;Kashani et al., 2018). Calls that involve risk to children or professional colleagues can be especially taxing and wrought with emotion (Gallagher & McGilloway, 2008;Pierce & Lilly, 2012). Given the nature of their operational responsibilities, communication specialists are at risk of "repeated or extreme indirect exposure to aversive details of the events," which aligns with a PTSD diagnostic criterion in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 (American Psychiatric Association, 2013). ...
Article
In public safety, individuals working behind what are often traditionally thought of as the frontlines, such as dispatchers, 911 operators, administrators, health professionals, and civilian police officers, as well as non-deployed police and correctional officers, firefighters, and paramedics, provide invaluable and needed support for frontline employees. Yet, too often the occupational stress and trauma they experience is less recognized or acknowledged. Drawing on qualitative data from an online Canadian survey, where 828 persons provided feedback when asked if they had any final comments, we explore how public safety personnel who are not deployed to incidents or working on the traditional frontline interpret occupational stressors and the justice underpinning their access to mental health supports. Emergent themes reveal those working to support traditional frontline operations also experience trauma and struggle with help-seeking behaviours—specifically they: i) feel like outsiders; ii) are mired with self-doubt while trying to recognize and validate their own struggles with mental health; and iii) express despair that there is no improvement for their situation. Findings are discussed within the context of the justice underpinning such struggles of validating their difficulties.
... 50 51 A physical space for reflection and collective support from peers was especially important. 50 51 Support received from management and at an organisational level was described as mixed ranging from positive, empathic support and provision of time out, 50 51 to an absence of a climate of care 52 and lack of concern from management. 50 51 81 82 Staff described the stigma surrounding expressions of stress experienced within organisations 50 51 and while professional services and peer support services were available, 52 uptake of these was variable, with concerns raised about being treated as an 'outcast' for accessing such services. ...
Article
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Objective: To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. Design: A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis. Data sources: MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019. Eligibility criteria for selecting studies: Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand. Results: Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored. Conclusions: To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.
... Most of the call takers described an abscent management, not giving any feedback or support. Research support this, showing that emergency personnel feel frustrated due to poor management, and this enhance the burden of professional responsibility and increase reported stress [7,17,20,21]. Hence, management have an essential role in decreasing the EMCC personnels' feeling of stress and extensive work demands through being visible, and facilitate for personnel to discuss situations. ...
Article
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Background: Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers' work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work? Methods: The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis. Results: Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) "Core technologies" and 2) "Environmental issues" . The theme "Core technologies" included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme "Environmental issues" included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service. Conclusion: At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker's ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.
... Most studies dealing with exposure of ambulance personnel to CIs have addressed the negative implications for their mental and physical health (e.g., Alexander & Klein, 2001;Bennett et al., 2004;Bennett et al., 2005;Clohessy & Ehlers, 1999;Gallagher & McGilloway, 2008;Halpern, Gurevich, Schwartz, & Brazeau, 2009a, 2009bSterud, Ekeberg, & Hem, 2006). Nevertheless, little attention has been given to the distinction between the different events in terms of their characteristics, and to the emotional experiences of the workers involved. ...
Article
Paramedics frequently encounter critical incidents (CIs). Their emotional, cognitive, and behavioral responses to these encounters present them with a variety of difficulties on the way to, during, and after events. The aim of our study was to examine how paramedics working in a large emergency service organization in Israel experienced CIs and the coping strategies they used to deal with these experiences. We interviewed 15 paramedics from this organization. Through data analysis, we revealed two main themes: (1) between connection and detachment and (2) between control and lack of control of the situation. Paramedics, who connected with their feelings regarding the patient and/or the family in different CIs, as well as those who sensed a lack of control, experienced difficult and negative emotions. To achieve detachment, they used a variety of coping strategies. Those who experienced cognitive and functional control of the situation reported a positive and empowering experience.
Chapter
Das Meldebild der Leitstelle lautet: »Kindlicher Fenstersturz«. Bei Eintreffen am Unfallort findet der Notarzt, der einen seiner ersten Einsätze fährt und mit Patienten diesen Alters keine Erfahrung hat, ein 15 Monate altes bewusstloses Kleinkind mit Tachypnoe und schwachen zentralen Pulsen vor. Der Notarzt untersucht das Kind grob orientierend und diagnostiziert ein Gesichtsschädeltrauma und ein großes subgaleales Hämatom linksparietal. Passanten berichten, dass das Kind aus ungeklärtem Grund aus einem offenen Fenster im 3. Stock gestürzt sei. Während das Kind von einem Rettungsassistenten mit der Maske assistiert beatmet wird, bemüht sich der Notarzt um die periphere Venenpunktion. Diese bleibt jedoch trotz mehrerer Versuche frustran. Während der Punktionsversuche zeigt das Kind kurzzeitig bradykarde Episoden im EKG. Erst nach 20 Minuten, als der Notarzt bereits erwägt, das Kind ohne weitere Versorgung in die Klinik zu begleiten, erfolgt vom Rettungsdienstpersonal der Hinweis auf eine intraossäre Nadel, die sich im Kindernotfallkoffer befindet.
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A small trauma team provides care to a seriously injured infant. The team leader is an emergency medicine resident who has no experience with pediatric trauma management. This emergency situation is a significant challenge for him, and the patient’s young age adds even more emotional strain. Both factors combined put the physician under enormous stress. The stress is further increased due to his difficulty in performing time-critical procedures such as obtaining i.v. access and intubation child. Due to the prolonged initial stabilization, it takes nearly 1 h before the patient is sufficiently stable to be transported to CT.
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See: http://www.oudconsultancy.nl/Resources/Proceedings_Violence_Health_Sector_2010.pdf
Chapter
In diesem Kapitel geht es um Stress und seine Auswirkungen auf das menschliche Handeln. Stress ist ein Anspannungszustand, der als physische und psychische Reaktion auf eine Beanspruchung hin eintritt und den Organismus auf eine schnelle und zielgerichtete Aktion vorbereitet. Ob und inwieweit eine Situation Stress auslösen kann, liegt an der persönlichen Beantwortung der beiden Fragen: „Ist diese Situation für meine Ziele bedrohlich, neutral oder günstig?“ (Situationsbewertung) und „Werde ich mit der Situation zurechtkommen?“ (Ressourceneinschätzung); diese Bewertung erfolgt meistens unbewusst und sehr schnell. Ein moderates Ausmaß an Stress kann auch positive Auswirkungen auf die eigene Leistung haben, ein zu hohes Ausmaß wirkt sich hingegen negativ aus. In der Akutmedizin kann chronischer Stress gesundheitsschädlich wirken und zur Entwicklung eines Burnout-Syndroms führen. Neben diesem steht auch die posttraumatische Belastungsstörung (PTBS) im Fokus des Kapitels, ebenso wie die Frage nach der Stressprophylaxe, die von Organisationen geleistet werden kann.
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Background The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives. Methods Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. Results A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: ‘Organisational and Operational Factors’ and ‘Interactions with Others’. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pressured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. Discussion EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health. PROSPERO Registration Number CRD42014010806.
Chapter
In diesem Kapitel geht es um Stress und seine Auswirkungen auf das menschliche Handeln. Stress ist ein Anspannungszustand, der als physische und psychische Reaktion auf eine Beanspruchung hin eintritt und den Organismus auf eine schnelle und zielgerichtete Aktion vorbereitet. Ob und inwieweit eine Situation Stress auslösen kann, liegt an der persönlichen Beantwortung der beiden Fragen: „Ist diese Situation für meine Ziele bedrohlich, neutral oder günstig?“ (Situationsbewertung) und „Werde ich mit der Situation zurechtkommen?“ (Ressourceneinschätzung). Diese Bewertung erfolgt meistens unbewusst und sehr schnell. Ein moderates Ausmaß an Stress kann auch positive Auswirkungen auf die eigene Leistung haben, ein zu hohes Ausmaß wirkt sich hingegen negativ aus. In der Akutmedizin kann chronischer Stress gesundheitsschädlich wirken und zur Entwicklung eines Burn-out-Syndroms führen. Neben diesem steht auch die posttraumatische Belastungsstörung (PTBS) im Fokus des Kapitels, ebenso wie die Frage nach der Stressprophylaxe, die von Organisationen geleistet werden kann.
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This study examined the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety in a sample of emergency ambulance personnel. Of 1029 personnel in one ambulance service mailed a questionnaire, 617 were returned. Among respondents, the overall rate of PTSD was 22%. Levels of PTSD did not differ according to grade, but men had a higher prevalence rate than women (23% compared with 15%). Nearly one in ten reported probable clinical levels of depression, 22% reported probable clinical levels of anxiety based on Hospital Anxiety and Depression Scale scores.
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predisaster stress management transdisaster stress management postdisaster stress management (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Volunteer firefighters in NSW were surveyed for experiences of posttraumatic stress. Firefighters were asked to describe their experiences of stress and indices were obtained of psychological disturbance. Findings indicated that most firefighters felt that their safety had been threatened. One-quarter of firefighters indicated that they experienced significant levels of posttraumatic stress, although many respondents attributed their stress to personal events. Posttraumatic stress was associated with multiple and recent critical incidents. Findings are discussed in terms of etiological factors of posttraumatic stress and the need for appropriate intervention.
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Qualitative methods were used to explore the aetiology of occupational stress experienced by on-road ambulance officers. The researcher found that the way in which a service is organised and its officers valued can create and reproduce workplace stressors that are as causative of occupational stress as the often acknowledged occupational specific stressors like night shifts, irregular work hours and witnessing human trauma and tragedy. These stressors thought to be intrinsic to the work of ambulance officers were found to have an organisational dimension.
Doing psychological research: Gathering and analyzing data
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Critical Incident Stress Debriefing: An operations manual for CISD, Defusing and other group crisis intervention services
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