Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
Arce19 2018 USA
Qualitative study that employed a theoretical approach consisting of a review of documented literature, and qualitative data from that literature.
The study examined evidence for efficacy of psychological first aid (PFA) and critical incident stress debriefing (CISD) to determine which of the 2 models is better for first responders following critical incidents:
RQ1. How is CISD effective in helping first responders with PTSD symptoms or other work-related symptomology?
RQ2. How is PFA effective in helping first responders with PTSD symptoms or other work-related symptomology?
RQ3. What is the preferred method of debriefing among emergency agencies?
RQ4. What are other environmental or social factors that can help improve or enhance the use of PFA or CISD?
Mobile first responders in this study included Royal Canadian Mounted Police, volunteer firefighters, law enforcement officers, Vietnam veterans, ambulance personnel, and Red Cross Volunteers.
Findings in the literature suggest that CISD helps responders to manage stress in the long-term.
Debriefing is an appropriate intervention after a crisis and during the immediate impact phase.
Individuals experiencing acute stress with the inability to regain normal functioning responded well to PFA.
Debriefing is effective in helping first responders after a critical incident, but is not harmful, as previously thought.
Debriefings, and the social support which is included, allow first responders a forum to discuss matters that are upsetting and stressful and thereby, to alleviate the effects of trauma.
Implementing effective debriefing promotes good mental health for first responders, improves work performance and patient care, longevity, and overall mental health. PFA is ideal for treatment immediately following traumatic incidents, in conjunction with CISD as a way of promoting longevity and overall positive mental health for first responders.
Arsenault20 2016 USA
Phenomenological discussion with 10 paramedics on work-related stress – in-depth interviews.
Distress arises from critical incidences.
Influences are:
Individual traits (debate in literature on whether stress develops post-employment or initially - findings tend towards predisposition model)
Impact of stressors:
Personality change
Stimulation seeking
Trauma junkies
Anxiety and hyper vigilance
Identification with patient
Semi-structured interview.
10 EMS.
All levels, including volunteers.
1,000 hours experience.
174 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
Organisational factors within workplace Symptoms:
PTSD
Substance use disorders
Major depressive disorder
Absenteeism
Difficulties with home environment Treatment:
EMS workers not willing to access help
Relationship impact.
Physical impact (fatigue, sleeplessness, diet).
Level of PTSD higher in EMs population than general population in the USA.
Findings:
Sense of fulfilment
Diverse range of experiences
Purpose/being part of a team Stressors:
Working with vulnerable populations –
paediatric/elderly/death/interaction with families
Pay seen as too low
Shift length and work-week structure
Scene safety issues
Being perceived different from police and fire
Personal connection to
patient/suicide/uncertainty and second guessing Other strategies:
Negative:
Confrontation
Distancing
Self-controlling
Escape-avoidance
Alcohol and substance use
Recruited through letters to services and snowball.
Clearly outlines questions and why they were asked.
Usual data storage.
Debriefing of
participants occurred.
175 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
Positive:
Accepting responsibility
Problem-solving
Positive reappraisal
Social support
Humour
Religion
Talk therapy either with family or peers or professionals
Keeping some distance from work
Hobbies
Continuing education
Normalising responses
Emotional suppression strategy correlated with PTSD
Recommendations:
Debriefing must not be from a script
Mental health providers should have knowledge of the field
Developing a personal connection with therapist is important
Helping colleagues who are reluctant to talk
Developing fitness for practice
Shifting agency culture
176 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
Single session de-briefing may have harmful outcomes (suggestion that it is offered too soon) Dicks24
2014 Canada
Do Canadian 911 operators suffer from PTSD symptoms due to their experiences with the traumatic incidents of others?
What is the prevalence of PTSD symptoms in 911 operators?
What coping methods do 911 operators utilise?
Are there other factors that may be affecting the level of stress experienced by 911 operators?
What is the nature of 911 calls that are most likely to cause fear, horror, or helplessness among 911 operators?
Coping mechanisms included drugs and alcohol.
Mentions typical coping strategies, compassion fatigue/same as secondary trauma.
Approximately 80% had one symptom of PTSD.
Six organisations, mixed methods. 146 respondents
completed. Survey and then interviews. Survey used the Post
Traumatic Stress checklist and Lazarus and Folkman ‘The Cope inventory’.
20% male/80% female.
Qualitative component was written on survey.
Dow21 2018 USA
Grounded theory study that outlines paramedic stress triad theory.
Three areas: personal, environmental, and organisational.
Stress in EMS:
More stress due to paper work
Seen as an occupational hazard Personal Stressors:
Paramedic’s personal response and reactions to stress
Stress changes over a career?
Spousal support/competition with marriage of two members
Chronic cumulative stress can lead to burnout - not just one event, but build up and cumulative
Is spirituality a part of your life?
Major solution is education and training.
Interventions:
Personal coping methods
Training in academy for stress exposure and management
Peer support
Critical incident debriefing
Grounded theory using focus groups within the Chicago Fire Brigade that includes
paramedics.
Focus groups occurred according to grade to reduce power differentials.
177 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
There are generational differences in what causes stress and stress responses: older drink, younger addicted to Facebook Environmental Stressors:
Stress from civilians and other stakeholders for what paramedics do
Worst runs are midnight
Burnout
Morale in EMS - tension between venting and cynical culture Organisational Stressors:
Agency stressors
Supervisor’s role in mitigating subordinate stress - most interviewees found management difficult
The EMS Coordinator’s role in mitigating paramedic stress
Organisation responds to crisis, rather than pre-empting or spotting paramedic in crisis
Stress of trauma that occurred in the past
Shift work Meaney-Pieroway22
2014 USA
Families may share in critical incidents and their own trauma is compounded by symptoms of first responder.
Data suggests that with this sample, at least, First Responders have PTSD symptoms that are as severe as a known group with a diagnosis of PTSD. Secondly, the support of a spouse seems very important for the reduction of PTSD symptoms. Finally,
spouse/partner support may work by allowing the person with PTSD to feel a sense of hope. This may occur by reducing the amount of self-focus, as evidenced by the number of “I” statements.
While the study used qualitative methods to collect the data, analysis was a statistical content
analysis.
Having a partner in treatment is beneficial to the first responder as less focus on the self and shared hope in recovery, and issues around marriage relationship impacted by trauma can be addressed.
Discourse context analysis – qualitative collection of free text, but statistical analysis of words used, number of times used.
CASP.
Pare23 By applying data from the participants’ post-traumatic lived experiences to the mapping of emerging pathways to Post-
Some support for the theoretical PTG model of Tedeschi and Calhoun, but also revealed some
Sample of 10 fire fighter paramedics and
178 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
2013 USA
Traumatic Growth (PTG), the researcher’s intent was to investigate the data to reveal pathways to PTG. Findings revealed. Asks is PTG an outcome or a process?
The study looks for individual differences and common themes in PTG.
Used Moustakas (1994) transcendental phenomenological approach and positive psychology.
What do first responders’ post-traumatic experiences reveal about the present theoretical pathway to PTG developed by Tedeschi and Calhoun (1996, 2009)?
Conversely, what do first responders’ post-traumatic experiences reveal about alternate pathways that lead to PTG?
evidence of negative changes. Further research to clarify pathways to PTG was advised.
Key themes:
A desire to help people
Personality: optimistic, caring
Guilt is the most often mentioned theme linked to PTSD: Difficult cases, babies, dealing with family Coping strategies leading to PTG: Social support and talking issues through and maintaining balance in life.
Negative strategies:
Avoidance
Drinking
Internalising
Less trusting
Cynical
Fear of risk for self Other changes:
Changes in faith
Respect for life
Separating work from personal life
Putting family first
Always on guard
Survivors reach out to community
police officers/first responders, who have been on the job for at least five years, a mid- sized Virginia city.
Used Van Kaam method of analysis.
Researcher self- reflective.
CASP in file.
179 Author, date,
country 1: The dissertation question
2: Coping strategies/innovations proposed to manage stress, psychosocial, or physical
consequences of workplace stress in Australian context (e.g., policy, legislation,
industrial agreements)
3: CASP audit
There is no definitive pathway from PTS to PTG.
Male first responders seek social support, but also keeping it inside.
Female first responders seek therapy and medication - acknowledging it.
PTSD can occur well after event.
180