Implementation of post-traumatic stress injury programs in Alberta first responder organizations: a qualitative study

Introduction First responders (FR) such as police, paramedics, and firefighters are routinely exposed to traumatic situations and may suffer from post-traumatic stress injuries (PTSI) as a result. The scientific evidence on optimal treatment and workplace practices for PTSI is not strong. The objective of this project was to examine first responder workplace policies and practices for the prevention of PTSI work disability. Methods The research team worked with a stakeholder advisory committee (police, paramedics, firefighters) to conduct an interview study with FR (workers and manager roles) from Alberta, Canada. A thematic analysis was used for the qualitative interview data. Results We gathered data via interviews with 47 FR members from police (16), fire (16), and paramedic (15) services who shared their experience with PTSI and workplace programs. The data reveal three key themes related to workplace PTSI programs and policies: Improving Culture, Programs under development, and Trusted communication. Three additional themes emerged related to recommendations to improve policies and programs in the workplace: stream-lined processes, better resources, and continuing to reduce stigma. The themes and recommendations from participants provide some practical information about how programs can be improved. Discussion and conclusions The interview data yielded rich descriptions of current workplace PTSI practices. While participants noted that awareness about PTSI and the culture of first responder workplaces there was still room for improvement. Recommendations regarding improved processes and resources were considered paramount. Future research should examine FR workplace program development as well as implementation.

IntroductionDuring the evening of 13 November 2015, a terror attack occurred in France in the Paris area. Overall, 130 people were killed, 643 were injured and several thousands were psychologically impacted. Thousands of first responders (FRs), including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on FRs, and its associated factors 12 months after the 13 November 2015 terrorist attacks, as well as their engagement in mental health care and its associated factors.MethodsFRs who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of Post Traumatic Stress Disorder (PTSD). PTSD and partial PTSD were measured using the PTSD checklist for DSM-5 (PCL-5) and depression with the hospital anxiety and depression (HAD) scale.ResultsOverall, 663 FRs were included in the analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers. Low educational level, social isolation, intervention on unsecured crime scenes and lack of training were associated with PTSD. Among FRs with PTSD, partial PTSD or depression, 38% sought mental health care. Mental health care engagement was associated with a history of mental health care, post-immediate support and the presence of PTSD, partial PTSD or depression.ConclusionsOur results highlight that improving access to mental health care for FRs after terror attacks is needed. Efforts should be made before and after potentially traumatic events to ensure mental health education for FRs. Special attention should be given to FRs living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes.

Following the Paris terror attacks in November 2015, a large number of first responders (FR) were mobilized and consequently were at risk of developing posttraumatic stress disorder (PTSD). Based on the ESPA 13 November survey, the objectives of this study were to 1) describe the prevalence of PTSD and partial PTSD in FR five years after the attacks, 2) describe the changes in PTSD and partial PTSD from one to five years after the attacks, and 3) examine factors associated with PTSD and partial PTSD five years after the attacks. Data were collected using an online questionnaire. PTSD and partial PTSD were measured using the Post-Traumatic Stress Disorder Checklist based on the DSM-5 (PCL-5). Gender, age, responder category, education level, exposure, mental health history, history of traumatic events, training, social support, concern about the COVID-19 epidemic, and somatic problems present after the attacks were all analyzed as potential factors associated with PTSD and partial PTSD using multinomial logistic regression. A total of 428 FR were included 5 years after the attacks, of which 258 had participated also 1 year after the attacks. Five years after the attacks, the prevalence of PTSD and partial PTSD were 8.6% and 22%, respectively. Presence of somatic problems after the attacks were associated with PTSD. Involvement in dangerous crime scenes was associated with a higher risk of partial PTSD. No awareness of psychological risks in the context of professional activity through specific training was associated with partial PTSD, in particular among participants aged 45 years or more. To mitigate PTSD for FR, monitoring mental health symptoms, providing mental health education, and providing treatment may be needed for several years after the attacks.

Cumulative exposure to work-related traumatic events and current post-traumatic stress disorder in New York City's first responders

Prevalence and correlates of psychiatric symptoms among first responders in a Southern State

First responders (FR-police, firefighters, paramedics) are exposed to trauma which can result in post-traumatic stress injuries (PTSI). Despite a lack of strong evidence on interventions to address PTSI work disability, workplace PTSI programs and policies are necessary to prevent work disability. The study objective was to examine experiences and perspectives about workplace programs, policies, and experiences related to the prevention of PTSI work disability among FR in Alberta, Canada. This qualitative study collected the perspective of police members, firefighters, and paramedics in Alberta, Canada regarding current workplace PTSI programs and policies. Qualitative interview data underwent descriptive thematic analysis. Interviews were conducted with 47 FR members from police (16), fire (16), and paramedic (15) services who shared their experience with PTSI and workplace programs and policies. Three key themes emerged: improving culture, programs under development, and trusted communication. Three additional themes related to recommendations to improve programs and policies in the workplace were also identified: streamlined processes, better resources, and continue to reduce stigma. The themes and recommendations from participants provide practical information about how programs and policies can be improved. Interviews provided rich descriptions of current FR workplace PTSI practices and policies. While participants noted that awareness about PTSI and the culture of FR workplaces has improved, more needs to be done. Paramount were recommendations regarding the need for streamlined processes and better resources to reduce PTSI work disability. Study findings suggest that the development and implementation of workplace PTSI programs have a positive impact on FR organizations and on the mental wellbeing of the FR workforce. Future research should examine FR workplace program and policy development as well as implementation.

First responders (FRs) commonly present for treatment with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no FR study has validated these measures on a treatment-seeking sample. Confirmatory factor analysis was utilized to validate measures that assess these constructs (Posttraumatic Stress Disorder Checklist for DSM-5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7) on a treatment-seeking sample of FRs ( N = 390). The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting factor model of the depression measure was a two-factor structure, cognitive-affective and somatic depression. Lastly, generalized anxiety was a unidimensional construct. Follow-up studies should validate these measures on each FR subtype. We position these findings within the FR literature, review clinical implications for providers, and offer recommendations for future research.

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η 2 = .015). We found that TEs had a direct effect on EDM, β = −.16, Z = −3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, β = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.

Introduction Work disability is a fundamental problem in ageing societies. In its various forms, this incurs substantial costs for employers and the society. Better identification of the work disability would presumably encourage employers to pay attention to its prevention. This study explores first the costs that work disability (disability pension, accidents at work, absence from work due to illness, occupational health care) incurs in the public sector in Finland. Second it is analysed how employers could reduce work disability and related costs. Methods Calculation of the total costs of work disability among the public sector employers in Finland. Assessments have been made about organisation’s actions to minimise these costs. Result The costs of work disability represent an average of 10% of the total salaries paid by the organisations in the study. There are considerable differences in costs between various organisations. The differences may be caused by differences in age, gender and job structures as well as the employers’ methods to prevent work disability. The costs caused by absence from work due to illness form the largest category. Discussion Better identification of costs might help reduce work disability and the related costs. Organisations could achieve significant savings and improvements in productivity by focusing on reducing work disability. The society would benefit from reducing work disability in terms of longer working careers. A financial perspective is a useful approach when the objective is to reduce work disability and the resulting costs. Presently, there are many challenges related to the data on work disability and analysing it. However, digitalisation obviously leads to significant improvements here in the near future.

BackgroundThe COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.ObjectivesExamine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.DesignObservational, self-report, single time-point online assessment.ParticipantsA total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic.Main Outcomes and MeasuresCROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.ResultsCROS total scores correlated significantly with all four psychiatric symptom domains (R’s = .42–.53), likelihood of leaving one’s current occupation (R = .18), and trouble doing usual work (R = .28), all p’s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.Conclusions and RelevanceThese results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

The aim of this study was to examine the associations of comorbid posttraumatic stress disorder (PTSD), affective or somatic depression, and suicide among first responders (FRs). We used baseline data from FRs ( N = 232) who sought services at a nonprofit mental health agency specializing in treating trauma exposed FRs. We conducted two PROCESS simple mediation models with PTSD as the predictor, affective depression and somatic depression as the mediators, and suicidality as the dependent variable. Affective depression significantly mediated the relationship between PTSD and suicidality, whereas somatic depression did not. The direct effect of PTSD on suicidality was not significant. These data are cross-sectional and should be followed up with longitudinal analyses across the course of treatment. To reduce suicide risk, it is recommended that clinicians target affective depression instead of PTSD symptoms.

This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.

2215 – Cumulative Exposure To Work-related Incidents And Current Posttraumatic Stress Disorder In New York City's First Responders

First responders (FRs) are routinely exposed to traumatic events, increasing risk for posttraumatic stress disorder (PTSD). This study compared heart rate variability (HRV) and skin conductance level (SCL) between FRs with and without probable PTSD at baseline and during a virtual reality (VR) task. Eighty-four FRs completed questionnaires and physiological assessments. Participants with probable PTSD showed significantly lower baseline HRV, indicating reduced parasympathetic modulation. No group differences emerged for HRV during VR or for SCL at either point. The results confirm reduced HRV at rest in PTSD, but further work is needed to clarify why this difference was not observed during the task and why SCL showed no group effects. To advance understanding of these results, future studies should include larger samples, longer baselines, recovery phases, and clinical interviews.

Automated external defibrillators and first responders: a satisfaction survey