Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel.

Abstract

There is a lack of literature exploring vicarious trauma (VT) in emergency medical services (EMS) personnel. VT is emotional countertransference that occurs between the clinician and patient. The presence of trauma- or stressor-related disorders could be a factor in the rising suicide rate in these clinicians. This was a cross-sectional statewide study of American EMS personnel, using one-stage area sampling. Nine EMS agencies were selected to participate based on geographic area, who then provided data about annual call volume and mix. The Impact of Event Scale-Revised was used to quantify VT. Univariate analyses used chi-square and ANOVA to evaluate the relationship between VT and various psychosocial and demographic characteristics. Factors significant in the univariate analyses were included in a logistic regression to determine predictors of VT while controlling for potential confounders. A total of 691 respondents participated in the study, of which 44.4% were female and 12.3% were minorities. Overall, 40.9% had VT. Of those, 52.5% scored high enough to potentially illicit immune system modulation. Compared to those without VT, more than four times as many EMS professionals with VT self-reported as currently in counselling (9.2% v. 2.2%; p < 0.01). Approximately one in four EMS professionals (24.0%) had considered suicide, while nearly half (45.0%) knew an EMS provider who had died by suicide. There were multiple predictors of VT, including female sex (odds ratio [OR] 1.55; p = 0.02) and childhood exposure to emotional neglect (OR 2.28; p < 0.01) or domestic violence (OR 1.91; p = 0.05). Those with other stress syndromes, such as burnout or compassion fatigue, were 2.1 and 4.3 times more likely to have VT, respectively. Among study participants, 41% suffered from VT, and 24% had considered suicide. As a largely understudied phenomenon in EMS professionals, additional research on VT should focus on causality and the mitigation of sentinel events experienced in the workplace.