Abstract
Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms. Methods EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed. Results Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory. Conclusions Emotional sequelae are associated most strongly with EMT/paramedics’ personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.
Highlights
Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact
Researchers have compiled lists of the qualities of critical incidents based on EMT/paramedics’ reports, which include characteristics of the patient
We identified the characteristics of incidents that cause EMT/paramedics’ immediate distress and subsequent symptoms in three ways
Summary
Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. Emergency medical technicians and paramedics (EMT/ paramedics) are subject to critical incidents, defined as stressful workplace incidents that evoke acute distress and which may impair functioning in the short- or longterm [1]. Paramedics’ critical incidents and is found in 12% to 20% of EMT/paramedics compared to a community prevalence of 1-3% [6]. Depression and anxiety have been attributed to critical incidents [5] These syndromes likely contribute to EMT/paramedics’ high sickness-absence rates compared to other health professions [7]. Objective tools to identify critical incidents which are likely to result in emotional difficulties might reduce the stigma that EMT/paramedics experience when reporting such incidents, facilitating timely support
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