Critical Incident Management Research Articles

Healthcare and social care professionals’ experiences of respite care: a critical incident study

ABSTRACT Introduction Aging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers’ delays in using it. The experiences of informal caregivers are well-studied, but the professionals’ experiences of respite care quality and critical incident management are underexplored. Aim To explore professionals’ experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents. Materials and methods A qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted. Results Barriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals’ positive approach. Conclusions The study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.

Critical Incident Management: Strengthening the Relationship Between Crisis Negotiations and Tactical Teams

Critical Incident Management: Strengthening the Relationship Between Crisis Negotiations and Tactical Teams

State Level Policies on First Responder Mental Health in the U.S.: A Scoping Review.

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

Evaluation of a critical incident management system on mental health in lifeguard organisations: a retrospective study

BackgroundLifeguards may face many life-threatening situations during their careers and may be at increased risk of post-traumatic stress disorder (PTSD). Minimal evidence concerning critical incident management systems in lifeguard organisations...

Can the Ebola experience in West Africa help to combat the COVID-19 pandemic? Testing the critical incident management systems model in the COVID-19 context

PurposeThis study explored whether the critical incident management systems (CIMS) model can predict the EMS performance in the COVID-19 context. Past research has established the significance of early detection and response (ER) in the context of Ebola virus disease (EVD), prompting a question of whether the model can also be helpful in the COVID-19 context. Consequently, the authors assessed whether ER influences the impact of communication capacity (CC), reliable information channel (RC) and environment (EN) on COVID-19 EMS performance. Assessing these relationships will advance emerging infectious disease (EID) preparedness.Design/methodology/approachThe authors employed standardized measurement instruments of the CIMS model (CC, ER, RC and EN) to predict the performance of COVID-19 EMS using structural equation modeling (SEM) in a study of 313 participants from frontline responders.FindingsThe results show that the relationship of ER and EN with COVID-19 EMS performance is positive, while that of EN on CC is negative. The relationship between EN and COVID-19 EMS performance was insignificant. Contrary to the hypothesis, CC was negatively significant to COVID-19 EMS performance due to poor communication capacities.Research limitations/implicationsThe authors acknowledge some limitations due to challenges faced in this study. First, Data collection was a significant limitation as these questionnaires were built and distributed in June 2020, but the response time was prolonged due to the recurring nature of the pandemic. The authors had wanted to implore the inputs of all stakeholders, and efforts were made to reach out to various Ministry of Health, the local CDC and related agencies in the region via repeated emails explaining the purpose of the study to no avail. The study finally used the frontline workers as the respondents. The authors used international students from various countries as the representatives to reach out to their countries' frontline workers. Second, since the study was only partially supported using the CIMS model, future studies may combine the CIMS model with other models or theories. Subsequent research reassesses this outcome in other contexts or regions. Consequently, further research can explore how CC can be improved with COVID-19 and another future EID in the region. This may improve the COVID-19 EMS performance, thereby expanding the lesson learned from the pandemic and sustaining public health EID response. Additionally, other authors may combine the CIMS model with other emergency management models or theories to establish a fully supported theoretical model in the context of COVID-19.Practical implicationsThe findings have practical implications for incident managers, local CDCs, governments, international organizations and scholars. The outcome of the study might inform these stakeholders on future direction and contribution to EID preparedness. This study unfolds the impact of lessons learned in the region demonstrated by moderating early detection and responses with other constructs to achieve COVID-19 EMS performance. The findings reveal that countries that experienced the 2013–2016 Ebola outbreak, were not necessarily more prepared for an epidemic or pandemic, judging by the negative moderating impact of early detection and response. However, these experiences provide a foundation for the fight against COVID-19. There is a need for localized plans tailored to each country's situation, resources, culture and lifestyle. The localized plan will be to mitigate and prevent an unsustainable EID management system, post-epidemic fund withdrawals and governance. This plan might be more adaptable and sustainable for the local health system when international interventions are withdrawn after an epidemic. Public health EID plans must be adapted to each country's unique situation to ensure sustainability and constantly improve EID management of epidemics and pandemics in emergency response. The high to moderate importation risk in African countries shows Africa's largest window of vulnerability to be West Africa (Gilbert et al., 2020). Therefore, they should be in the spotlight for heightened assistance towards the preparedness and response for a future pandemic like COVID-19. The West African region has a low capacity to manage the health emergency to match the population capacities. The COVID-19 outbreak in West Africa undoubtedly inflicted many disruptions in most countries' economic, social and environmental circumstances. The region's unique challenges observed in this study with CC and reliable information channels as being negatively significant highlight the poor maintenance culture and weak institutions due to brain drain and inadequate training and monitoring. This outcome practically informs West African stakeholders and governments on aspects to indulge when trying to improve emergency preparedness as the outcomes from other regions might not be applicable.Originality/valueThis study explored the relevance of the CIMS model in the context of the COVID-19 pandemic, revealing different patterns of influence on COVID-19 EMS performance. In contrast to the extant literature on EVD, the authors found the moderating effects of ER in the COVID-19 context. Thus, the authors contribute to the COVID-19 EMS performance domain by developing a context-driven EMS model. The authors discuss the theoretical and practical implications.

Healthcare professionals’ perceptions of interprofessional teamwork in the emergency department: a critical incident study

BackgroundInterprofessional teams contribute to patient safety during clinical care. However, little is known about how interprofessional teams manage and cope with critical incidents in the emergency department (ED). Therefore, the study aimed to describe healthcare professionals (HCPs) perceptions of critical incidents linked to the enablers of and barriers to interprofessional teamwork in a high-risk setting, the ED.MethodsIndividual interviews with HCPs regarding events at the ED were held during the period of May 2019–January 2020. The Critical Incident Technique approach was used to guide the interviews and the qualitative analysis. Data were analyzed inductively using qualitative content analysis.ResultsInterview participants (n = 28) included 7 physicians (25%), 12 registered nurses (43%), 7 nurse assistants (25%) and 2 administrators (7%). Overall, 108 critical incidents were described. Eight categories that described functional and dysfunctional experiences within interprofessional teamwork were identified: salience of reflection; professional experience makes a difference; demanding physical and psychosocial work environment; balancing communication demands; lacking management support, structure, and planning; tensions between professional role and responsibility; different views on interprofessional teamwork; and confidence in interprofessional team members.ConclusionFindings of this study indicate that poor ED-specific communication and limited professional experience are essential factors in handling critical incidents related to interprofessional teamwork. An important aspect of critical incident management is the ergonomics of the physical work environment and how it enables interprofessional teamwork. This study emphasizes the factors enabling interprofessional teamwork to manage critical incidents in the complex working environment of the ED.

Access, Engagement, and Experiences with Critical Incident Response Resources in Athletic Training

Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to identify the emerging domains and categories. Results: Two emergent domains were identified from the study. External support referenced multiple personnel resources available after a critical incident occurred, specifically, trained mental health professionals, untrained personnel, and trusted colleagues/coworkers. Coping with the emotional response included debriefing, spirituality, and complementary mental health strategies. Conclusion: In preparation for critical incidents, emergency action planning and after-action planning for healthcare delivery and the emotional response are both essential. Many ATs do not have the formal training, but continuing education courses, community-based mental health resources, and the promotion of professional organization resources can assist ATs in critical incident management.

Impact of Railway Critical Incidents on Train Drivers and Effectiveness of Critical Incident Management and Support Protocols: A Recovery Trajectory Analysis.

Train drivers are regularly involved in railway critical incidents (CI) and critical incident management and support protocols (CIMSPs) have been developed to support them. This study describes the impact of CIs and evaluates the effectiveness of CIMSPs. We interviewed 74 train drivers 1 week, 1, 3, and 6 months after a CI. We performed Linear growth model analyses to describe recovery paths and the effect of CIMSPs, considering the effect of CI complexity, proximity to victims, social support, self-assessment of health, use of resources, and attribution of responsibility. CIs have a significant negative impact on train drivers. Recovery paths can be explained by the level of implementation of CIMSPs, and other contributing factors. CIMSPs are effective in reducing the negative impact of CIs and should be implemented rigorously by employers.

Evaluation of the Implementation of a Railway Critical Incident Management and Support Protocol to Help Train Drivers Cope With Accidents and Suicides.

Railway accidents and suicides can have severe psychological consequences for train drivers. This study evaluates the implementation of railway critical incident management and support protocols (CIMSP) by employers. It also identifies environmental factors, characteristics of critical incidents, and types of work relations affecting implementation. A longitudinal study was conducted with 74 train drivers. Participants were interviewed 1 week, 1, 3, and 6 months after a critical incident. Correlational analyses were performed to identify factors associated with implementation and satisfaction. CIMSP are generally partially applied by employers when a railway incident occurs. Workers' satisfaction toward implementation of the protocol is moderate. Obstacles to implementation are: geographic isolation, severity of the incident, and poor quality of work relations. These obstacles should be addressed in CIMSP design and implementation strategies.

Collaborative and efficient privacy-preserving critical incident management system

When a critical incident occurs, timely location-based status messages (known as alerts) conveyed by a witness present at the incident site to the competent authority constitute a key part of an effective approach to handle the situation. Details provided by witnesses are of extreme significance, but their collaboration with the authority may make them susceptible to various threats such as loss of anonymity, false implication, unwarranted surveillance, etc. As a solution, an anonymous reporting mechanism can be provided to encourage the witnesses to report the incident to the concerned authority. However, there is a possibility of system collapse in case the anonymous witnesses inundate the authority with multiple fake reports, resulting in delayed response to the critical incident. In this paper, we present a critical incident reporting system that provides privacy to honest witnesses but can disclose the identity and punish the malicious ones. The proposed system facilitates the indistinguishability of the witness among a group of users such that reports are linked to groups of k (or more) users instead of a single user. We use a game-theoretic approach based on the co-utility principle to encourage the users of the system to engage in mutually beneficial collaboration, which leads to a “rewards and punishment” mechanism to encourage legitimate information and discourage false information. The incident management authority rewards honest witnesses with a blockchain-based cryptocurrency, which can be redeemed anonymously by the awardees from the city council. We have analyzed the security and privacy properties of the system, and carried out real-device testing to evaluate the system performance and its feasibility.

From deployment to debriefing: introducing the D.I.A.M.O.N.D. model of hostage and crisis negotiation

ABSTRACT Hostage and crisis negotiation is one tactical option available to incident commanders when responding to critical incidents. Whilst several models of negotiation exist, there is limited research addressing negotiation from a United Kingdom perspective. This paper presents findings from semi-structured interviews with 15 negotiators from nine police forces in England. Data were analysed using grounded theory and 6 primary, 11 secondary, 19 tertiary, and 23 quaternary categories were identified to depict the procedural, operational and communicational aspects of negotiation. Findings indicate that negotiation takes place sequentially in three stages, with the core aspects being conceptualised using the D.I.A.M.O.N.D. mnemonic: 1) D eployment; 2) I nformation and intelligence gathering; 3) A ssessment of risk and threat; 4) M ethods of communication; 5) O pen dialogue with subject; 6) N egotiator toolbox and repertoire, and 7) D ebriefing procedures. The model represents the first attempt at modelling negotiation from an Anglo-centric perspective and provides insight into the entire critical incident management process, as opposed to focusing solely on the aspect of communication between negotiator and subject that has historically dominated the literature. The model highlights the breadth and complexity of the negotiator role and enables several recommendations to be made in relation to the training and operational support of negotiators.

A Systematic Methodology for Preserving the Whole in Large-Scale Qualitative-Temporal Research

Large-scale qualitative-temporal research faces significant data management and analysis challenges due to the size and the textual and temporal nature of the datasets. We propose a systematic methodology that employs visual exploration to produce a purposive sample of a much larger collection of data, followed by a combination of thematic analysis and visualization. This method allows for the preservation of the whole, producing thematic timelines that can be used to elucidate a narrative of incidents or issues as they unfold. We present a step-by-step guide for this methodology and a comprehensive example from the domain of social media analysis to illustrate how it can be used to reveal interesting temporal patterns among tweets relevant to a noteworthy incident. The approach is useful in sport management, particularly for research related to fan behavior, critical incident management, and media framing.

Critical incidents in mental health units may be better understood and managed with a Freudian/Lacanian psychoanalytic framework

This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.

Ambulante Anästhesie - Risikomanagement in der ambulanten Anästhesie

Outpatient anaesthesia has increased considerably in recent years. More complex procedures are performed on an outpatient basis and patients suffer from more co-morbidities. A patient- and procedure-centred risk management system includes guidelines for patient-selection and -evaluation, selection of adequate anaesthetic drugs, structured post-anaesthesia care and discharge-procedures, and a critical incident management plan. Risk management for ambulatory anaesthesia is supposed to reduce malpractice and prevent complications. Ultimately, procedure related cost will decrease and confidence as well as satisfaction of patients, surgeons and anaesthesia team members will increase.

Occupational stress, paramedic informal coping strategies: a review of the literature

Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.

The Influence of Trust on Senior Investigating Officers’ Decision Making in High-Profile Critical Incidents

This article examines the interpersonal relationships between lead commanders and senior investigating officers in high-profile critical incidents and focuses on the influence trust and mistrust have on investigative decision making of senior officers. Semistructured interviews were conducted with officers who have recent experience within lead command groups as senior officer, lead commander, and head of criminal investigation department or advisor in a number of high-profile critical incidents across the United Kingdom. Thematic analysis identified trust as the key emergent theme. Factors that either facilitate and/or inhibit the development of trust, such as previous experiences, perceptions of skills competence, ability, and theoretical contributions relative to trust building in organizational settings are reflected upon. Broadly speaking, the article indicates that previous knowledge and experience do influence the development of trust in organizational relationships. Trust development within critical incident management roles is thereby crucial to decision making in high-profile critical incidents. Policy implications are noted.

The Design and Realization of the Safety Emergency System for the Longgang High-surfer Gas Field Based on 3DGIS

Based on World Wind Java SDK,the authors have developed the 3DGIS applied in the emergency management of the high-sulfur field.Through temporal-spatial construction analysis and pre-creation clips,difficulties of data-transmission and visualization of numerical simulation model of H2S gas dispersion in 3D environments caused by massive data volume can be solved.Emergency management data and model database are achieved in the visualized 3D environment and the emergency application functions are developed in terms of business process,which include receiving alarm,emergency analysis and emergence disposal on the 3DGIS platform.This research not only attempts to construct the technology of 3DGIS but also offers a tool of 3DGIS to both research and practice for critical incident management in the high-sulfur gas field.

Critical Incident Management and Geographically–Based Systems

In the United States there is a strong dependence on decentralized policing services, distributed by thousands of police departments. As a primary police professional development management institute in the United States, the Law Enforcement Management Institute of Texas (LEMIT) identified that there existed a paucity of management development opportunities for police command staff engaged in critical incident management. This paper describes how LEMIT met this challenge and became a leading U.S. institute in this exciting field of operation.

Responsible management and use of a personal take-home naloxone supply: A pilot project

Aims: To assess if Scottish drug users, their family and friends could be trained in critical incident management and the safe and effective administration of naloxone. The project also sought to monitor whether drug users can manage their own personal take-home naloxone (THN) supply and use it appropriately in an emergency opiate overdose situation.Methods: Twenty-three clients were trained alongside 18 ‘buddies’ and 19 clients were issued with naloxone packs following successful completion of training.Findings: Three overdoses were witnessed by three participant clients during the pilot with two reported ‘saves’; pilot training procedure was followed on both occasions. Each reported overdose was validated by police and ambulance service records. Eighty-nine percent (n = 17) were followed up at 2 months; 94% (n = 16) of these claimed to still have their THN; 89% (n = 17) followed up at 6 months; 100% (n = 17) of these claimed to still have their THN.Results: This data suggests that Scottish drug users can be trained to identify and respond to an opiate overdose utilizing basic life support and naloxone administration skills similar to their counterparts from other parts of the world. Moreover these results suggest that a majority of opiate users can responsibly manage their own personal THN supply when trained appropriately.

Simulated Critical Incident Management for Graduating Medical Students

Abstract This resource is a series of eight simulated critical medical incidents designed for graduating medical students to rehearse their diagnosis and management skills. Each case is presented i...