Emergency Services Organization Research Articles

Experiences of Police and Emergency Services Employees with Workers' Compensation Claims for Mental Health Issues.

Purpose To assess employees' experiences of the workers' compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers' compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers' compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6-9.8) while 70.3% had a poor experience (95% CI 67.6-73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers' compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees.

This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.

Gaps in the Organization of Emergency Room Care and Services for Women Experiencing Miscarriage: A Multiple Case Study of Four ERs in Quebec

Introduction: Miscarriage is common, occurring in nearly 20% of pregnancies. Most women experiencing symptoms such as bleeding or abdominal pain in early pregnancy consult emergency services, the front line of care. While research has shown the psychological and physical effects of miscarriage on women, less is known about how emergency services are organized to manage their care. Objective: To describe and analyze the organization of emergency services for women experiencing miscarriage. Methods: A multiple case study was conducted in four emergency rooms in Quebec, Canada, between 2014 and 2015. A reference framework setting out an organized system of action in care adapted to emergency services was used to analyze 198 medical records of women who experienced miscarriage and were treated in these emergency rooms. Results: From the analysis, observations were made regarding the accessibility, responsiveness, and productivity of emergency services, as well as deficiencies in care continuity. While medical treatments generally corresponded to standards, system responsiveness was poor, with long waits that may have added to women’s psychological distress. Gaps were observed in care continuity, effectiveness, and quality, including missing notes in charts, high readmission rates, and lack of referrals to relevant psychosocial and other support services. Discussion and conclusion: Recommendations include developing clinical guidelines, care trajectories, and checklists for nurses’ clinical assessments. As well, early pregnancy assessment clinics are an innovative care delivery model that has proven effective in reducing admissions, shortening hospitalizations, and providing comprehensive support services.

"Why do you stay?": The lived-experience of partners of Australian veterans and first responders with Posttraumatic Stress Disorder.

This study examined the multidimensional nature of experiences of being an intimate partner of an Australian veteran or emergency service first responder (ESFR) with posttraumatic stress disorder (PTSD). Using a qualitative phenomenological approach, inductive thematic analysis was undertaken on data collected in 2017-2018 through individual interviews with a purposive sample of 22 partners of veterans, paramedics, fire and police officers living in Australia. Analysis revealed that the key concern of the participants was to protect their family unit and the intimate relationship, highlighting the ways in which they adapted, managed and coped with the changes that PTSD brought to the relationship. However, lack of understanding by healthcare providers, government, military and emergency service organizations of their daily lives, and of the strength of commitment to their relationship, resulted in a sense of invisibility and was revealed as the key barrier to the support they crave. The findings underscore the importance of recognizing the significance of the intimate relationship in trauma recovery and of responding to the support needs of the intimate partner.

A prospective study of pre-employment psychological testing amongst police recruits.

Pre-employment psychological screening to detect psychological vulnerability is common amongst emergency service organizations worldwide, yet the evidence for its ability to predict poor mental health outcomes is limited with published studies looking at post-recruitment research data rather than data collected by the organizations themselves. The present study sought to investigate the ability of pre-employment screening to predict later psychological injury-related absenteeism amongst police officers. A nested case-control study using prospective data was conducted. One hundred and fifty police officers with a liability-accepted psychological injury were matched to a control group of 150 psychologically healthy officers. Conditional logistic regression was used to examine associations between Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales measuring factors research has shown to predict psychological injury (Neuroticism, Psychoticism, Introversion, Disconstraint and Aggressiveness) and psychopathology (Depression, Anxiety and post-traumatic stress disorder [PTSD]) with subsequent psychological injury. Contrary to expectations, we were unable to demonstrate any association between validated pre-employment measures of personality and psychopathology with mental health outcomes amongst newly recruited police officers over a 7-year follow-up. Other measures may be better able to predict future mental health problems in police recruits.

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials.

A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies. Retrospective, cohort, observational, single-center study that reviewed all consecutive files of patients presenting with acute neurological symptoms who underwent CT scan or MRI from July 1, 2016 to July 1, 2017. 736 patient files were reviewed. 385 patients (52.3%) presented with confirmed acute ischemic infarct, 93 (12.6%) had another brain lesion mimicking acute ischemia, and 258 (35.1%) had normal imaging. Acute stroke was more frequent in elderly patients with atrial fibrillation, arterial hypertension, or dysarthria or right motor impairment. Stroke mimic was associated with female patients with low vascular risk factors, low NIHSS, and patients with decreased level of consciousness or symptoms suggestive of posterior circulation. 47.7% of all patients seen at the stroke unit did not have acute stroke lesions. Clinical assessment data have been used to provide indicators of acute stroke and stroke mimic patients, and symptoms corresponding to acute stroke and stroke mimic seem to be similar in the literature. Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI.

Impact of Workplace Bullying Amongst First Responders- Systematic Review

The phenomenon of workplace bullying is pervasive and exposure to bullying leads to long-term, systemic and individual negative impacts to targets of bullying and the organizations in which they work. Multiple studies confirm that workplace bullying is associated with psychological trauma and serious negative long-term outcomes for targets including mental health disorders and in extreme cases suicide. Emergency service organizations by design are hierarchical in nature, creating power structures that can lead to increased potential for bullying. The literature shows that first responders who work in emergency service organizations report rates of workplace bullying at upwards of 60% (six times the National average). The prevalence of workplace bullying amongst first responders, given their already high stress jobs, along with the long term negative impacts to a targets health, mental health and wellbeing are significant and constitute a serious crisis within the emergency services community.

A public health approach to reducing violence: Can data linkage help to reduce demand on blue light services?

Scotland has witnessed a remarkable reduction in violent crime in recent years. In part, the success of this reduction has been attributed to a ‘public health’ approach, which includes improvements in partnership working across multiple agencies – especially law enforcement and public health. Nevertheless, the emergency services continue to deal with a high volume of violent incidents, an increasing number of which involve some aspect of underlying vulnerability. Policy makers are keen to understand more about how aspects of vulnerability impact on violent crime, especially as this is a primary driver for policies like the public health approach to reducing violence.
 In a project that brings together stakeholders from the Scottish Government, Police Scotland and the Scottish Ambulance Service, the Scottish Centre for Administrative Data Research aims to examine patterns of ambulance callouts and/or hospital admissions involving people who experience violence. The study, which will link together a range of health datasets, will bring together data about violence-related incidents with wider information about an individual’s history of drug misuse, alcohol-related conditions and mental health problems. The study will also examine the extent to which violence and vulnerability contribute to increasing risk of premature death.
 This paper will focus on the development of the research proposal and the opportunities and challenges of trying to bring together data from different emergency service organisations. If possible, it will present preliminary findings from the research. It is anticipated that this study will support the development of further violence prevention policies in Scotland, especially in terms of helping to identify opportunities for better partnership working and points of intervention that could reduce demand on blue light services to deal with violent incidents.

Mind The Gap: Towards and Beyond Impact Messaging to Enhance Tropical Cyclone Risk Communication

ABSTRACT Traditionally, meteorological agencies collect, analyse, and share technical information about natural hazards with emergency services organisations and community members; often sending different warning products to each of these groups. For the general public, effective risk communication requires that technical information be translated to first gain attention and build understanding of risk, and then continue to be exchanged by all parties. The World Meteorological Organization and its partner agencies have recognised this need for translated information by moving away from warnings describing risks solely in terms of meteorological parameters and towards clearer messaging emphasizing significance and potential impacts. While the move towards more relatable weather warning messaging is a positive one, risk communication is a complex, dynamic and interactive process that is highly dependent on audience psychology, knowledge, skills, and capabilities; presenting at once difficulties and opportunities for agencies. Over recent years, advertisers, politicians and public safety advocates have all improved their messaging through the use of big data, psychology, social networking and behavioural economics principles, yet the links between these elements and weather risk communication are still relatively immature. This report aims to build links between weather forecasters, social scientists and related industries by outlining three conceptual models social scientists have developed to meet different challenges in the field of risk communication; the mental models approach, risk information seeking and processing, and the protective action decision making model. Recent issues and successes in the communication of tropical cyclone risk will then be examined and compared to these models, and future opportunities will be discussed.

Making the transition from law enforcement to emergency management: Organizational, occupational, and cultural issues.

While the number of higher education programs in Emergency Management has increased significantly, many emergency management agencies continue to rely on emergency services organizations-including law enforcement agencies-as sources of experienced or trained emergency management practitioners. As the field of emergency management matures, however, becoming more complex, more technical, and significantly broader, law enforcement experience may no longer prepare an individual to succeed as a professional emergency manager. To ensure a successful transition, government officials seeking to fill emergency management leadership positions and law enforcement officers seeking to transition to emergency management must recognize the significant occupational, organizational, and cultural differences between law enforcement and emergency management, and they should develop strategies for mitigating those differences.

The role of psychological screening for emergency service responders

PurposeThe purpose of this paper is to examine the role that psychological screening and surveillance can take in improving the delivery of psychological support to emergency service responders (ESRs) at a time of increasing demands and complexity.Design/methodology/approachThe study aims to present and discuss the use of psychological screening and surveillance of trauma exposed emergency service workers.FindingsThe evidence supports the use of psychological screening and surveillance using appropriate validated questionnaires and surveys.Research limitations/implicationsThe findings suggest that emergency services should be using psychological screening and surveillance of ESRs in roles where there is high exposure to traumatic stress.Originality/valueThese findings will help emergency service organisations to recognise how psychological screening and surveillance can be used as part of a wider programme of well-being support. This approach can also help them meet their legal health and safety obligations to protect the psychological health and well-being of their ESRs.

Paramedics' Perspectives on Factors Impacting On-Scene Times for Trauma Calls.

This project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data. Thirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics' ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment. These findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard. LevitanM, LawMP, FerronR, Lutz-GraulK. Paramedics' perspectives on factors impacting on-scene times for trauma calls. Prehosp Disaster Med. 2018;33(3):250-255.

Enhancing Learning in Emergency Services Organisational Work

The paper aims to assist emergency services organisations to learn how to learn so that managers better understand how to embed effective learning practices and systems into their organisation’s culture. Learning in emergency services organisations occurs in a range of contexts. These include after-action reviews, externally led inquiries, and practice-led research projects. The paper outlines key themes from the work-related learning literature and introduces a modified experiential learning framework to ground real-world experiences. Interviews were conducted with 18 emergency services practitioners. The findings provide examples of the broad challenges that agencies need to manage to enhance and sustain learning. These include shifting value from action post an event, to reflection, focusing on the bigger picture and allowing enough time to effectively embed new practices after an emergency. No organisation can forgo learning. All experiences provide opportunities for learning to occur. A key insight for agencies interested in facilitating improvements in learning is to locate potential weak links in the learning cycle and to develop a better understanding of how to learn.

Protocol for evaluation of the continuum of primary care in the case of a miscarriage in the emergency room: a mixed-method study

BackgroundIn Quebec (Canada), nearly 20,000 pregnancies end in miscarriage, and the majority of the miscarriages are dealt with in an emergency unit. Although there are studies documenting the effects of this type of grief on mental health, men’s experiences are much less discussed than those of women. Similarly, no study has evaluated best practices in terms of service continuity, from emergency care to community resources. The aim of this study is to better understand the relationships that exist between the organization of emergency room and primary care health services for women presenting with miscarriage, on the one hand, and the positions and experiences of women and men within these services, on the other.MethodsThe general objective of this mixed-method study can be broken down into three methodological sections. Focus 1. Institutional discourses and practices. This section is structured as a multiple case study of the mandates of five participant institutions. The study will involve (a) a documentary analysis; (b) a quantitative survey (N: 200) and (c) group interviews (N: 75) with caregivers and emergency unit managers. Focus 2. Women’s and men’s experiences of miscarriages and the institutional response. This section includes (a) a survey (N: 232) and (b) individual interviews (N: 80) designed to identify best practices in emergency involving women and their partners in each area. Focus 3. This section will integrate the information furnished by the first two sections in order to create an ethnographic overview of the situation.DiscussionThis innovative project will provide answers to critical questions on how to improve the effectiveness and quality of interdisciplinary and multisectoral interventions to promote the mental health and psychosocial well-being of couples having experienced a miscarriage. It will have a material effect on the organization of emergency services and of the primary care pathway for women experiencing a miscarriage and for their partners.Trial registrationNot applicable. This study involves a retrospective view of usual health care interventions. This study is not a clinical trial that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.

Workplace belongingness, distress, and resilience in emergency service workers.

Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently, the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel while controlling for more routinely examined factors. Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10, Brief Resilience Scale, and Psychological Sense of Organizational Membership scale. Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organizations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events. (PsycINFO Database Record

Boundaries as mechanisms for learning in emergency exercises with students from emergency service organisations

To prepare emergency response organisations for collaborative work in unpredictable and dynamic situations, various types of exercises are widely used. Still, our knowledge of collaboration exercises with emergency response students is limited. This study aimed to contribute to this field by exploring boundaries that emerged between collaborating organisations in exercise activities and how these boundaries could be understood for learning. Drawing on the Akkerman and Bakker framework of boundaries as learning mechanisms, this study explored an exercise, including full-scale scenarios and seminars with students from the police, ambulance and rescue services education in Sweden. Thematic analysis of interviews and observations illustrated boundaries that emerged regarding vocabulary, prioritisation, roles, knowledge gaps and overlapping responsibilities across organisations. Rather than dissolving boundaries, this article suggests that boundaries can be utilised in exercises to support the students to contextualise their knowledge in relation to the demands of collaborative work. The concepts boundary work and boundary awareness were suggested to capture more generally the dynamics of learning in exercise contexts.

Making collaboration work – developing boundary work and boundary awareness in emergency exercises

PurposeThis study aims to investigate how boundary work is carried out at the incident site during exercises with police, ambulance and rescue services, and how boundary awareness is developed based on this boundary work. Collaboration in emergency work is challenging on many levels. The unforeseen and temporary nature of incidents presents basic challenges. Another important challenge is boundaries between specialised and autonomous emergency service organisations. Knowledge on how exercises are performed to increase the individuals' and organisations' preparedness for future joint-response work is relatively limited.Design/methodology/approachEmpirically, full-scale exercises involving police, ambulance and rescue services and with repetition of practical scenarios and joint-reflection seminars are studied. Interview data with 26 exercise participants were analysed using thematic analysis. The analytic focus is on how boundaries are identified, negotiated and managed in the participants’ work.FindingsMuch of the work in the exercises was performed within distinct areas of expertise, in accordance with concrete routines, skills and responsibilities. Boundary work was often organised in the form of distribution of labour or creating chains of actions. The exercises shed light on challenges related to other aspects of emergency response, such as a lack of resources, diverging primary responsibilities, time-criticality and hazardous environments. The design allowed participants to explicate boundaries, to test and discuss alternative solutions and to visualise the effects of different solutions, as the scenarios were repeated.Originality/valueThe study found that the boundaries that were identified were often of institutional character, and were also related to the specific scenarios and to the actions taken in the activities. By integrating real-life experiences of collaborative work in the exercise, the exercise gained a certain meaning that was essential for the participants to develop boundary awareness.

Resilience: The New Paradigm in Disaster Management—An Australian Perspective

During past decades, frameworks relating to emergency and disaster management have been based on a risk management approach to prevention/mitigation and preparedness coupled with a strong emphasis on response by police and emergency service organisations. Numerous reviews and inquiries of significant events however have identified significant issues relating to the preparation for such events and the management thereof; in particular, critical shortcomings in the capability of emergency response agencies, their leaders and senior decision-makers. In 2008, the Australian Government, through The First National Security Statement to the Australian Parliament by Prime Minister Rudd, has incorporated non-traditional threats and hazards, such as those posed by the impact of climate change, on the national security agenda. In doing so, the Government has announced a paradigm shift in policy for the nation’s approach to emergency and disaster management, namely a move from “response” to “resilience”. In support of this policy shift, the Australian Government, through the Council of Australian Governments, has endorsed the National Strategy for Disaster Resilience and the Critical Infrastructure Resilience Strategy. These documents make resilience the responsibility of all levels of government, private industry, emergency response agencies, and the community. A review of the reports published following Australian reviews and inquiries into significant events has identified that existing frameworks do not provide the necessary mechanisms for baselining and assessing community resilience, that is, their ability to respond to and recover from significant events. Internationally, indices have been developed for assessing community resilience, however, inherent limitations have also been identified in their scope and application. This paper will review Australian and international events which have led to inquiries that have resulted in criticisms of the emergency and disaster response, as well as introducing the organisational capability and resilience of organisations particularly in the context of climate change.

An Interpretative Phenomenological Analysis of Stress and Well-Being in Emergency Medical Dispatchers

This study explored stress and well-being among emergency medical dispatchers (EMDs) who remotely provide crisis intervention to medical emergencies through telehealth support. Semistructured interviews with 16 EMDs were conducted, and interpretative phenomenological analysis was used to identify themes in the data. Results indicated that despite their physical distance from the crisis scene, EMDs can experience vicarious trauma through acute and cumulative exposure to traumatic incidents and their perceived lack of control, which can expound feelings of helplessness. Three superordinate themes of operational stress and trauma, organizational stress, and posttraumatic growth were identified. Practical implications are suggested to enable emergency services organizations to counteract this job-related stress and promote more positive mental health outcomes.

Organisational features and their effect on the perceived performance of emergency management organisations

Purpose– This study reports on a survey of experienced emergency management personnel in Australia and New Zealand to identify the influence of organisational features in perceived emergency management performance. The purpose of this paper is to analyse the influence of organisational features in emergency response performance and to discuss how this knowledge can be used to enhance the response capacity of emergency services organisations.Design/methodology/approach– Based on a review of the literature, a conceptual theoretical model for organisational performance is first developed based on four organisational features found to be previously important in emergency management organisation. These are, adaptability, leadership, stability (mission and direction) and stakeholder communication. An organisational survey was distributed to all 25 fire and emergency services agencies in Australia and New Zealand which included indicators of these elements. Responses were received from experienced emergency management personnel from fire and emergency services agencies. The sample was stratified into the three main organisational types, namely, established, expanding and extending organisations.Findings– The findings reveal that the predictive significance of organisational features in emergency response performance vary among established, expanding and extending organisations. The predictive significance of stability, adaptability and leadership for perceived success is strong in all organisational types. It is interesting to note that the predictive significance of communication with external stakeholders is low in all organisation types. This indicates the preference of emergency services agencies to look internally within their own operations than externally to build relationships with different specialism.Originality/value– The theoretical model in this study makes a first attempt to understand the role of organisational features in emergency response performance of organisations in Australia and New Zealand. This work contributes to theorizing emergency operations by highlighting how organisations need to manage two orientations simultaneously: their own internal as well as external orientations, together with their processes for managing both mission and direction and the need for change and flexibility.