Emergency Service Workers Research Articles

Delayed injuries in the emergency department in hospitalised trauma patients

Introduction Busy emergency departments are associated with medical errors in care and evaluation for unstable trauma patients. Our study aimed to determine the extent, causes and adverse clinical consequences of missed injuries and delayed diagnoses in patients hospitalised with trauma in a Turkish Level 3 emergency department, and provide recommendations for emergency service workers and supervisors to help them reduce the number of injury diagnoses that are delayed. Methods In our prospective study, a total of 515 emergency department patients presenting with trauma between 1 July 2014 and 1 July 2015 were examined by an emergency physician and by a consultant, if necessary. Identified injuries were recorded using case forms, and hospitalised patients were discharged when their treatment was completed. After the patients were discharged their files were reviewed again and new injuries, different from those recorded in the case forms, were investigated. Results Of the 515 patients included, it was shown that an injury diagnosis had been delayed in 21 (3.9%). Of these injuries, 65% were related to the musculoskeletal system. Insufficient clinical evaluation of 95% of the patients who had a missed injury was identified, and, in 70% of missed injuries, the radiology reports had been delayed or incorrectly completed. Conclusion We believe that the delayed injury rate can be reduced in trauma patients with the use of fast and reliable radiological support and the intervention of a multidisciplinary trauma team.

Burnout in the emergency service of a hospital

In order to describe the prevalence of the burnout syndrome in the health personnel working in the emergency area of a public hospital in Cusco, a descriptive cross-sectional analytical study was carried out in 110 workers, among which doctors, nurses, obstetricians and technical personnel were included. We found that 10% of the population suffered from the burnout syndrome. Sixteen point three percent (16.3 %) of the group of physicians, and 8.6 % of the nurses and obstetricians presented signs and symptoms of burnout, and no burnout was found in nurse technicians. Male personnel with temporary contracts who had a service time between 1 to 10 years suffered more frequently from this syndrome. Among the study population, 34.5 % presented a slight-level burnout syndrome, 18.2 % presented a moderate-level burnout syndrome, 15.5 % had high levels of emotional exhaustion, 33.6 % experienced high levels of depersonalization, and finally 51.8 % presented a low personal fulfillment. It is concluded that one out of every ten (10) emergency service workers suffered from the burnout syndrome at the time of the survey, which was greater in doctors and workers with temporary contracts. This situation, which must be corrected, can influence the quality of care in these services.

REGULATORY AND SCIENTIFIC SUPPLY OF FUNCTIONING OF THE STRIP OF PSYCHOLOGICAL PREPARATION OF FIRE-RESCUERS AND RESCUERS

Based on the analysis of the regulatory support of the operation of the strip of psychological preparation in the territorial divisions of the State Emergency Service of Ukraine, the place of the strip in the training of fire-rescuers and rescuers was established and a change in its name was proposed. The experience of using by the territorial divisions of the State Emergency Service of Ukraine, educational institutions of civil protection, the Ukrainian Civil Protection Research Institute the strip of psychological preparation in the system of service training of fire-rescuers and rescuers is given, the composition parts of the strips of psychological preparation available in the divisions are analyzed. The absence of a unified approach to the structure of a typical strip of psychological preparation and the expediency of developing technical and regulatory documentation of the strip of preparation (modules). Taking into account the proposals of the territorial divisions of the State Emergency Service of Ukraine, educational institutions of civil protection, the Ukrainian Civil Protection Research Institute on the using the strip of psychological preparation in the system of official training of fire-rescuers and rescuers, programmed the main components of the modules (simulators). The statistical data on fires during 2013-2017 are analyzed, the conditions were determined in which fire extinguishing was carried out by the State Emergency Service workers in living rooms, in production facilities, in trade and storage facilities. Conditions, which complicated the fire extinguishing, the general characteristics of the objects of fires and obstacles, which fire-rescuers were overcoming during performing the tasks for the intended purpose were given. To determine the main obstacles through which rescuers moved, and the conditions in which the rescuers worked during carrying out tasks for their purpose, the analysis of statistical data on the quantitative indicators of classified emergency situations, the characteristics of emergency situations and examples of participation of the personnel of the Operational-Rescuer Services of Civil Protection in the liquidation of emergency situations was conducted. The main obstacles that must be overcome and the conditions necessary to create on the strip of preparation for fire-rescuers and rescuers during working out skills of work in difficult and extreme conditions. Taking into account the foreign experience of fire divisions, it was proposed to form a strip from separate functional modules.

АСПЕКТИ МЕДИЦИНСКОГ ПРАВА У РЕГУЛАМА ТРАНСПОРТНЕ МЕДИЦИНЕ

The subject of this paper is to make closer clarification of the role and the specificities of services in transporting medicine by caring of vulnerable populations, or individuals who are in an emergency condition or critical situations. The field of medical transport presents a few legal questions and challenges. The aim is to research the rate of legal regulation and whether the legal and other regulation should be revised for reasons of achieving better health care of endangered. Issues of performing different types of transport of patients are observed in cases where the transport emergency and when it is not an emergency but is done on the orders of a doctor, be it on intrahospital moving the patient, moving within health facilities, or at home treatment. Each hospital should have a formalized plan for intra- and interhospital transport that addresses: a) pretransport coordination and communication; b) transport personnel; c) transport equipment; d) monitoring during transport; and e) documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined regularly using a standard quality improvement process. Each transport of critically ill patients carries inherent risks. So equally important is a commitment to providing high-quality, compassionate clinical care in a team-based environment with excellent documentation and communication. The results of the legal analysis and the illustrated example from the foreign jurisprudence are that when it comes to transport some of the patients' rights can be suspended under the condition of keeping a medical record properly. The urgency of transport is the reverse of the merits of enjoyment of the corresponding rights. The conclusion is that the regulations Serbia in the field of healthcare under-cover transportation problems of patients. Some amendments to the regulations and draft decisions regarding the current work of emergency services are of more recent date and insufficiently implemented. There is no doubt that groups or individuals in transport deserve a better quality of transport services, as well as the effective protection of the complaints against the department. Developed countries, experiencing and legislation in this regard can be a good model for the Law of Serbia. This is very important because today some aspects of transport, the case of the so-called. air ambulances in the health care, have given international situation.

The role of disclosure attitudes in the relationship between posttraumatic stress disorder symptom severity and perceived social support among emergency service workers

The social-interpersonal framework model of posttraumatic stress disorder (PTSD; Maercker and Horn, 2012) highlights the relevance of interpersonal factors in the development and maintenance of PTSD symptoms. Therefore, the present study examined the role of self-perceived disclosure abilities to elucidate the well-known link between PTSD symptom severity and social support. In a cross-sectional design, 131 emergency service workers completed the Impact of Event Scale (IES-R), the Disclosure of Trauma Questionnaire (DTQ) and the Social Acknowledgement Questionnaire (SAQ) as well as answering trauma-specific questions to provide in-depth information regarding their experiences in potentially traumatic incidents and subsequent social interactions. We reveal the predescribed association between PTSD symptom severity and social support. However, bootstrap mediation analyses reveal the self-referential perceptions of disclosure abilities, particularly a reluctance to talk, to fully account for the link between PTSD symptom severity and social acknowledgement. Our findings strongly support the relevance of the self-perceived disclosure abilities in the processing of traumatic events. A reluctance to speak is associated with more severe PTSD symptoms and with lower levels of social support; therefore, facilitating and encouraging disclosure in individuals who feel unable to disclose traumatic contents may be clinically relevant in preventing feelings of social disapproval and isolation.

Assessment of confined space entry and rescue training for aircraft rescue and fire fighting (ARFF) members in the United States

IntroductionFire and emergency service workers, including Aircraft Rescue and Fire Fighting members, may be called on to perform confined space entry and rescue operations. The purpose of the present study was to develop a comprehensive and valid understanding of the present state of confined space entry and rescue training effectiveness and resultant compliance or use of best practices among trained Aircraft Rescue and Fire Fighting personnel. MethodThe study used a convergent, parallel mixed-methods approach. Qualitative data (n = 20) were collected via semi-structured interviews at four locations. Data were coded, analyzed and super-ordinate and sub-ordinate themes were derived. Quantitative data (n = 158) from Aircraft Rescue and Fire Fighting members were analyzed. ResultsInterviewees believed there is a lack of standardization in training, but believed training should not be completed in the same format every time. Several participants (50%) desired more realistic training. Other concerns were associated with staffing, personal readiness, and resource adequacy. With regard to survey outcomes, most respondents reported that their organizations completed confined space training (69.8%), but only 55.3% indicated this training was conducted as a full-scale exercise and nearly 40% indicated that rescue practice was not performed despite standards mandating annual rescue practice. Following training, 55.4% indicated training evaluation information was not presented. ConclusionsParticipants mostly agreed their training effectively addressed OSHA requirements, such as how to test the atmosphere, the need for and use of personal protective equipment, how to identify pertinent permit information and methods to retrieve victims in limited space. Some gaps exist between current training practices and established training requirements and standards. Practical applicationsAircraft Rescue and Fire Fighting organizations need to bolster aspects of their training, particularly with regard to standardizing training efforts, practicing rescues, providing evaluation feedback and written materials and providing adequate resources.

OccupationalIdentity Under Tension: Occupational Identity in the Global South

With the increase use of critical approaches in management, research has started to challenge the “Western-centric” character of our field of inquiry. At the same time, calls have been made to academics to produce research about management and organization peculiarities in the Global South. Occupations are important lenses to understand people at work. Occupational identity research has mainly being produced by Northern academics analyzing organizations in the North. Moreover, despite the significant importance of emergency service workers in a time of global security and environmental challenges, few researches in our field has addressed the peculiarities of emergency service workers occupations. This paper aims to understand what do characterize emergency service workers occupational identity in the Global South? The paper contributes by discussing the issue of occupational identity in the Global South and characterizing how such occupational identity is marked by tensions and ambiguities associated with peculiar conditions of work occupations face in the Global South. We stress the need to understand under which organizational and social conditions emergency occupational work is performed as a relevant element to make sense of occupational identity. As a result, we provincialize the finds about occupational identity in the North and calls for more research about occupations in the Global South to be produced.

The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service

Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.

Stress coping styles in firemen exposed to severe stress.

Emergency service workers such as firemen are exposed to severe stress, which may result in deteriorated functioning and development of posttraumatic stress disorder (PTSD). The aim of the presented study was to assess the stress coping styles of firemen exposed to severe stress, the prevalence of PTSD symptoms, and the correlation between them. The study was carried out in a group of 147 Polish firemen. Two questionnaires were used: the Coping Inventory for Stressful Situations (CISS) and the PTSD Interview (PTSD-I) in the Polish language version (K-PTSD). The study was carried out in a group of 147 Polish firemen. Two questionnaires were used: the Coping Inventory for Stressful Situations (CISS) and the PTSD Interview (PTSD-I) in the Polish language version (K-PTSD). Nearly one third of the investigated group of firemen suffered from symptoms of PTSD, with the stress coping strategy most often observed in that subgroup being style focused on avoidance. Age proved to be a factor associated with the readiness to undertake behavioral measures to cope with stress tension; such behavior tends to be undertaken by older firemen.

Change of Hand Floor During the Shift in Emergency Servise Staff

Objective: This study aims to reveal if there will be any change in hand flora and pathogen microorganism before and after shift of emergency service staff in order to determine the infection risc to the patients who admit to our emergency department. Materials and methods: Our study was planned to evaluate the change of the hand floor and pre-shift and post-shift hand cultures from 10 physicians, 13 nurses, 10 transport personnel in the emergency department of Cumhuriyet University. Also the micro-organisms of air samples from special intervention areas (resuscitation, red area) as well as general use areas were analyzed. Results: We compared the washing status between pre (4,%11.1) post-contact16 (44.4%) hand washing rate was significantly higher (p <0.05). there wasn’t any difference between the microorganisms samples that were reproduced on the pre-shift right and left hand samples and post-shift right and left hand. According to the total count of samples taken from the left and right hand before shift in terms of the microorganism seen the difference was significiant (t=7,48; p=0,001). Conclusions: Although our participants knew the hand hygiene indications of emergency service workers, their harmony was found to be low, consistent with many studies in the literature. It has been observed that the habit of using gloves and hand disinfectant was low also. Efficient strategies may be developed; improving institutional healthcare conditions, conducting educations at certain intervals, observing the practitioner and collecting feedback. However, it should be noted that the most significant issue is that the significance in hand washing is ensured with changes in habits. Key Words: Hand Hygiene, hospital-acquired infection control, hand washing, health workers, methicillin-resistant staphylococcus aureus.

Effectiveness of mitigation interventions on occupational violence against emergency service workers: a mixed methods systematic review protocol.

The objective of this review is to develop an aggregated synthesis of qualitative and quantitative data on occupational violence (OV) mitigation interventions for Emergency Service Workers (ESW), to cultivate useful conclusions and recommendations for paramedic occupational safety and policy development. Emergency Service Worker is a broad term encompassing all elements of community-based emergency support and includes paramedics, firefighters, and police.The objective of the quantitative component of this review is to quantify the effectiveness of OV mitigation interventions for ESW.The objective of the qualitative component of this review is to explore the perceptions and experiences of ESW on the effectiveness of OV mitigation interventions.This review seeks to address the following questions.

Sexism, attitudes, and behaviors towards violence against women in medical emergency services workers in Erzurum, Turkey

ABSTRACTBackground: In Turkey, almost every 4 out of 10 married women have been subjected to physical abuse by their spouses. Although studies on the prevalence of domestic violence in Turkey abound, little has been published about first responders’ attitudes and behaviors towards violence against women and on sexism.Objective: Our study examined the attitudes and behaviors of Erzurum City medical emergency services workers towards violence against women, and their relationship with sexist attitudes.Methods: A cross-sectional survey was conducted among 370 medical emergency service personnel using a self-administered questionnaire of 35 items, which included two scales utilizing a three-point Likert format; 15 questions measured attitudes and behaviors towards violence against women (VAW) and 12 items measured sexist attitudes.Results: The mean age of participants was 29.6 ± 8.0 years with a sex distribution of (47.6%) women and 194 (52.4%) men. Less than half of the participants (48.5%; n = 173) felt competent in recognizing and managing VAW; moreover, when faced with such cases, 18.5% (n = 67) said they would try to reconcile the victim with the perpetrator. Male participants had higher mean scores both on VAW (20.7 ± 5.2 vs. 16.9 ± 2.8; t = 7.927; p < 0.001) and on sexist attitudes (24.3 ± 5.3 vs. 18.6 ± 4.3; t = 1.714; p < 0.001). Age (B = 0.067; 95% CI: 0.014–0.119; p = 0.013) and sexism scores (B = 0.487; 95% CI: 0.407–0.566; p < 0.001) were revealed as independent significant predictors of the VAW attitude scores.Conclusions: Educational and public health measures must be instituted to change attitudes and behaviors towards violence against women; measures must focus not only on violence but also on sexism. Health care professionals need to reflect on their own gender biases in clinical practice and prevent gender discrimination.

Sleep quantity and quality of on‐call from home fire and emergency service workers

Sleep quantity and quality of on‐call from home fire and emergency service workers

Salivary alpha amylase in on-call from home fire and emergency service personnel.

The effect of working on-call from home on the sympatho-adrenal medullary system activity is currently unknown. This study had two aims, Aim 1: examine salivary alpha amylase awakening response (AAR) and diurnal salivary alpha amylase (sAA) profile in fire and emergency service workers who operate on-call from home following a night on-call with a call (NIGHT-CALL), a night on-call without a call (NO-CALL) and an off-call night (OFF-CALL), and Aim 2: explore whether there was an anticipatory effect of working on-call from home (ON) compared to when there was an off-call (OFF) on the diurnal sAA profile. Participants wore activity monitors, completed sleep and work diaries and collected seven saliva samples a day for one week. AAR area under the curve with respect to ground (AUCG), AAR area under the curve with respect to increase (AUCI), AAR reactivity, diurnal sAA slope, diurnal sAA AUCG and mean 12-h sAA concentrations were calculated. Separate generalised estimating equation models were constructed for each variable of interest for each aim. For Aim 1, there were no differences between NIGHT-CALL or NO-CALL and OFF-CALL for any response variable. For Aim 2, there was no difference between any response variable of interest when ON the following night compared to when OFF the following night (n = 14). These findings suggest that there is no effect of working on-call from home on sAA, but should be interpreted with caution, as overnight data were not collected. Future research, using overnight heart rate monitoring, could help confirm these findings.

Suicide among emergency and protective service workers: A retrospective mortality study in Australia, 2001 to 2012.

Emergency and protective services personnel (e.g., police, ambulance, fire-fighters, defence, prison and security officers) report elevated levels of job stress and health problems. While population-level research is lacking, there has been some research suggesting suicide rates may be elevated in emergency and protective services. This paper compares suicide rates between emergency and protective services occupational groups over a 12-year period (2001-2012) in Australia. Labour force data was obtained from the 2006 Australian Census. Suicide data was obtained from the National Coroners Information System (NCIS). Negative binomial regression was used to estimate the association between suicide and employment as an emergency or protective service worker (including prison and security officers) over the period 2001-2012, as compared to all other occupations. Information on suicide method was extracted from the NCIS. The age-adjusted suicide rate across all emergency and protective service workers was 22.4 (95% CI 19.5 to 25.2) per 100,000 in males and 7.8 in females (95% CI 4.6 to 11.00), compared to 15.5 per 100,000 (95% CI 15.2 to 15.9) for males and 3.4 (95% CI 3.2 to 3.6) for females in other occupations. The highest risk by subgroup was observed among those employed in the defence force, prison officers, and ambulance personnel. The major method of death for all occupational groups was hanging. Our results clearly highlight the need for suicide prevention among emergency and protective service occupations.

Designing smartphone mental health applications for emergency service workers.

Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions; however, little is known about the acceptability and preferences regarding such initiatives. To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. Overall, approximately half the sample (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred.

Ruminacje a potraumatyczny wzrost u ratowników medycznych

Przedstawiciele służb ratowniczych narażeni są na doświadczanie zdarzeń o charakterze traumatycznym w związku z wykonywaną pracą. Celem badań było ustalenie roli ruminacji w występowaniu pozytywnych zmian potraumatycznych. Badaniami objęto 120 ratowników medycznych, spośród których 85 (55 mężczyzn i 30 kobiet) potwierdziło wystąpienie w ostatnich 5 latach przynajmniej jednego zdarzenia traumatycznego w związku z wykonywaną pracą. Wiek badanych mieścił się w granicach 25–61 lat (M = 38,07, SD = 9,61). W badaniach wykorzystano polskie wersje standaryzowanych narzędzi, tj. Inwentarz Potraumatycznego Rozwoju oraz Inwentarz Ruminacji o Negatywnym Zdarzeniu. Badani ratownicy medyczni ujawnili niski poziom potraumatycznego wzrostu oraz niskie nasilenie ruminacji, tak natrętnych, jak i refleksyjnych. Spośród dwóch analizowanych rodzajów ruminacji jedynie refleksyjne okazały się predyktorami potraumatycznego wzrostu i wszystkich jego czynników. Ruminacje refleksyjne pełnią istotną – choć słabą – rolę w występowaniu pozytywnych następstw doświadczonej traumy.

The burden of attempted suicide: The attitude of emergency services workers

IntroductionThe great global burden of suicide requires specific preventive strategies focused on emergency services (ES) workers, providing first aid after attempted suicide.ObjectivesTo investigate the approach of ES workers toward attempted suicides, and to assess work-related stress and teamwork attitude as variables likely to influence suicide risk perception.MethodsA total of 265 ES workers (73 medical doctors, 130 nurses, 62 health and social care workers) from 3 hospitals in the area of Modena (Northern Italy) were involved. In a group setting, titles from local newspapers reporting about suicides were read, and ES workers were asked to fill in 3 psychometric scale questionnaires (SUIATT, MBI and SAQ).ResultsThe questionnaires returned were 88 (33%), 47% (n = 42) were filled by women, median age was 40 years. Doctors group had the highest response rate (60%). Burnout levels were intermediate at the Emotional Exhaustion subscale, severe at the Depersonalization subscale and mild at the Professional Efficacy subscale. Eighteen percent recorded a good team perception, 33% had a good perception of their work conditions. SUIATT subscales showed a restrictive attitude toward suicide, regardless of hospital and task.DiscussionNo associations emerged among SUIATT, MBI and SAQ subscales; male sex alone correlated to the SUIATT factor “rationality/mental alteration”, suggesting more “tolerance” of suicidal behaviour.ConclusionsIt is crucial to raise awareness among ES workers on this issue, since those workers considering suicide as “more acceptable” are more likely to recognise its signs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trauma exposure and post‐traumatic stress disorder within fire and emergency services in Western Australia

ObjectiveWhile it is widely accepted that fire and emergency work is of high risk for potentially traumatic event exposure and post‐trauma pathology, there has been limited published data regarding Australian fire and emergency service workers. The relationship between trauma exposure and mental health outcomes, in particular the significance of social support and coping style was explored.MethodParticipants were 210 Department of Fire and Emergency Services (DFES) career firefighters in Western Australia (WA). This study employed a cross‐sectional, correlational design, with a combination of self‐selection and random sampling.ResultsResults found that DFES career members were exposed to trauma at significantly higher rates than the general population and reported elevated rates of post‐traumatic stress disorder (PTSD) symptomatology. Trauma exposure, social support, and coping style significantly contributed to variation in PTSD symptomatology, with maladaptive coping strategies accounting for more PTSD variance than adaptive coping.ConclusionsElevated rates of PTSD identify WA DFES members as a high risk population. There was evidence that trauma exposure, social support, and coping style significantly contributed to levels of PTSD symptomatology. Maladaptive coping strategies, such as distraction, substance use, venting and self‐blame, accounted for more variance in PTSD symptomatology than adaptive coping strategies, indicating that prevention or treatment interventions may be most effective by targeting reduction of maladaptive coping strategies, with a secondary focus on building adaptive coping strategies.

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