Development of a critical incident stress inventory for the emergency medical services.

Donnelly, Elizabeth; Bennett, M.A.

doi:10.1177/1534765613496646

Cited by 50 publications

(88 citation statements)

References 34 publications

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“…But cumulative exposure to smaller-scale traumatic incidents outside the realm of extraordinary events may be equally deleterious, and examination of the full continuum of CI exposure in EMS workers is needed. The development of a comprehensive inventory to assess CI exposure in EMS professionals has been led by Donnelly and Bennett, 31 who administered a modified version of the CIHQ in a sample of U.S. paramedics and EMTs. Their findings and suggested modifications served as the basis for the instrument used in our study.…”

Section: Discussionmentioning

confidence: 99%

“…We assessed exposure to CIs during EMS work using a modified version of the Critical Incident History Questionnaire (CIHQ). 30 The CIHQ was initially developed for use with law enforcement officers, but similar to a previously described approach 23 , 31 it was modified in this application by altering or removing items not relevant in EMS work. For example, “ Made a mistake in the line of duty that led to the serious injury or death of a fellow officer ” was replaced with “ Made a mistake that led to the injury/death of a patient.…”

Section: Methodsmentioning

confidence: 99%

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Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

Boland

Kinzy

Myers

et al. 2018

WestJEM

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IntroductionVery little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession.MethodsWe administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service. We defined the presence of burnout as a high score on either the emotional exhaustion or depersonalization subscales of the MBI.ResultsSurvey respondents who provided regular 911 response at the time of the survey and completed the MBI portion of the survey were included in our analysis (190 paramedics/EMTs, 19 dispatchers; 54% response). The overall prevalence of burnout was 18%, with prevalence reaching 32% among dispatchers. The seven pediatric critical incident types presented in the survey accounted for seven of the top eight rated most difficult to cope with, and severity ratings for pediatric critical incidents did not differ by parental status (all p>0.30). A significant number of respondents reported that they had been threatened with a gun/weapon (43%) or assaulted by a patient (68%) at least once while on duty. Being over the age of 50, a parent, or in a committed relationship was associated with reduced odds of burnout in unadjusted models; however, these associations did not remain statistically significant in multivariate analysis. Increasing tertile of career exposure to critical incidents was not associated with burnout.ConclusionMedical dispatchers may be an EMS subgroup particularly susceptible to burnout. These data also demonstrate quantitatively that in this EMS agency, responders find pediatric critical incidents especially distressing and that violence against responders is commonplace. In this study, a simple measure of career exposure to potentially critical incidents was not associated with burnout; however, individual reactions to incidents are heterogeneous, and assessment tools that more accurately enumerate encounters that result in distress are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

Boland

Kinzy

Myers

et al. 2018

WestJEM

View full text Add to dashboard Cite

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“…Critical incident stress was assessed using the EMS Critical Incident Stress Inventory 21 . This inventory assesses 37 patient‐care‐related stresses and is assessed on a 7‐point Likert scale.…”

Section: Methodsmentioning

confidence: 99%

“…(the stress of working in the field of paramedicine regardless of the service) and organizational stress (the stress associated with working in a specific paramedic service) 20 . Critical incident stress refers to the stress associated with patient care 21,22 . These workplace stresses have been empirically linked to post‐traumatic stress and post‐traumatic stress may be linked to safety outcomes, therefore the question becomes, what influence might work‐related stress have on safety?…”

Section: Introductionmentioning

confidence: 99%

What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes

et al. 2020

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Objective The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. Methods A cross‐sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post‐traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non‐responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. Results This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. Conclusion These findings illustrate that a host of different stressors may influence safety‐related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.

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“…Critical incident stress was assessed using the Critical Incident Stress Inventory for EMS, 35 an inventory that examines both the number of exposures to a select number of critical incidents, as well as levels of stress associated with those exposures. If respondents indicated they had been exposed to a critical incident, they were asked to report on a 7-point Likert scale how much stress that incident had caused them over the past six months.…”

Section: Instrumentsmentioning

confidence: 99%

Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics

Donnelly

Bradford

Davis

et al. 2015

CJEM

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Objective: Emergency medical service (EMS) providers are exposed to a variety of stressors endemic to the profession. These exposures may contribute to stress reactions, including posttraumatic stress. The objective of this study was to evaluate the relationship between work-related stressors and posttraumatic stress. The secondary objective was to determine paramedics' preferred sources of support for managing work-related stress. Methods: 269 paramedics in a county-based EMS service were invited to complete an online survey. Respondents reported their demographic characteristics, levels of chronic stress, critical incident stress, posttraumatic stress symptomatology (PTSS), and preferred sources of support for managing work-related stress.

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Development of a critical incident stress inventory for the emergency medical services.

Cited by 50 publications

References 34 publications

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota

What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes

Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics

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