Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies

Abstract

Background Ambulance care professionals are regularly confronted with critical incidents that increase risks for mental health disorders. To minimize these risks, it is important that ambulance care professionals adequately cope with critical incidents. Especially from the perspective of starting ambulance care professionals it is unknown which coping styles they use when experiencing a critical incident and how they are trained to cope with critical incidents. The aim of this study was to gain insight in (a) what starting ambulance care professionals describe as critical incidents, (b) how they experience these critical incidents and their consequences, (c) how they cope with these incidents, and (d) how they are trained and guided to cope with these incidents. Methods A qualitative design with individual, semi-structured interviews was used. The data was analyzed by using inductive thematic analysis. Results Twenty-two starting ambulance care professionals were interviewed of which, 11 were male. The age ranged from 23 to 31 years, with 11 participants being 27 years or younger. Three key-themes emerged that make an incident critical: (1) emotional connection versus emotional detachment, (2) feeling loss of control, and (3) incomprehension. All participants experienced several short to middle term physical, psychological and social consequences after encountering a critical incident. Starting ambulance care professionals applied different coping strategies during different phases of the ambulance care process: a mix of depersonification, focus on the medical task, support from colleagues and their own network, seeking confirmation, and distraction. Most starting ambulance care professionals don’t actively remember they received education about coping with critical incidents during their initial educational program. During and after traineeships, the workplace preceptor has a crucial role for starting ambulance care professionals to learn them how to cope with critical incidents. Conclusions Three key-themes interact to make an incident more critical for starting ambulance care professionals. To cope with these critical incidents, starting ambulance care professionals use a variety of coping strategies. These results can be used to develop training and coaching for starting ambulance care professionals so they can adequately cope with critical incidents.

A qualitative, cross-cultural investigation into the impact of potentially traumatic work events on Saudi and UK ambulance personnel and how they cope

“…These legal penalties may lead to ten years in prison or paying one million Saudi riyals (approximately £200,000) [ 35 ]. Furthermore, the ambulance personnel in both cultures were negatively impacted by events with vulnerable victims, which is consistent with previous studies [ 18 , 32 , 36 – 39 ]. These findings expand previous knowledge by showing that similar types of events have comparable impacts on paramedics cross-culturally; however, exposure to different event types varies.…”

“…Moreover, there is a lack of qualitative cross-cultural research in ambulance personnel. Qualitative studies which have been conducted in single country samples are informative, suggesting that critical events involving the death of a patient can cause ambulance personnel significant distress but are not events they feel able to disclose and discuss with others [ 18 – 20 ]. A qualitative approach could be particularly beneficial for helping to explain the variation in rates between ambulance personnel in different countries.…”

Paramedics’ perceptions of job demands and resources in Finnish emergency medical services: a qualitative study

“…However, the notion of having this 'right stuff ' from the start is simply not feasible. There is certainly an advantage, especially at the early stage of one's career, in having adopted good and functional coping mechanisms to handle the unexpected job-related stressors inherent in EMS work [19]. However, paramedic education needs to focus on identifying and forming such initial building blocks while the work culture and environment then furthers to support them, aiming to strengthen these internal resources and finally enabling the growth of paramedics' necessary resilience [53].…”

“…Other commonly reported job demands among paramedics are environmental, sociocultural and organisational; critical incidents causing psychological distress [19]; traumatic events concerning patient care [20]; the threat of violence from patients and bystanders [21]; and the risks related to alarm-vehicle driving [22], uncertain working environments [8] and physical injuries [23,24]. Meanwhile, individual performance pressure [25], conflicts of an ethical nature [26] and social pressures [7], as well as continuously occurring emotional patient encounters [27], seem to be inherent phenomena within the EMS profession.…”

Coping Strategies for Exposure to Trauma Situations in First Responders: A Systematic Review

“…7 How people perceive and respond to stressful situations is key, particularly in the emergency responder scenario. 8 Adaptive coping skills allow individuals to increase their ability to recover psychologically after stressful events, overcome long-term emotional damage, and reduce the psychological impact of exposure to stress, particularly in high-risk groups such as emergency personnel. 9 In contrast, nonadaptive strategies are actions, thoughts, and feelings that avoid confronting and dealing with various stressors, which leads to negative effects on mental health, including the development of different mental disorders.…”