Walk the line: a systemic perspective on stress experienced by emergency medical personnel by comparing military and civilian prehospital settings

Abstract

IntroductionEmergency Medicine (EM) personnel in both military and civilian prehospital settings are often exposed to stressful and extreme events. Therefore, a cross-pollination between both contexts in terms of coping strategies may generate new information for purposes of training, prevention, and support programs. In the current study, we aimed at comparing both contexts to understand the type of stress events personnel experience; whether experience differs between civilian and military personnel; and how they cope with it.MethodsWe used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information.ResultsWhereas the questionnaire pointed to a significant preference for task-oriented coping over avoidant and emotion-oriented coping, the interviews offered a more nuanced insight, showing a constant aim to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress, a vulnerable disbalance between an excessive passion for the job with the sacrifice of own's personal life (for a growing volatile and dangerous working environment) and a lack of recognition from both the patient and organizational environment. The combination of these factors may carry the risk for moral injury and compassion fatigue. Therefore, mutual trust between the organizational level and EM personnel as well as among team members is crucial.DiscussionThe results are discussed from a systemic SHELL perspective, indicating how the specific profile of EM personnel relates to the software, hardware, environmental and liveware components of their professional and private life. Trainings on stress- and risk awareness should be approached both on an individual and systemic level, knowing that there is clearly no “one-size-fits-all” manner.

A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks

“…Knowing what other colleagues were capable of provided a certain sense of security and comfort for emergency responders, as they were able to focus on their own tasks, instead of micromanaging ( 10 ). Such teamwork might act as a protective factor against the severe stress experienced during the acute phase ( 9 , 31 ).…”

“…A semi-structured topic guide was used (see Table 2 ). The topic guide was developed on the basis of several previous studies, including similar qualitative studies ( 9 , 10 ), quantitative studies and reviews ( 14 , 18 , 19 ), and studies on debriefings ( 15 , 16 ). After development, the interview guide was reviewed by the research group, with several researchers having experience in qualitative research.…”

“…Furthermore, there is little insight in how proper preparation for such events plays a role, how the feeling of “knowing what to do” acts as resilience against stress, or how having the right equipment can increase or decrease the sense of threat and sense. However, studies have shown the importance of such elements in how stress is experienced during the acute phase of a terrorist attack ( 9 , 10 ). For example, depending on the type of disaster, different preparations will be necessary ( 11 ).…”

“…For example, one study showed that hospital personnel after the Manchester Attacks in the United Kingdom felt stress due to being ill-prepared for the massive inflow of victims and felt guilty for not being able to work at the scene of the terrorist attacks ( 9 ). Another qualitative study showed that stressors are also the scene in which emergency responders work, as each large disaster is, in a way, unique ( 10 , 11 ).…”

“…However, here, too, more insight is needed. For example, emergency responders’ culture might play a role, with some not wanting to show emotions, due to something that some authors have called “John Wayne syndrome” (named after the famous Hollywood actor who often played cowboys) ( 10 ). Furthermore, to ensure that the guidelines on post-response aid are improved, more studies on the experiences and needs of emergency responders in the acute phase of an attack are necessary ( 9 , 10 , 15 , 16 ).…”