What makes an incident critical for ambulance workers? Emotional outcomes and implications for intervention

Abstract

Ambulance workers use the term ''critical incident'' to refer to a category of workplace stressor. Developing an evidence-based approach to critical incident stress begins with identifying what makes incidents critical. The aim of this qualitative study was to characterize critical incidents as well as elicit suggestions for interventions. We interviewed 60 ambulancebased workers, both front-line and supervisors, and analysed interview transcripts. Having presented their suggestions for interventions more fully elsewhere (Halpern et al, 2009), here we characterize the incidents that emerged as critical and the emotional responses evoked by them. We found they suffered considerable distress from critical incidents and would welcome interventions. Incidents that were identified as critical commonly involved patient death, often combined with poignancy. These events appeared to evoke vulnerable feelings of inability to help and intense compassion, which led to further emotional, cognitive, and behavioural responses. Difficulty in acknowledging distress and fear of stigma presented significant barriers to accessing support. These barriers may be overcome by educating both ambulance personnel and their supervisors to recognize and tolerate the vulnerable feelings often evoked by critical incidents. While gender and length of service did not seem to impact on evoked emotions, recent recruits may be more open to this type of education.

Passing Away: An Exploratory Study into Physiotherapy Students' Experiences of Patient Death whilst on Clinical Placement

“…Feeling upset or saddened by patient death is consistently reported amongst a range of healthcare workers, including ambulance workers (Halpern et al 2009), doctors (Redinbaugh et al 2003, Rhodes-Kropf et al 2005, Moores et al 2007, Kelly & Nisker 2010 and nurses (Yang & McIlfatrick 2001). Over a quarter of emergency workers reported intense discomfort lasting several weeks to several years after attending critical incidents (Halpern et al 2009), which has significant implications in respect of the long-term, cumulative effects of caring for the dying patient.…”

“…Over a quarter of emergency workers reported intense discomfort lasting several weeks to several years after attending critical incidents (Halpern et al 2009), which has significant implications in respect of the long-term, cumulative effects of caring for the dying patient. Some nurses reported that they preferred to cry in private (Yang & McIlfatrick 2001), which was reflected in the behaviour described by some of the participants.…”

“…Focus groups have previously been used to explore a wide range of issues relating to end-of-life care from a number of perspectives (Costello & Trinder-Brook 2000, Hudson 2003, Halpern et al 2009, Espinosa et al 2010, Kelly & Nisker 2010 and were therefore considered an appropriate method to employ. Group interviews were selected as peer support was considered important when discussing end-of -life care experiences, and the interaction between members is thought to generate and refine data which individual interviews may not (Kitzinger 2005, Plummer-D'Amato 2008a.…”

“…There is extensive research into patient death, the effects on healthcare professionals involved and the coping strategies they employ (Yang & McIlfatrick 2001, Redinbaugh et al 2003, Moores et al 2007, Halpern et al 2009, Shorter & Stayt 2009, Gerow et al 2010, Wilson & Kirshbaum 2011. Much of this research focuses on deaths that occur within palliative care settings despite only 6% of patient deaths taking place in this environment (Office for National Statistics 2012, p11).…”

“…However, the difficulties in identifying and implementing appropriate care plans to facilitate a 'good death' can also be traumatic (Costello 2006) and may manifest as either emotional or physical reactions (Rich 2005, Moores et al 2007, Halpern et al 2009). Emotional distress may have long-term detrimental effects both personally and professionally such as post-traumatic stress disorder, burnout, reduced clinical effectiveness (Matzo et al 2003, Clouder 2005, Rich 2005, Halpern et al 2009, Shorter & Stayt 2009) and professional compassion fatigue (Wilson & Kirshbaum 2011, Melvin 2012). Such distress may also limit emotional engagement and thereby contribute to lack of support and compassion for the dying patient and/or their family (Matzo et al 2003, Espinosa et al 2010, Melvin 2012).…”