11/5/2015 STRESS IN EMS. Workplace stress has been linked with OBJECTIVES OF PRESENTATION SO, IS IT STRESSFUL TO WORK IN EMS? CHRONIC STRESSES IN EMS
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1 STRESS IN EMS OBJECTIVES OF PRESENTATION Discuss the empirical and theoretical underpinnings of research into stress reactions in EMS ELIZABETH DONNELLY, PHD, MPH, LICSW, NREMT Review the results of three research studies into stress in EMS PARAMEDICINE 2015 NIAGARA FALLS, ON Discuss implications for the field SO, IS IT STRESSFUL TO WORK IN EMS? CHRONIC STRESSES IN EMS Yes. Any situation faced by personnel that causes them to experience unusually strong emotional reactions that have the potential to interfere with their ability to function on scene or after the call. Every day stresses (chronic stress) Enduring problems, conflicts, and threats that many people face in their daily lives. Organizational stress Stressors associated with the organizational culture Operational stress Stress associated with doing the job HOW DO WE REACT TO WORK STRESS? HOW DOES IT ALL GO TOGETHER? Workplace stress has been linked with Low job satisfaction Poor physical health Depression Fatigue Burnout Who are you? Type of stress? Severity? How do you react to stress? Donnelly, E. A. & Siebert, D. C. (2009). Occupational risk factors in the emergency medical services. Prehospital and Disaster Medicine, 24(5) doi: /s x
2 OUTCOME VARIABLES (STRESS REACTIONS) Occurs after a traumatic exposure Symptoms may include: Re-experiencing the event Avoidance of stimuli associated with the trauma Persistent symptoms of increased arousal Symptoms persist for at least one month Hazardous drinking is a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others. Alcohol dependence is a cluster of behavioral, cognitive, and physiological phenomena that may develop after repeated alcohol use4 STUDY #1: TESTING THE THEORETICAL MODEL Probability sample of 12,000 EMTs and paramedics from the NREMT Contacted via , invited to complete a survey Survey included questions about: Chronic operational stress Chronic organizational stress Demographics : STRESS EXPOSURE 1633 people responded (13.6% response rate) The sample was mostly male (74.3%) Primarily paramedics (70.2%) Caucasian (86.6%) Average age: 34.6 years (SD 10.2) Average length of service: 9 years (SD 7.8) Organizational stress Mean score 39.0 (SD 13.4) Operational stress Mean score 34.9 (SD 13.3) Top 5 most stressful critical incidents were: Saw someone dying Encountered the body of someone recently dead Encountered an adult who had been badly beaten Responded to a scene involving family, friends, or others known to the crew Encountered an adult who had been sexually assaulted. Mean score 28.8 (SD 25.5) : POSTTRAUMATIC STRESS : ALCOHOL USE 6% of the sample met criteria for PTSD Cutoff for PTSD is 35 (range 0-60) Mean score was 11.9 (SD 10.6) 15.1% of respondents reported hazardous drinking 1.3% reported possible alcohol dependence 18.8% of respondents reported binge drinking at least monthly. 49.2% of respondents reported using alcohol to cope with a bad call or shift 83.7% reported seeing co-workers use alcohol to cope with a bad call or shift. 2
3 EVEN MORE 1+1 = 5? Controlling for length of service, age, gender, hours worked, income, level of training, and marital status. Operational stress, organizational stress, critical incident stress, and alcohol use were significant predictors of posttraumatic stress (p<.01) All three kinds of stress and alcohol use increased the risk for posttraumatic stress However, operational stress has another way of increasing the risk of posttraumatic stress Operational stress interacts with critical incident stress and alcohol use to further increase the risk of posttraumatic stress STUDY #2: STRESS IN THE CANADIAN CONTEXT isn t the only source of stress in EMS Operational stress, organizational stress, and alcohol use also increase the risk of posttraumatic stress High levels of operational stress, combined with high levels of alcohol use or critical incident stress further increase risk for a posttraumatic stress reaction. Donnelly, E. A. (2012). Work-related stress and posttraumatic stress in the emergency medical services. Prehospital Emergency Care, 16(1), doi: / Replication and extension of Study #1 Participants from one EMS Service in Southwest Ontario Survey included questions about: Chronic operational stress Chronic organizational stress Demographics Preferred sources of social support in managing work-related stress We had a 54% usable response rate (n=162) The sample was mostly male (71%) Primarily PCPs (80.7%) Average age: 38.3 years (SD 10.3) Average length of service: years (SD 11.7) Operational stress Mean score 31.4 (SD 12.1) Organizational stress Mean score 34.8 (SD 13.5) Mean score 59.4 (SD 36.9) ACPs reported significantly higher levels than PCPs Mean score 30.5 (SD 11.3) 5.6% exceeded the cutoff for PTSD 3
4 - PREFERRED SOURCES OF SOCIAL SUPPORT FOR MANAGING WORK RELATED STRESS Controlling for length of service, age, gender, hours worked, income, level of training, and marital status. Operational stress and Operational stress x critical incident stress remained significant predictors of PTSS (p<.01). Note: this study did not replicate the significant relationship between PTSS and organizational stress or alcohol use. A family member or friend 81.4% Your partner 73.2% A co-worker 49.7% The employee assistance program/another therapist 38.6% A union representative 22.1% A supervisor 17.2% A base hospital educator 7.6% Donnelly, E. A., Bradford, P., Davis, M., Hedges, C., & Klingel, M. (2015). Predictors of posttraumatic stress and preferred sources of social support in Canadian paramedics. Canadian Journal of Emergency Medicine, 1-8. doi: /cem STUDY #3: STRESS AND SAFETY Operational stress appears to have the same relationship to PTSS in the Canadian context The other findings weren t replicated, which may be due to Structural differences Sample size Clear differences in preferred sources of support May provide support for peer-driven interventions Data collection is ongoing Replication, expansion, and extension of previous studies Involves 10 EMS services in Ontario, multiple waves of data collection Assessing chronic and critical incident stress, posttraumatic stress, fatigue, and safety outcomes Paramedic injury Medical errors Safety compromising behaviors Supported by a grant from the Paramedic Chiefs of Canada PRELIMINARY PRELIMINARY These data are from Wave 1 of the survey Data are from eight EMS services with a 41% response rate (n= 664) The sample was mostly male (66.1%) Primarily PCPs (76.2 %) Average age: 37.8 years (SD 10) Average length of service: 13.3 years (SD 10.0) In the past three months 75% of paramedics reported being injured 95% reported safety compromising behaviors 72% reported making medical errors 4
5 PRELIMINARY : FATIGUE PRELIMINARY 55% reported being fatigued at work If a paramedic reported being fatigued, they were significantly more likely to report Injury (OR =2.8, 95% CI 1.9, 4.3) Safety Compromising Behaviors (OR 5.3, 95% CI 2.1, 13.2) Medical Errors (OR 5.3, 95% CI 2.1, 13.2) This is consistent with findings in American paramedics Patterson, P. D., Weaver, M. D., Frank, R. C., Warner, C. W., Martin-Gill, C., Guyette, F. X.,... & Hostler, D. (2011). Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emergency Care, 16(1), Paramedic injury and safety compromising behaviors were significantly related to operational stress (p <.01), organizational stress (p <.01), critical incident stress (p <.01) and post-traumatic stress (p <.01). In contrast, most of the stress variables (organizational stress, operational stress, critical incident stress, and PTSS) were not significantly related to medical errors Right now, it is too early to say definitively data collection is ongoing Early evidence indicates that Like in American paramedics, there is a relationship between fatigue and safety in Canadian paramedics In addition to fatigue, other types of workplace stress and stress reactions like PTSS seem to have a relationship with paramedic safety and safety compromising behaviors Stay tuned! SO WHAT TO DO? We need to better manage stress in EMS Think holistically and broaden our idea of workplace stress Consider prevention efforts Education Mentorship Reduce stigma Reduce risk by maximizing support Peer support programs Involving family Creating EMS specific stress reduction curricula (e.g., MBSR) SO WHAT TO DO? Make appropriate care available Use evidence based best practices (e.g., guidelines just released by Black Dog Institute) Cultivate mental health professionals that speak the language Minimize barriers to accessing existing mental health services More research What works? Evaluate existing and new interventions. What do we know about resilience in EMS? Keep up the conversation! If you have questions, would like copies of any of this research, or would like to continue the conversation, please don t hesitate to contact me! Elizabeth A. Donnelly donnelly@uwindsor.ca 5
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