A Scoping Review of Trauma, Mental Health and First Responders in Australia.

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer-reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders.

Blood Product Administration in the Prehospital Setting: A Scoping Review.

OBJECTIVES: Implementing prehospital blood products for treating hemorrhagic shock has been utilized globally in military and civilian settings. This review aims to compare various guidelines for using blood products, including the types of blood products, injuries, biomarkers (hemodynamic measurement) to indicate use, associated treatments and risks, and the logistical concerns of storage and wastage in the prehospital setting. Furthermore, it explores whether prehospital blood transfusions are beneficial and a safe treatment option. METHODS: Data were collected using a systematic search and screening process of online databases CINAHL, Medline, and Scopus, as well as by creating a PRISMA flow diagram to screen articles using inclusion and exclusion criteria. Forty-five articles were screened, with twenty-five excluded, resulting in twenty articles in this scoping review. RESULTS: The most frequently used blood product used was red blood cells, with twelve studies using either red blood cells alone or in combination with other products. Indications for blood use varied across services, but all aimed to address hemodynamic instability as a primary indication for blood transfusion. Eleven studies recorded no adverse reactions. Only one study reported chills and shivers; however, it was unclear if blood products were the cause. Nine studies avoided logistical issues of storage and wastage to create a feasible rotation system. CONCLUSIONS: Prehospital blood was used in medical, trauma, and maternity-related hemorrhage. Many types of blood products are in use, ranging from component therapy to whole blood, with each protocol having different indications of use and treatment guidelines aimed at improving hemodynamic stability.

The significance of paramedic communication during women's birth experiences: A scoping review.

BACKGROUND: Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked. METHODS: A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint. RESULTS: Three themes were generated: 1. First Impressions Count: paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. Choice as a Pathway to Control: when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. Exposed, Violated and Disempowered: some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby. CONCLUSIONS: This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.

Mental Health First Aid training for paramedic students: An evaluation study.

BACKGROUND: The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges. METHODS: A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses. RESULTS: The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18-24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice. CONCLUSION: The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences.

How do paramedics cope? A scoping review.

Exposure to repeated trauma is an inherent component of paramedicine. Additionally, paramedics are exposed to threats that can undermine healthy workplaces, social connectedness, and health behaviour, predisposing them to overwhelming distress and unhealthy coping, including suicidality and psychiatric disorders. This scoping review aimed to identify how paramedics cope. PubMed, PsycINFO and CINAHL were searched between January 1, 2010, to April 21, 2021. Studies were included if they used any research design to identify specific coping strategies used by paramedics. Three studies met the inclusion criteria-two qualitative and one cross-sectional survey design. There was a high risk of bias across all studies. Studies were conducted in Israel, Poland, and the UK, primarily with males. Two studies only identified healthy coping strategies-self-soothing and social and professional support. Unhealthy strategies identified in the third study were limited to negative self-talk and alcohol use, with no mention of other harmful behaviours, social withdrawal, or suicidality. There is limited research describing how paramedics cope, and in particular, how female paramedics cope. Further research exploring the breadth of coping strategies used by paramedics is needed to understand the impact of the work paramedics undertake on coping and inform prevention and support activities.