'I've got no PPE to protect my mind': understanding the needs and experiences of first responders exposed to trauma in the workplace.

ABSTRACTBackground: First responders (FRs) are at high risk of being exposed to traumatic events in their occupational roles. Responding to critical incidents often involves exposure to life-threatening circumstances, dealing with fatalities and encountering highly stressful situations that may trigger traumatic responses. These experiences can lead to poor physical and mental health (MH) outcomes including post-traumatic stress disorder, co-morbid conditions such as depression, anxiety, substance abuse, insomnia, and suicidality. Little research has explored the perspectives and experiences of FRs in dealing with occupational trauma(s) and how best to meet their health needs.Objective: This study aimed to explore FRs' experiences of exposure to occupational trauma and its impact on their mental wellbeing. The wider objective was to investigate how FRs can be supported to access appropriate and relevant help, addressing barriers like stigma.Method: A qualitative research design using in-depth semi-structured interviews with FRs (n = 54) was adopted. Interviews were audio-recorded, transcribed and analysed using an inductive thematic approach.Results: Themes developed were: (1) the pervasive, cumulative and salient impact of occupational trauma on MH (micro-traumas, nightmares, flashbacks and reliving experiences); (2) the demands of the job exacerbating the adverse effects of trauma (self and others); (3) insufficient support and unhelpful ways of coping following exposure to trauma (lack of psychological safety); (4) stigma and fear of judgement as barriers to MH help-seeking; and (5) need for specific, accessible and credible trauma-focused interventions and workplace support.Conclusions: The implications of these findings are discussed at the individual, service provider and organisational level, emphasising the importance of implementing a strengths-based, non-pathologising and de-stigmatising approach to trauma in the workplace as experienced by FRs. Emphasis is placed on the importance of overcoming barriers to accessing MH support and improving access to evidence-based, trauma-focused psychological interventions and workplace support.

First responders regularly experience traumatic events in their workplace which can bring about traumatic stress, which is further exacerbated by the demands and pressures of their jobs.First responders' coping needs are not being met to a sufficient extent, especially in terms of psychological/MH input.There is need for evidenced-based, easily accessible, occupation-specific trauma-focused interventions to support first responders with their MH needs from occupational trauma-related stressors.

Emergency medical services infrastructure development and operations in low- and middle-income countries: Community first responder-driven (Tier-1) emergency medical services systems.

Low- and middle-income countries face unique challenges in delivering prehospital emergency care, often requiring context-appropriate emergency medical services development focused on community-driven solutions (tier 1 systems). Replicating high-income country tier 2 systems in low- and middle-income countries is not financially feasible in resource-limited settings. Instead, tier 1 systems composed of trained layperson first responders use locally available vehicles and involve local communities and stakeholders in their design and implementation to address specific local needs and emergencies. Community engagement is crucial for establishing sustainable and inclusive emergency medical services systems. This article focuses on the development and operation of tier 1 systems in low- and middle-income countries, covering technology integration, local appropriateness and co-operation, training curricula, trainee recruitment and selection, volunteer incentivization, monitoring and evaluation, and coordination with tier 2 systems. Layperson first responder programs are essential to address the global injury burden that disproportionately affects low- and middle-income countries and to evolve into, or coordinate with, tier 2 systems in resource-limited settings, but this requires community involvement to increase local ownership, drive sustainable solutions, and respect local values and cultures.

[PREVENTING SECONDARY TRAUMATIZATION IN MAGEN DAVID ADOM FIRST RESPONDERS DURING THE IRON SWORDS WAR: AN INTERIM REPORT].

INTRODUCTION: Following the onset of the "Iron Swords" war, Israel's National Emergency Medical Organization Magen David Adom (MDA) implemented a program designed to prevent post-traumatic sequelae among its teams. 'Team debriefing' is at the core of the program, which also includes primary, secondary, and tertiary prevention carried out regularly to preclude psychological harm to employees and volunteers. Apart from the initial team debriefings, MDA's enhanced prevention program includes several other components and stages. Beginning on October 9, 2023, potentially traumatized teams met with senior mental health professionals: a refresher course on how to conduct debriefing sessions was offered to assist managers and senior staff to plan for appropriate prevention responses. Personal follow-ups were enacted by MDA's Human Resources Department for all team members living in southern Israel and others who took part in operations there when the war first broke out. Periodic team discussions were held for potentially traumatized staff and volunteers with senior mental health professionals. Meetings with senior mental health professionals via two modes of video conferencing were conducted: specialized meetings with at-risk teams and open meetings for the entire organization in the webinar format. A centralized referral system was expanded for assessment and immediate treatment, if necessary, by mental health professionals for employees and volunteers in need. We trust that these measures will enhance the operational readiness of the MDA staff and volunteers in the face of their increased workloads and the associated psychological pressures. We are convinced that the prompt implementation of a debriefing strategy within our organization cultivates resilience and confidence in the MDA teams, promotes a sense of togetherness among the personnel, and advances a state of readiness and operational alert.

Exploring national and international experiences with community first responder models: protocol for a scoping review.

INTRODUCTION: Timely arrival of emergency medical services (EMS) is pivotal for effective prehospital care, and efforts by EMS leaders and policymakers to reduce response times, especially in cardiac arrests responsible for 70%-80% of coronary heart disease-related deaths, underscore the global urgency. With approximately 55 out-of-hospital cardiac arrests per 100 000 people annually, survival rates hinge on timely cardiopulmonary resuscitation, emphasising its initiation within a 4-6 min window. Trauma, causing 6 million deaths and nearly 40 million injuries a year, further underscores the need for prompt prehospital care. Acknowledging these challenges, health systems have incorporated community first responder (CFR) models, where trained community members provide initial aid, aiming to bridge the crucial gap until professional help arrives. This scoping review intends to explore the experiences of various countries with CFR models, including their conceptual and theoretical frameworks, recognising CFR as a critical solution for reducing response times in prehospital emergency care. METHODS AND ANALYSIS: Arksey and O'Malley's approach will be followed in this scoping review. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols extension for Scoping Reviews. The study objective is to comprehensively understand and map current knowledge about CFR model characteristics and identify effective components and indicators. The review will encompass available articles indexed in PubMed, Scopus and Web of Science without restrictions on date of publication. Additional searches will explore grey literature on Google Scholar and reliable websites in the field of EMS. Articles published in languages other than English and those inaccessible in full text will not be considered for inclusion. ETHICS AND DISSEMINATION: Since the study data are accessible from publicly accessible secondary sources, no ethical approval is necessary. Peer-reviewed publications will be used to report the study findings.

Live agent training as an important process safety measure to strengthen resilience in hazardous (CBRN) work situations.

Various occupational groups as well as emergency responders are important human factors in combating incidents and emergencies in a broad range. Negative deviations from a process-safe condition should be detected and transformed into a safer condition to prevent negative consequences. Therefore, training and education of personnel is an important measure in this case as well as a major influencing factor on the vulnerability to errors during operations and their resilience. From lack of training to incorrect execution due to excessive stress, fear, or unfamiliar situations, it is important to counteract this with targeted training under conditions that are as close to reality as reasonably achievable. Realistic training situations involving live agents allow to recognize mistakes or inadequacies not only in personnel but also in material or in mission planning and to create a more effective working environment. Many violations of work guidelines are due to well-intentioned deviations from nonexecutable standard operation procedures that have never been tested. Repeated, progressive training under real hazardous conditions can help to strengthen mission readiness and resilience of teams. It better prepares them for their dangerous activities.

A Disaster Response Complex for training of emergency responders in the Northwest United States.

The Disaster Response Complex (DRC) is a year-round training complex that specializes in training emergency responders in realistic indoor and outdoor environments. The outdoor site is comprised of 3 acres of secured customizable space for various exercises. The indoor site is designed to include an indoor facility with a full-size city street, complete with storefronts and motor vehicles that can be configured for emergency response training exercises, and a train or subway station where mockups of derailments can be simulated. The DRC includes large parking areas to accommodate multiple vehicles, allowing trainees the space needed to set up equipment and tactical operations. In addition, a campus office space is also available for an off-site operations center.

Assessing the role of sustainability competencies in enhancing psychological first aid effectiveness for disaster responders in Fiji.

Background: Psychological first aid (PFA) is essential for mental health and wellbeing after traumatic events. Integrating competency-based outcomes is crucial with the increasing demand for effective psychological first-aid interventions. This study examines the correlation between sustainability competencies and PFA principles within Fiji's disaster responder's context. Method: The research was guided by a theoretical framework based on a comprehensive review of sustainability competencies and PFA principles. A cross-sectional survey assessed the importance of sustainability competencies in disaster responders to deliver PFA effectively. The survey used a stratified random sampling method to get diverse PFA-trained participants (66%) and non-PFA trained (34%), aiming to understand how these competencies can impact PFA success in various disaster situations. The survey, encompassing various domains of disaster response and a diverse range of respondents age, gender, and years of experience, employed the Likert scale to assess the importance of competencies such as integrated problem-solving, strategic, systems thinking, self-awareness, normative, collaboration, anticipatory, and critical thinking. Results: The study involved 49 PFA-trained participants (55% female, 45% male) and 15 non-PFA-trained participants (53% female, 46% male), excluding 10 responses from the latter group due to ambiguous answers to critical questions. The correlation between age, experience, and the valuation of professional competencies among disaster responders indicates that disaster responders, with extensive experience and PFA training, rated competencies as "important," reflecting a perspective shaped by long-term career development and practical experiences. Equally, younger and early career responders emphasize competencies as "very important," indicating an initial recognition of their significance. The appraisal patterns across different age groups, especially among those with PFA training, suggest a tendency to moderate assessments of competency importance with increasing experience. Statistical analysis, including mean, median, standard deviation, and variance, provided a detailed understanding of the data, underscoring competencies like self-awareness in both data sets and integrated problem-solving and collaboration within PFA-trained responders as the key for effective PFA interventions. Conclusion: The study underlines the critical need to integrate sustainability competencies into the PFA curriculum in Fiji's unique sociocultural context. This interplay between age, experience, and competency assessment stresses the diverse factors influencing perceptions in the disaster response field beyond experience alone. The results show that sustainability competencies are the ultimate to the effectiveness of PFA measurement and interventions. The research lays the foundation for future studies to develop validated tools for assessing sustainable competencies in different cultural contexts, thereby improving the effectiveness of PFA in disaster management. Integrating these competencies into PFA training could significantly strengthen PFA intervention and competency-based evaluation.

A longitudinal follow-up study of rescue and recovery narratives of Oklahoma City bombing responders nearly a quarter century later.

BACKGROUND: Most research examining first responders of terrorist incidents has been conducted in early post-disaster periods, utilized quantitative research methods, and focused on psychopathology such as post-traumatic stress. METHODS: Longitudinal follow-up assessments of 124 workers from 181 baseline volunteer rescue and recovery workers originally studied were completed nearly a quarter century after the terrorist bombing of the Murrah Federal Building in Oklahoma City. Open-ended qualitative interviews were used in the follow-up study. RESULTS: The rescue and recovery work, vividly described decades later, was gruesome. These workers' descriptions captured their mental toughness and their professional missions, as well as the emotional and mental health (MH) toll on their lives. CONCLUSIONS: The extreme nature of rescue and recovery work in the aftermath of terrorism suggests potential utility for MH interventions to address the psychological toll that can be expected of human beings under the most extraordinary circumstances.

Design considerations for protective boots for first responders to hazardous materials incidents.

First responder professionals are at high risk for work-related injuries (e.g., extreme temperatures, chemical and biological threats); boots are essential to ensure body protection since they have full contact with the ground in all scenarios. A substantial body of work has investigated the necessity of improvements in protective boots, but there is limited research conducted on boots with fit-adjustable fasteners for secure and adjustable fit within this context. Thus, this study explored the areas for improvement in boot design for the development of form-fitting and yet comfortable boots focusing on two different boot designs, prototype all-hazards tactical boots (lace-up) and rubber boots (slip-on). Findings indicated that the boot design should address participants' concerns with the material choices of boots, specifically with bulkiness, weight, and flexibility. Our findings provide insights into boot material and design choices to improve protective boots for first responders.

Community First Responders' role in the current and future rural health and care workforce: a mixed-methods study.

Background: Community First Responders are trained volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved. Objectives: We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce. Design: We used a mixed-methods design, using a lens of pragmatism and the 'actor', 'behaviour change' and 'causal pathway' framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study. Results: In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders' scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders. Limitations: Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias. Future research: Future research should include a robust evaluation of innovations involving Community First Responders. Trial registration: This trial is registered as ClinicalTrials.gov, NCT04279262. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information.

Community First Responders are volunteers who attend emergencies, particularly in rural areas, and provide help until the ambulance arrives. We aimed to describe Community First Responder activities, costs and effects and get the views of the public, Community First Responders, ambulance staff and commissioners on the current and future role of Community First Responders. Our study design combined different approaches. We examined routine ambulance patient information, reviewed ambulance policies and guidelines, and gathered information from interviews to make sense of our findings. Through interviews we learned about ways that the work of Community First Responders had been enhanced or could be improved. In a 1-day workshop, a group of lay and professional experts ranked in order of importance ideas about future developments involving Community First Responders. Community First Responders arrived before ambulance staff for a higher proportion of calls in rural than in urban areas. They attended people with various conditions, including breathing problems, chest pain, stroke, drowsiness, diabetes and falls, and usually the highest-priority emergencies but also lower-priority calls. Policies aimed to ensure that Community First Responders provided safe, effective care. Costs, mainly used for management, training and equipment, were sometimes incomplete or inaccurate and varied widely between services. Community First Responders attending meant faster responses and positive experiences for those patients and relatives interviewed. A Community First Responder scheme responding to people who had fallen at home led to fewer ambulances attending and possible financial savings. Survival among people attended because their heart had stopped was no better when Community First Responders arrived early. Interviews revealed why and how Community First Responders volunteered and were trained, what they did and how they felt. Interviewees were largely positive about Community First Responders. Improvements suggested included support from colleagues or counsellors, better communication with ambulance services, technology for communication and locating patients, and better training. Community First Responders have benefits in terms of response times and patient care. Future improvements should be evaluated.

Physical and psychological status of emergency assistance personnel at major public health events: a qualitative descriptive study.

BACKGROUND: Many personnel respond to natural disasters like earthquakes and tsunamis and frequent public health events like Ebola and COVID-19. However, research on emergency assistance personnel remains limited. This study aims to describe the perceived well-being among responders deployed in isolated or emergency international missions while providing practical references to intervene in developing similar missions. METHODS: For this qualitative phenomenological study, purposive sampling was used following the principle of maximum differentiation to select personnel deployed on an emergency mission for over a year. Data collection continued until data saturation. Phenomenologically semi-structured interviews helped explore the physical and psychological status of the participants with Colaizzi's method. RESULTS: Eleven personnel were interviewed after the mission, with four major themes being identified: 'perceived somatic change,' 'perceived emotional change,' 'behavioral change,' and 'coping with perceived change.' CONCLUSIONS: The mental health status of the emergency assistance personnel was affected by multiple factors from external and internal environments. The current study explored the physical and psychological feelings and emotions of emergency assistance personnel during an emergency mission. The study provided a practical reference for health management under similar missions. REGISTRATIONS: Not registered.

Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions.

Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

Exploring medical first responders' perceptions of mass casualty incident scenario training: a qualitative study on learning conditions and recommendations for improvement.

OBJECTIVE: Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols. DESIGN: Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis. SETTING: MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries. PARTICIPANTS: 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study. RESULTS: Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation). CONCLUSIONS: This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources.

Lack of association of impaired upper airway sensation with the presence or absence of obstructive sleep apnoea or chronic rhinosinusitis in World Trade Center responders.

OBJECTIVE: Examine sensory function of the upper airway in four groups of subjects recruited from the World Trade Centre General Responder Cohort (WTCGRC), with/without obstructive sleep apnoea (OSA), and with/without chronic rhinosinusitis (CRS). METHODS: Upper airway sensory function was determined using 2-point discrimination (2-PD) and vibration threshold (VT) in 163 WTCGRC subjects with both OSA and CRS (cases), OSA or CRS alone and without OSA or CRS (controls). Presence of OSA was determined from clinical sleep studies or home sleep testing. Presence of CRS was determined by nasal symptom questionnaire. The relationship between the presence of OSA and CRS and upper airway sensory impairment was assessed using linear regression analysis with each of 2PD and VT sensory threshold values as the dependent variable; OSA, CRS and their interaction were the independent variables. Age, gender and body mass index were covariates in the statistical model. The primary analysis was comparison of OSA+CRS versus controls (no OSA and no CRS) evaluated by linear contrasts. RESULTS: There were no differences in 2-PD or VT in those with OSA+CRS, OSA and CRS alone or controls. However, both 2-PD and VT were significantly higher in the WTCGRC controls compared with values seen in historical controls using the same methodology (median 2-PD 13.0; CI (11.0 to 13.5) vs 10.5; CI (8 to 11); VT: mean±SEM (9.3±0.6 vs 2.2±0.1)). CONCLUSION: While no differences were found in upper airway sensation between cases of OSA and CRS versus controls in the WTGRC population, there was evidence of impaired upper airway sensation in the WTGRC overall.

Formulating policies and procedures for managing diving related deaths: a whole of state engagement from frontline and hospital services in Tasmania.

Introduction: Tasmania is a small island state off the southern edge of Australia where a comparatively high proportion of the 558,000 population partake in recreational or occupational diving. While diving is a relatively safe sport and occupation, Tasmania has a significantly higher diving death rate per head of population than other States in Australia (four times the national diving mortality rate). Methods: Three compressed gas diving deaths occurred in seven months between 2021-2022 prompting a review of the statewide approach for the immediate response of personnel to diving-related deaths. The review engaged first responders including the Police Marine and Rescue Service, hospital-based departments including the Department of Hyperbaric and Diving Medicine, and the mortuary and coroner's office. Results: An aide-mémoire for all craft groups, digitalised checklists for first responders (irrespective of diving knowledge), and a single-paged algorithm to highlight inter-agency communication pathways in the event of a diving death were designed to enhance current practices and collaboration. Conclusions: If used, these aids for managing diving related deaths should ensure that time-critical information is appropriately captured and stored to optimise information provided for the coronial investigation.

HAZMAT Technician-level Emergency Response: A Mental Model Framework for Radiological Dispersal Device (RDD) Incidents.

ABSTRACT: This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are conventional explosive devices with radioactive materials incorporated. The objective is to introduce the Expected Mental Model State (EMMS) as a comprehensive evaluation tool for assessing and enhancing the expertise and situational awareness of emergency responders dealing with radiation crises. Through a series of expert focus group sessions using the well-established qualitative methodology of grounded theory, an Expected Mental Model State (EMMS) was developed. The methodology used an influence diagram architecture to conceptually capture and codify key areas relevant to effective emergency response. The research identifies fourteen EMMS key conceptual domains, further elaborated into 301 subtopics, providing a multi-dimensional structure for the proposed mental model framework. Three pivotal notions of mental model emerged within the EMMS framework: Knowledge Topology, Envisioning (Belief), and Response and Operability. These notions were found to align with previous theories of mental models and are vital for understanding how HAZMAT technicians conceptualize and respond to RDD incidents. The study emphasizes the critical role of mental models in enhancing preparedness and effective response strategies during radiation emergencies. The EMMS framework offers a versatile methodology that can be adapted across various kinds of emergency responders and high-risk situations, including the broader Chemical, Biological, Radiological, and Nuclear (CBRN) spectrum. Using this EMMS framework to develop an EMMS Diagnostic Matrix can provide a roadmap for identifying areas for the development of specialized training modules that have the potential to significantly elevate both the quality and efficacy of responder training and preparation.

'Safety in the Grey Zone': Evaluation of a training program to improve the safety of incident responders on high-speed roads.

INTRODUCTION: Workers operating on high-speed roads (i.e., incident responders and emergency service workers) are at significant risk of being fatally injured while working. An identified gap in current prevention strategies is training focused on developing the skills of workers to effectively communicate and coordinate safety responses when operating on roads. METHODS: This study discusses the development of a program designed to optimize communication and coordination of safety practices at the scene of an incident on a high-speed road. The program is referred to as 'Safety in the Grey Zone.' The goal of the study is to present the results from an evaluation on its implementation across 23 sessions involving 158 participants from 7 incident response agencies in 1 state in Australia. RESULTS: The results of this study provide support for effectiveness in implementing the program as planned. The results also provide preliminary support for effectiveness of the program in achieving its learning outcomes as demonstrated by feedback received from participants following completion of the program. CONCLUSIONS: The findings of this study provide recommendations to consider in the program's future roll-out, as well as suggestions for future evaluations to assess the program's effectiveness in improving the safety of incident responders operating on high-speed roads.

Use of Self-Efficacy Scale in Mass Casualty Incidents During Drill Exercises.

INTRODUCTION: Medical First Responders (MFRs) in the emergency department SUMMA 112 are tasked with handling the initial management of Mass Casualty Incidents (MCI) and building response capabilities. Training plays a crucial role in preparing these responders for effective disaster management. Yet, evaluating the impact of such training poses challenges since true competency can only be proven amid a major event. As a substitute gauge for training effectiveness, self-efficacy has been suggested. OBJECTIVE: The purpose of this study is to employ a pre- and post-test assessment of changes in perceived self-efficacy among MFRs following an intervention focused on the initial management of MCI. It also aimed to evaluate a self-efficacy instrument for its validity and reliability in this type of training. METHOD: In this study, we used a pretest (time 1 = T1) - post-test (time 2 = T2) design to evaluate how self-efficacy changed after a training intervention with 201 MFRs in initial MCI management. ANOVA within-subjects and between subjects analyses were used. RESULTS: The findings reveal a noteworthy change in self-efficacy before and after training among the 201 participants. This suggests that the training intervention positively affected participants' perceived capabilities to handle complex situations like MCI. CONCLUSION: The results allow us to recommend a training program with theory components together with practical workshops and live, large-scale simulation exercises for the training of medical first responders in MCI, as it significantly increases their perception of the level of self-efficacy for developing competencies associated with disaster response.

Évaluation du risque par les professionnels de la santé et les équipes de secours lors d'incidents chimiques.

CONTEXT: The literature review highlights that joint preparation and training of first aid responders is necessary to deal with a major chemical incident. Improved knowledge of exposure assessments makes it possible to estimate the risk and adjust immediate measures. The aim of this paper is to summarize recommendations for assessing exposure during chemical incidents that require emergency responses. Actions allowing the chemical contamination to be better anticipated and health protection to be optimized were analyzed. METHODOLOGY: A review of the literature was conducted, and research questions were formulated using the PECO method. The PRISMA method was used to select the literature. RESULTS AND DISCUSSION: The selected papers (n=16) show that preparation for chemical incidents in terms of individual and collective protective equipment, and knowledge of the risk assessment process remain lacking. We propose training to master the steps of risk assessment. Our analysis also points out the importance of monitoring the state of the environment after a chemical incident, allowing adjusted measures to protect the health of the exposed population and vulnerable groups in particular. This monitoring must be accurate and dynamic to provide realistic recommendations during the intervention phase. CONCLUSIONS: All first-aid responders and health workers knowing the risk assessment process should result in improvements: in the use of protective measures in time and space, the delimitation of exposure to contamination, and the characterization of the risk.