Considering the Impact of Early Trauma on Coping and Pathology to Predict Posttraumatic Growth Among 9-1-1 Telecommunicators.

Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators (N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

Exploring the Physical and Mental Health Challenges Associated with Emergency Service Call-Taking and Dispatching: A Review of the Literature.

INTRODUCTION: Emergency service (ambulance, police, fire) call-takers and dispatchers are often exposed to duty-related trauma, placing them at increased risk for developing mental health challenges like stress, anxiety, depression, and posttraumatic stress disorder (PTSD). Their unique working environment also puts them at-risk for physical health issues like obesity, headache, backache, and insomnia. Along with the stress associated with being on the receiving end of difficult calls, call-takers and dispatchers also deal with the pressure and demand of following protocol despite dealing with the variability of complex and stressful situations. METHODS: A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases. RESULTS: A total of 25 publications were retrieved by the search strategy. The majority of studies (n = 13; 52%) reported a quantitative methodology, while nine (36%) reported the use of a qualitative research methodology. One study reported a mixed-methods methodology, one reported an evaluability assessment with semi-structured interviews, one reported on a case study, and one was a systematic review with a narrative synthesis. DISCUSSION: Challenges to physical health included: shift-work leading to lack of physical activity, poor nutrition, and obesity; outdated and ergonomically ill-fitted equipment, and physically confining and isolating work spaces leading to physical injuries; inadequate breaks leading to fatigue; and high noise levels and poor lighting being correlated with higher cortisol levels. Challenges to mental health included: being exposed to traumatic calls; working in high-pressure environments with little downtime in between stressful calls; inadequate debriefing after stressful calls; inappropriate training for mental-health-related calls; and being exposed to verbally aggressive callers. Lack of support from leadership was an additional source of stress. CONCLUSION: Emergency service call-takers and dispatchers experience both physical and mental health challenges as a result of their work, which appears to be related to a range of both operational and support-based issues. Future research should explore the long-term effects of these physical and mental health challenges.

Impact of the caller's emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation.

OBJECTIVE: This study determined the impact of the caller's emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics. METHODS: This was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1-3 callers were graded as cooperative and ECCS 4-5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated. RESULTS: Of the 367 cases, 336 (91.6%) callers were assigned ECCS 1-3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient's breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4-5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4-5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to 'caller refused' or 'overly distraught' factors. CONCLUSIONS: The caller's high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller's emotional state if dispatchers are able to skilfully reassure the emotional callers.

Destress 9-1-1-an online mindfulness-based intervention in reducing stress among emergency medical dispatchers: a randomised controlled trial.

OBJECTIVES: Emergency medical dispatchers (EMDs) experience significant stress in the workplace. Yet, interventions aimed at reducing work-related stress are difficult to implement due to the logistic challenges associated with the relatively unique EMD work environment. This investigation tested the efficacy of a 7-week online mindfulness-based intervention (MBI) tailored to the EMD workforce. METHODS: Active-duty EMDs from the USA and Canada (n=323) were randomly assigned to an intervention or wait list control condition. Participants completed surveys of stress and mindfulness at baseline, post intervention, and 3 months follow-up. Repeated measures mixed effects models were used to assess changes in stress and mindfulness. RESULTS: Differences between the intervention group and control group in pre-post changes in stress using the Calgary Symptoms of Stress Inventory were statistically significant, with a difference of -10.0 (95% CI: -14.9, -5.2, p<0.001) for change from baseline to post intervention, and a difference of -6.5 (95% CI: -11.9, -1.1, p=0.02) for change from baseline to 3 months follow-up. Change in mindfulness scores did not differ between groups. However, increases in mindfulness scores were correlated with greater reductions in stress for all participants, regardless of group (r=-0.53, p<0.001). CONCLUSIONS: Development of tailored online MBIs for employees working in challenging work environments offer a promising direction for prevention and intervention. This study found that a short, weekly online MBI for EMDs resulted in reductions in reports of stress. Implications of online MBIs in other emergency responding populations and directions for future research are discussed.

Public knowledge and expectations about dispatcher assistance in out-of-hospital cardiac arrest.

AIM: To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out-of-hospital cardiac arrest incidents. BACKGROUND: In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. DESIGN: A cross-sectional observational survey containing six questions and seven demographic items. METHOD: From January-June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis. RESULTS: Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one-third knew that the emergency telephone number operator was a trained nurse. CONCLUSION: The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.

Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota.

INTRODUCTION: Very little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession. METHODS: We administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service. We defined the presence of burnout as a high score on either the emotional exhaustion or depersonalization subscales of the MBI. RESULTS: Survey respondents who provided regular 911 response at the time of the survey and completed the MBI portion of the survey were included in our analysis (190 paramedics/EMTs, 19 dispatchers; 54% response). The overall prevalence of burnout was 18%, with prevalence reaching 32% among dispatchers. The seven pediatric critical incident types presented in the survey accounted for seven of the top eight rated most difficult to cope with, and severity ratings for pediatric critical incidents did not differ by parental status (all p>0.30). A significant number of respondents reported that they had been threatened with a gun/weapon (43%) or assaulted by a patient (68%) at least once while on duty. Being over the age of 50, a parent, or in a committed relationship was associated with reduced odds of burnout in unadjusted models; however, these associations did not remain statistically significant in multivariate analysis. Increasing tertile of career exposure to critical incidents was not associated with burnout. CONCLUSION: Medical dispatchers may be an EMS subgroup particularly susceptible to burnout. These data also demonstrate quantitatively that in this EMS agency, responders find pediatric critical incidents especially distressing and that violence against responders is commonplace. In this study, a simple measure of career exposure to potentially critical incidents was not associated with burnout; however, individual reactions to incidents are heterogeneous, and assessment tools that more accurately enumerate encounters that result in distress are needed.

Stressors of Korean Disaster Relief Team Members during the Nepal Earthquake Dispatch: a Consensual Qualitative Research Analysis.

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.

Evaluation of Stress Experienced by Emergency Telecommunications Personnel Employed in a Large Metropolitan Police Department.

Emergency telecommunications personnel (ETCP) form the hub of police agencies and persistently deal with distressing situations on a daily basis, making them highly susceptible to psychological and physiological ailments. To date, few studies have examined the necessity or feasibility of implementing a resilience training intervention for ETCP. In this study, the authors assessed baseline psychological data from the ETCP of a large police department to determine the differences in baseline measures for ETCP and police officers. Participants included ETCP ages 29 to 64 years ( n = 19). Results showed that ETCP self-reported greater levels of psychological stress compared with police officers ( p < .05) for the majority of measures; ETCP experience excessive levels of stress and greater prevalence of chronic disease. Consideration should be given to piloting resilience interventions within this group to manage stress; improve health, performance, and decision making; and decrease the prevalence of chronic disease.

Dispatcher Stroke Recognition Using a Stroke Screening Tool: A Systematic Review.

BACKGROUND: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy. We conducted a systematic review of the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools. METHODS: We conducted a comprehensive search of Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy. Those that specifically reported dispatcher utilization of any validated stroke screening tools in isolation or in the context of a comprehensive screening algorithm such as the Medical Priority Dispatch System (MPDS) were potentially eligible. Studies that reported data sufficient for calculation of dispatcher sensitivity or positive predictive value (PPV) using a hospital-based stroke/transient ischemic attack diagnosis as the reference standard were included. Two independent reviewers determined study eligibility, assessed quality using the QUADAS 2 instrument, and abstracted data. RESULTS: We identified 1,413 potential studies; 54 underwent full text review. Three retrospective and 4 prospective cohort studies enrolling a total of 16,382 patients met the inclusion criteria. Stroke screening tools included MPDS (n = 4), Face Arm Speech Time (n = 2), and a novel screening algorithm developed after analysis of emergency calls for stroke (n = 1). Regardless of the screening tool employed, dispatcher stroke recognition sensitivity was suboptimal (5 studies, range 41-83%) as was the PPV (7 studies, range 42-68%). Primary study limitations included application of variable reference standards and questions regarding exclusion of subjects. No studies directly compared stroke screening algorithms and no studies specifically examined stroke recognition among potential candidates for acute stroke therapies. CONCLUSION: Even when utilizing a stroke screening tool, the accuracy of stroke recognition by emergency dispatchers was suboptimal. More research is needed to identify the causes of poor dispatcher stroke recognition and should focus on potential candidates for time-dependent stroke treatment.