Behavioral Impairments and Increased Risk of Cortical Atrophy Risk Scores Among World Trade Center Responders.

Objective: World Trade Center (WTC) responders are susceptible to both cognitive and neuropsychiatric impairments, particularly chronic posttraumatic stress disorder. The present study examined self-reported behavioral impairments in a sample of 732 WTC responders, 199 of whom were determined to have high risk of WTC-related cortical atrophy by an artificial neural network. Results: We found that responders at increased risk of cortical atrophy showed behavioral impairment across five domains: motivation, mood, disinhibition, empathy, and psychosis (14.6% vs 3.9% in the low-risk group; P = 3.90 × 10-7). Factor analysis models revealed that responders at high risk of cortical atrophy tended to have deficits generalized across all aspects of behavioral impairment with focal dysfunction in sensory psychosis. We additionally describe how relationships are modulated by exposure severity and pharmacological treatments. Discussion: Our findings suggest a potential link between sensory deficits and the development of cortical atrophy in WTC responders and may indicate symptoms consistent with a clinical portrait of parietal dominant Alzheimer's disease or a related dementia (ADRD). Results underscore the importance of investigating neuropsychiatric symptomatology in clinical evaluations of possible ADRD.

PTSD and lower respiratory symptoms: A systematic review of longitudinal associations in early 9/11 World Trade Center responders.

OBJECTIVE: The objective of this systematic review is to examine longitudinal associations between post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) specifically among responders present at the World Trade Center (WTC) site on September 11, 2001 (9/11). This group, which we refer to as "9/11 early responders," appears to have particularly high rates of both mental and physical illness relative to other 9/11-exposed populations. METHODS: We performed a systematic literature review to examine associations between PTSD and LRS among 9/11 early responders in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. After a structured search of Pubmed and the Fire Department of New York (FDNY) WTC bibliography for relevant articles, we identified 4 articles commenting on associations between PTSD and LRS in this population; all 4 passed quality review and were included in our primary analysis. 10 other articles we found in our research discussed rates of PTSD and LRS, but not associations between them, in the population in question; we commented on these in a secondary analysis. RESULTS: The data demonstrate that there are significant associations between PTSD and LRS among 9/11 early responders. The data also suggest that both of these phenomena are more prevalent among 9/11 early responders relative to other 9/11-exposed populations. CONCLUSIONS: These findings are relevant for optimizing care for the population in question, as well as for other survivors of past and future disasters with both psychiatric and medical sequelae.

Logistic and cognitive-emotional barriers experienced by first responders when alarmed to get dispatched to out-of-hospital cardiac arrest events: a region-wide survey.

Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs' perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs' perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs' decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.

Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study. / Application du cadre Theoretical Domains Framework pour cerner les préférences des policiers, des pompiers et des ambulanciers en matière d'accès aux soins de santé mentale dans une clinique de traitement des blessures de stress opérationnel pour les premiers répondants : une étude qualitative.

INTRODUCTION: First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. METHODS: We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. RESULTS: The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. CONCLUSION: The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.

Successful Surgical Airway Performance in the Combat Prehospital Setting: A Qualitative Study of Experienced Military Prehospital Providers.

INTRODUCTION: Military first responders are in a unique category of the healthcare delivery system. They range in skill sets from combat medic and corpsman to nurses, physician assistants, and occasionally, doctors. Airway obstruction is the second leading cause of preventable battlefield death, and the decision for intervention to obtain an airway depends on the casualty's presentation, the provider's comfort level, and the available equipment, among many other variables. In the civilian prehospital setting cricothyroidotomy (cric) success rates are over 90%, but in the US military combat environment success rates range from 0-82%. This discrepancy in success rates may be due to training, environment, equipment, patient factors and/or a combination of these. Many presumed causes have been assumed to be the root of the variability, but no research has been conducted evaluating the first-person point of view. This research study is focused on interviewing military first responders with real-life combat placement of a surgical airway to identify the underlying influences which contribute to their perception of success or failure. MATERIALS AND METHODS: We conducted a qualitative study with in-depth semi-structured interviews to understand participants' real-life cric experiences. The interview questions were developed based on the Critical Incident Questionnaire. In total, there were 11 participants-4 retired military and 7 active-duty service members. RESULTS: Nine themes were generated from the 11 interviews conducted. These themes can be categorized into 2 groups: factors internal to the provider, which we have called intrinsic influences, and factors external to the provider, which we call extrinsic influences. Intrinsic influences include personal well-being, confidence, experience, and decision-making. Extrinsic influences include training, equipment, assistance, environment, and patient factors. CONCLUSIONS: This study revealed practitioners in combat settings felt the need to train more frequently in a stepwise fashion while following a well-understood airway management algorithm. More focus must be on utilizing live tissue with biological feedback, but only after anatomy and geospatial orientation are well understood on models, mannequins, and cadavers. The equipment utilized in training must be the equipment available in the field. Lastly, the focus of the training should be on scenarios which stress the physical and mental capabilities of the providers. A true test of both self-efficacy and deliberate practice is forced through the intrinsic and extrinsic findings from the qualitative data. All of these steps must be overseen by expert practitioners. Another key is providing more time to focus on medical skills development, which is critical to overall confidence and overcoming hesitation in the decision-making process. This is even more specific to those who are least medically trained and the most likely to encounter the casualty first, EMT-Basic level providers. If possible, increasing the number of medical providers at the point of injury would achieve multiple goals under the self-efficacy learning theory. Assistance would instill confidence in the practitioner, help with the ability to prioritize patients quickly, decrease anxiety, and decrease hesitation to perform in the combat environment.

Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State.

This study examined opportunities and challenges faced by individuals working to advance mental health policy and programming for first responders. We utilized qualitative content analysis and interviews with 16 firefighters, emergency medical services professionals, law enforcement officers, and others involved in programming or policy in the U.S. state of Ohio. Six themes characterized opportunities and challenges encountered: (1) variations in programming and policy exist across jurisdictions; (2) opportunities exist to enhance mental health awareness and self-care training for first responders; (3) need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders; (4) confidentiality protections are lacking for peer supporters not trained in critical incident stress management; (5) having an internal champion and broader support is key to program and policy advancement; and (6) interdepartmental collaboration provides opportunities for sharing resources and best practices. Results illustrate continued need for strategic policymaking, program development, and coordination.

Genetic Liability, Exposure Severity, and Post-Traumatic Stress Disorder Predict Cognitive Impairment in World Trade Center Responders.

BACKGROUND: There is a high incidence of cognitive impairment among World Trade Center (WTC) responders, comorbid with post-traumatic stress disorder (PTSD). Yet, it remains unknown whether genetic liability for Alzheimer's disease, PTSD, educational attainment, or for a combination of these phenotypes, is associated with cognitive impairment in this high-risk population. Similarly, whether the effects of genetic liability are comparable to PTSD and indicators of exposure severity remains unknown. OBJECTIVE: In a study of 3,997 WTC responders, polygenic scores for Alzheimer's disease, PTSD, and educational attainment were used to test whether genome-wide risk for one or more of these phenotypes is associated with cognitive impairment, controlling for population stratification, while simultaneously estimating the effects of demographic factors and indicators of 9/11 exposure severity, including symptoms of PTSD. RESULTS: Polygenic scores for Alzheimer's disease and educational attainment were significantly associated with an increase and decrease, respectively, in the hazard rate of mild cognitive impairment. The polygenic score for Alzheimer's disease was marginally associated with an increase in the hazard rate of severe cognitive impairment, but only age, exposure severity, and symptoms of PTSD were statistically significant predictors. CONCLUSION: These results add to the emerging evidence that many WTC responders are suffering from mild cognitive impairments that resemble symptoms of Alzheimer's disease, as genetic liability for Alzheimer's disease predicted incidence of mild cognitive impairment. However, compared to polygenic scores, effect sizes were larger for PTSD and the type of work that responders completed during rescue and recovery efforts.

Turning to 'Trusted Others': A Narrative Review of Providing Social Support to First Responders.

First responders, such as paramedics and firefighters, encounter duty-related traumatic exposures, which can lead to post-traumatic stress (PTS). Although social support protects against PTS, we know little about how first responders' families, spouses/partners, friends, and care-partners (i.e., 'trusted others') provide social support. This narrative review explores support behaviors, coping strategies, and resources trusted others use to support first responders. A structured literature search yielded 24 articles. We used House's (1981) conceptual framework to inform our analysis. We identified three main themes: providing support, finding support, and support needs. Additionally, we describe trusted others' self-reported preparedness, coping strategies, and barriers to providing social support. We found that trusted others provided different types of support: (a) emotional (fostering a safe space, giving autonomy over recovery, facilitating coping mechanisms, prioritizing first responders' emotional needs); (b) instrumental (prioritizing first responders' practical needs, handling household tasks, supporting recovery); (c) appraisal (active monitoring, verbal reassurance, positive reframing), and (d) informational (seeking informal learning). In their role, trusted others sought formal (organizational) and informal (peer and personal) support and resources, alongside intrapersonal and interpersonal coping strategies. Identified barriers include inadequate communication skills, maladaptive coping, and disempowering beliefs. Thus, we offer practical, treatment, and social support recommendations.

DTI Connectometry Analysis Reveals White Matter Changes in Cognitively Impaired World Trade Center Responders at Midlife.

BACKGROUND: More than 8% of responders who participated in the search and rescue efforts at the World Trade Center (WTC) following 9/11 developed early-onset cognitive impairment (CI). Approximately 23% were also diagnosed with chronic post-traumatic stress disorder (PTSD). OBJECTIVE: To shed light on the pathophysiology of these WTC-related conditions, we examined diffusion connectometry to identify altered white matter tracts in WTC responders with CI and/or PTSD compared to unaffected responders. METHODS: 99 WTC responders (mean age 56 years) consisting of CI-/PTSD- (n = 27), CI+/PTSD- (n = 25), CI-/PTSD+ (n = 24), and CI+/PTSD+ (n = 23) were matched on age, sex, occupation, race, and education. Cognitive status was determined using the Montreal Cognitive Assessment and PTSD status was determined using the DSM-IV SCID. Diffusion tensor imaging was acquired on a 3T Siemens Biograph mMR scanner. Connectometry analysis was used to examine whole-brain tract-level differences in white matter integrity as reflected by fractional anisotropy (FA) values after adjusting for confounders. RESULTS: Analyses identified that FA was negatively correlated with CI and PTSD status in the fornix, cingulum, forceps minor of the corpus callosum and the right uncinate fasciculus. Furthermore, FA was negatively correlated with PTSD status, regardless of CI status in the superior thalamic radiation and the cerebellum. CONCLUSION: This is the first connectometry study to examine altered white matter tracts in a sample of WTC responders with CI and/or PTSD. Results from this study suggest that WTC responders with early-onset CI may be experiencing an early neurodegenerative process characterized by decreased FA in white matter tracts.

Breaking down barriers to help-seeking: preparing first responders' families for psychological first aid.

Background: First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first responders' mental health suffers. Objective: We need more accessible routes to crisis intervention to ensure first responder resilience and wellbeing, so they may continue to function in the service of public safety. Family members and close friends may be ideally placed to provide this immediate care. This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved one's wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations. Conclusion: We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress. HIGHLIGHTS: By training family members in psychological first aid, we may strengthen existing social support for first responders, providing more options for, and potentially breaking down stigma associated with help-seeking.

Antecedentes: Los equipos de primera respuesta se encuentran regularmente con estresores operacionales y eventos potencialmente traumáticos, aumentando su riesgo de problemas de salud mental. Debido a las complejidades culturales únicas, ellos se dirigen a sus pares por apoyo psicosocial temprano. Sin embargo, el apoyo de pares y/o la asistencia de salud mental puede que no esté siempre disponible o sea de fácil acceso y la salud mental de los equipos de primera respuesta se resiente.Objetivo: Se necesitan rutas más accesibles para la intervención en crisis para asegurar la resiliencia y el bienestar de los equipos de primera respuesta, entonces ellos podrían continuar funcionando en el servicio de la seguridad pública. Los familiares y los amigos cercanos podrían estar en posición de otorgar este apoyo inmediato. Este artículo presenta el rol protector del apoyo social como una estrategia de intervención temprana para mitigar los efectos del trauma de los equipos de primera respuesta, explorando la oportunidad potencial de los familiares y amigos para jugar un rol creciente de apoyo en el bienestar de sus seres queridos. Este artículo sirve como un llamado a la acción para intervenciones educacionales prácticas que prepararan a los familiares para estas conversaciones críticas.Conclusión: Vemos un potencial en combinar las perspectivas de la teoría de intervención temprana, psicoeducación, y psicología positiva especifica de género basado en las fortalezas. Las investigaciones futuras deberían investigar cómo se puede ayudar de mejor forma los equipos de primera respuesta para derribar las barreras al apoyo, fortaleciendo sus redes sociales actuales y así reducir el estigma asociado con la experiencia de estrés traumático.

The nature of posttraumatic stress disorder in treatment-seeking first responders.

Background: Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD. Objective: This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. Method: Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results: First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. Conclusions: These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

Antecedentes: Aproximadamente el 10% de los primeros respondedores informan de un trastorno de estrés postraumático (TEPT). Aunque los informes dentro de los primeros respondedores sugieren que tienen presentaciones de síntomas distintos, es necesario comprender cómo los perfiles clínicos de los primeros respondedores pueden diferir de otros que buscan tratamiento para el TEPT.Objetivo: Este estudio comparó los perfiles de los síntomas del TEPT de los primeros respondedores y de los civiles que buscan tratamiento para el TEPT.Método: Los participantes se autorreferían a la Clínica de Estrés Traumático (Universidad de Nueva Gales del Sur, Sydney) para inscribirse en ensayos de tratamiento ambulatorio para el TEPT. Los participantes eran personas con una edad media de 41,72 años (SD = 10,71) que cumplían los criterios del DSM-IV para el TEPT. La muestra estaba compuesta por 128 primeros respondedores y 182 civiles. Se llevaron a cabo entrevistas administradas por el clínico sobre el TEPT (Clinician-Administered PTSD Scale) y depresión, así como medidas de auto-reporte sobre la depresión, el consumo de alcohol, las valoraciones postraumáticas y la ira.Resultados: Los primeros respondedores informaron mayores tasas de síntomas disfóricos, incluyendo la disminución del interés, el embotamiento emocional y el desapego social, y menos reactividad psicológica y evitación de situaciones, que los civiles con TEPT. Además de los síntomas del TEPT, los primeros respondedores también informaron de niveles más graves de depresión y de ira reprimida.Conclusiones: Estos resultados indican que los primeros respondedores que buscan tratamiento presentan un perfil clínico distinto que se caracteriza por síntomas disfóricos. Estos síntomas pueden predecir una mala respuesta al tratamiento y requieren una atención específica en el tratamiento del TEPT en los primeros respondedores.

Factors That Affect Emergency Responder Wellbeing: Considerations for Public Health Responders.

PURPOSE: The purpose of this study is to identify key risk factors that could negatively affect public health emergency responders' health and wellbeing. We seek to use this information to provide recommendations and strategies to mitigate such risks. DESIGN/METHODOLOGY/APPROACH: A narrative review of the peer-reviewed literature on wellbeing of military personnel and other responders was conducted. Data was grouped and categorized according to overarching domains. FINDINGS: Factors associated with wellbeing were categorized into 5 domains: (1) demographics; (2) mental health concerns; (3) social networks; (4) work environment; and (5) postdeployment life. The strategies identified to promote wellbeing included mental health assessments, preparedness trainings, debriefs in the field, postdeployment debriefs, resources in the field, and further postdeployment decompression strategies. ORIGINALITY/VALUE: This study provides a unique understanding of the risk factors associated with poor health and wellbeing outcomes in public health emergency response work by extending the body of knowledge that focuses on other types of emergency and military response.

The protective effects of perceived cohesion on the mental health of first responders.

First responders are repeatedly exposed to traumatic and stressful situations. Perceived cohesion can mitigate the potentially harmful psychological impact of these stressors. While the positive effects of cohesion have been established in other trauma-exposed populations such as the military, these effects have not been examined in first responders. Furthermore, prior studies have not ruled out the possibility that perceived cohesion may be acting as a proxy for another well-established protective factor, social support. We therefore examined how perceived cohesion among first responder organizations impacts psychological health and resilience, even after accounting for the effects of social support. First responders (N = 182) completed measures of perceived cohesion, social support, psychological symptoms (including depression, stress, anxiety, posttraumatic stress symptoms, secondary traumatic stress symptoms, and burnout), and psychological resilience. Even after controlling for social support, perceived cohesion was associated with lower levels of psychological symptoms (ß = -.18 to -.33; p < .05; for secondary traumatic stress, posttraumatic stress, depression, and each facet of burnout) and higher levels of resilience (ß = .37; p < .05). These results suggest that perceived cohesion promotes psychological health among first responders, even after controlling for social support. Thus, perceived cohesion does not seem to be acting as a mere proxy for social support. Further examination of how perceived cohesion benefits first responders could lay the groundwork for interventions to improve their mental health and psychological resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Understanding the psychological impacts of responding to a terrorist incident.

Background: Responding to a mass casualty event can cause significant distress, even for highly trained medical and emergency services personnel. Objective: The purpose of the study was to understand more about first responders' perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response. The aim of the work was to improve preparedness and response for future incidents. Methods: This study reports a detailed analysis of qualitative interview data from frontline staff who responded to a large mass casualty terrorist incident in the UK in 2017. Data highlighted the psychological distress caused by responding to terrorist events and thus became the focus of further, detailed analysis. Results: Participants (n = 21) articulated in their own words the psychological distress experienced by many of the first responders to the event. Participants reported that they were not prepared to deal with psychological impact associated with this mass casualty terrorist incident and their role in the response, and that follow-up support was inconsistent. Multiple factors were identified as potentially increasing psychological distress. Social support provided by peers and organizational debriefs were identified as two most common support mechanisms. Organizational support was identified as inconsistent. Conclusions: This research contributes to the literature the voices of first responders to UK terrorist incidents, building on existing findings while further contributing unique contextual perspectives. This research reinforces the importance of psychosocial support for those who respond to these tragic incidents, and offers a number of recommendations for organizational preparedness for future events. Abbreviations: A&E: Accident and Emergency; EPRR: Emergency Preparedness, Resilience and Response; ERD: Emergency Response Department; HEPE: Health Emergency Preparedness Exercise; PHE: Public Health England; PHE REGG: Public Health England Research Ethics and Governance Group; MCI: Mass Casualty Incident; NHS: National Health Service.

Antecedentes: Responder a un evento con presencia masiva de víctimas puede causar una angustia psicológica significativa, aún para el personal médico y de emergencias altamente entrenados.Objetivo: El propósito del estudio fue tener una mayor comprensión acerca de la perspectiva de los primeros respondedores sobre su participación en la respuesta a incidentes mayores, específicamente cómo y qué factores individuales y del sistema contribuyeron a su preparación o que pudieron haber habilitado u obstaculizado su respuesta. El objetivo del trabajo fue de mejorar la preparación y respuesta para futuros incidentes.Métodos: Este estudio reporta un análisis detallado de los datos de entrevistas cualitativas realizadas al personal de primera línea que respondieron a un gran incidente terrorista con víctimas masivas en el Reino Unido durante el 2017. Los datos destacaron la angustia psicológica causada por responder a eventos terroristas y, por lo tanto, se convirtieron en el foco de un análisis más detallado.Resultados: Los participantes (n = 21) articularon en sus propias palabras la angustia psicológica experimentada por muchos de los primeros en responder al evento. Los participantes reportaron que no se encontraban preparados para lidiar con el impacto psicológico asociado con este incidente terrorista con víctimas masivas y su rol en la respuesta, y que el soporte durante el seguimiento fue inconsistente. Se identificaron múltiples factores con pueden incrementar la angustia psicológica. El apoyo social proporcionado por los pares y el 'debriefing' organizacional fueron identificados como los dos mecanismos de apoyo más comunes. El apoyo organizacional se identificó como inconsistente.Conclusiones: Esta investigación contribuye a la literatura las voces de los primeros respondedores a los incidentes terroristas del Reino Unido, basándose en los hallazgos existentes y, al mismo tiempo, aporta perspectivas contextuales únicas. Esta investigación refuerza la importancia del apoyo psicosocial para quienes responden a estos trágicos incidentes, y ofrece una serie de recomendaciones para la preparación organizacional para eventos futuros.

PSYCHOPHYSIOLOGICAL FEATURES OF RADIATION RISK PERCEPTION. / PSYKhOFIZIOLOGIChNI OSOBLYVOSTI SPRYINIaTTIa RADIATsIINOGO RYZYKU.

OBJECTIVE: to determine the subjective and psychophysiological characteristics of the perception of radiation risk,to identify destructive individual-typological personality traits, as well as factors that can be the basis of psycho-logical compensation for victims of various radiation disasters and accidents. OBJECT AND METHOD: A comparative analysis of psychometric and neurophysiological parameters of hypertrophiedperception of radiation risk in the following groups was carried out: liquidators (clean-up workers) of the conse-quences of the Chornobyl accident and evacuees from the Chornobyl exclusion zone (CEZ) - 317 people total, par-ticipants in the anti-terrorist operation (ATO) - 101 people, and control group - 85 people. We used psychodiagnos-tic and neurophysiological (computerized electroencephalography) techniques. RESULTS: In the groups of liquidators and evacuees from CEZ there are significantly more people with hypertrophiedperception of radiation risk compared to the control group and the comparison group (liquidators - 71.88 %, liqui-dators-evacuees - 80.0 %, evacuees 76.92 %, ATO participants - 33.78 %, control group - 35.0 %). Among therespondents with hypertrophied perception of radiation risk radiation factors, and, most of all, diseases associatedwith ionizing radiation, hold the first rank places among 31 evaluated factors in all groups. The respondents withadequate perception of the radiation risk are primarily concerned about social stress and environmental factors.Correlation analysis showed that there are no correlation between hypertrophied perception of radiation risk andactual documented radiation dose. Hypertrophied perception depends on gender, level of education, family incomeand level of knowledge about ionizing radiation. It affects perception of one's health, makes you feel helpless,increase the level of distress from the Chornobyl disaster and the Fukushima-1 disaster in Japan, and is also associ-ated with the Revolution of Dignity. Hypertrophied perception of radiation risk contributes to disorders of psycho-somatic health and deformation of personality traits. Comparative analysis of the parameters of bioelectrical activ-ity of the brain of persons with hypertrophied perception of the radiation threat showed an increase in brain's delta-,theta- and beta- activity with suppression of alpha-activity and dominant frequency. CONCLUSIONS: In all examined groups a significant percentage of people with hypertrophied perception wererevealed. The key role in the process of perception of a radiation risk is played not by the real danger of the situa-tion and the documented dose of radiation, but by its perception and awareness. Hypertrophied perception of theradiation risk contributes to psychosomatic health disorders and deformation of personality traits, which is con-firmed by neurophysiological studies.

Trastornos del sueño en emergencias y desastres / Sleep disorders in emergencies and disasters

Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.

Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and/or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.

Dissociative symptoms predict severe illness presentation in Canadian public safety personnel with presumptive post-traumatic stress disorder (PTSD).

Background: Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD. Few studies have reported on the clinical characteristics of Canadian samples of PSP and even fewer have examined the dissociative subtype of PTSD, which is associated with more severe, chronic traumatic experiences, and worse outcomes. Objective: This study aimed to characterize dissociative symptoms, PTSD symptom severity, and other clinical variables among Canadian PSP with presumptive PTSD. Methods: We sampled current and past PSP in Canada from both inpatient and outpatient populations (N = 50) that were enrolled in a psychological intervention. Only baseline testing data (prior to any intervention) were analysed in this study, such as PTSD symptom severity, dissociative symptoms, emotion dysregulation, and functional impairment. Results: In our sample, 24.4% self-reported elevated levels of dissociation, specifically symptoms of depersonalization and derealization. Depersonalization and derealization symptoms were associated with more severe PTSD symptoms, greater emotion dysregulation, and functional impairment. Conclusions: Nearly a quarter of this sample of Canadian PSP reported experiencing elevated levels of PTSD-related dissociation (depersonalization and derealization). These high levels of depersonalization and derealization were consistently positively associated with greater illness severity across clinical measures. It is imperative that dissociative symptoms be better recognized in patient populations that are exposed to chronic traumatic events such as PSP, so that treatment interventions can be designed to target a more severe illness presentation.

Antecedentes: El trastorno de estrés postraumático afecta al 9% de los individuos a lo largo de su vida y se incrementa casi cuatro veces hasta el 35% en el personal de seguridad pública canadiense (PSP). Las experiencias en el trabajo de los PSP cumplen con frecuencia los criterios de eventos traumáticos, lo que hace que estos individuos sean muy vulnerables a la exposición al trauma y a las consecuencias negativas del TEPT. Pocos estudios han informado sobre las características clínicas de las muestras canadienses de PSP y aún menos han examinado el subtipo disociativo del TEPT, que se asocia con experiencias traumáticas más graves y crónicas, y con peores resultados.Objetivo: Este estudio tenía como objetivo caracterizar los síntomas disociativos, la gravedad de los síntomas del TEPT y otras variables clínicas entre los PSP canadienses con presunto TEPT.Métodos: Tomamos una muestra de PSP actuales y pasados en Canadá de poblaciones de pacientes hospitalizados y ambulatorios (N = 50) que se inscribieron en una intervención psicológica. En este estudio sólo se analizaron los datos de las pruebas de referencia (antes de cualquier intervención), como la gravedad de los síntomas del TEPT, los síntomas disociativos, la desregulación de las emociones y el deterioro funcional.Resultados: En nuestra muestra, el 24,4% auto-reportó niveles elevados de disociación, específicamente síntomas de despersonalización y des-realización. Los síntomas de despersonalización y des-realización se asociaron con síntomas de TEPT más graves, mayor desregulación de la emoción y deterioro funcional.Conclusiones: Casi una cuarta parte de esta muestra de PSP canadiense reportó experimentar niveles elevados de disociación relacionada con el TEPT (despersonalización y des-realización). Estos niveles elevados de despersonalización y des-realización se asociaron positivamente de forma consistente con una mayor gravedad de la enfermedad en las medidas clínicas. Es imperativo que se reconozcan mejor los síntomas disociativos en las poblaciones de pacientes que están expuestos a eventos traumáticos crónicos como el PSP, para que las intervenciones de tratamiento puedan ser diseñadas para dirigirse a una presentación de la enfermedad más severa.

Estrés post-traumático en la atención de emergencias y rescates / Post-traumatic stress disorder in emergency response

Introducción: Los trabajadores de emergencias están expuestos a situaciones potencialmente traumáticas, por lo que sería de interés evidenciar si existe relación entre dichos profesionales y el Trastorno de Estrés Postraumático (TEPT). Nuestro objetivo es conocer si existe evidencia de relación causal entre el desarrollo de TEPT y ser profesional de rescate, además de identificar factores de vulnerabilidad asociados e intervenciones preventivas y terapéuticas eficaces. Método: Revisión sistemática mediante búsquedas bibliográficas en MEDLINE en bases de datos PUBMED, SCOPUS, EMBASE, WOS, Cochrane Library Plus, IBECS, LILACS y CISDOC, usando términos MeSH «emergency responders» y «stress disorder, post-traumatic». Se aplicaron estándares de calidad CONSORT, STROBE y comprobamos la evidencia mediante el sistema SIGN. Resultados: Se seleccionaron 6 ECA (n=783) y 1 estudio de cohortes históricas (n=4487). Se describen como factores de riesgo más frecuentes: sexo femenino 2.93(1.42-6.07), diagnóstico de depresión o ansiedad 4.72(2.33-9.57) en cronicidad y abuso de sustancias 5.12(2.62-9.97) en empeoramiento del TEPT. No hay mejoras en las intervenciones preventivas (p=0.712-0.749) y (p=0.246-0.881). En 2 ECA se evidenció una reducción en la gravedad de los síntomas del TEPT mediante Terapia Cognitivo Conductual (TCC) (p=0.001 y 0.05). Existen 2 ECA con oxitocina que revelan impacto en regiones neurales para gestión emocional (p=0.0024-0.044). Conclusiones: Existe relación causal entre el TEPT y los trabajadores de emergencias (evidencia 2+). Como tratamiento, la TCC resulta efectiva para la reducción de síntomas de TEPT (evidencia 1+). Se mostraron como principales los factores de vulnerabilidad antes mencionados (evidencia 1+). La oxitocina mostró evidencia como aliado terapéutico (evidencia 1+). (AU)

Introduction: Emergency workers are exposed to potentially traumatic situations, so it would be of interest to show whether there is a relationship between these professionals and the development of Post-Traumatic Stress Disorder (PTSD). The aim is to know if there is evidence of such relationship, in addition to identify associated vulnerability factors and effective preventive and therapeutic interventions. Method: Systematic review through bibliographic research in MEDLINE in PUBMED, SCOPUS, EMBASE, WOS, Cochrane Library Plus, IBECS, LILACS and CISDOC databases, using MeSH terms «emergency responders» and «stress disorder, post-traumatic». CONSORT, STROBE quality standards were applied and we checked the evidence using the SIGN system. Results: They were selected 6 RCTs (n = 783) and 1 historical cohort study (n = 4487). The most frequent risk factors are: female sex 2.93 (1.42-6.07), diagnosis of depression or anxiety 4.72 (2.33-9.57) in chronicity and substance abuse 5.12 (2.62-9.97) in worsening of PTSD. There are no improvements in preventive interventions (p = 0.712-0.749) and (p = 0.246-0.881). In 2 RCTs, a reduction in the severity of PTSD symptoms was evidenced by Cognitive Behavioral Therapy (CBT) (p = 0.001 and 0.05). There are 2 RCTs with oxytocin that reveal an impact on neural regions for emotional management (p = 0.0024-0.044). Conclusions: There is a causal relationship between PTSD and emergency workers (evidence 2+). As a treatment, CBT is effective in reducing PTSD symptoms (evidence 1+). The aforementioned vulnerability factors were shown as the most important (evidence 1+). Oxytocin showed evidence as a therapeutic ally (evidence 1+). (AU)

Management of COVID-19-related challenges faced by EMS personnel: a qualitative study.

BACKGROUND: As the first link in the chain of providing healthcare services in the frontline of the battle against COVID-19, emergency medical services (EMS) personnel are faced with various challenges, which affect their professional performance. The present study aimed to identify some strategies to manage the COVID-19-related challenges faced by the pre-hospital emergency care personnel in the south of Iran. METHODS: In this qualitative descriptive study, 27 pre-hospital emergency care personnel who were selected through the purposeful sampling method. Data were collected through 27 semi-structured, in-depth, individual interviews. The collected data were then analyzed based on the Granheim and Lundman's method. RESULTS: Analysis of the data resulted in the identification of 3 main themes and eight sub-themes. These three main themes were as follows: comprehensive and systematic planning, provision of medical equipment, and reduction of professional challenges. CONCLUSION: The findings of the present study showed that, during the COVID-19 crisis, emergency medical services personnel should be provided with a comprehensive and systematic protocol to provide pre-hospital care and their performance should be assessed in terms of a set of scientific standards. Due to lack of equipment and work overload in the current crisis, emergency medical services personnel are faced with many psychological challenges, which adversely affect their quality of pre-hospital emergency care. Furthermore, emergency care senior managers should develop comprehensive protocols, provide more equipment, and eliminate professional challenges to pave the ground for improving the quality and safety of the healthcare services in pre-hospital emergency care during the current COVID-19 crisis.