Jeffrey T. Mitchell

Evaluation of psychological debriefings

This paper describes the impact of critical incidents and psychological debriefings on 172 emergency service, welfare and hospital personnel in Australia. Experience of trauma at work was found to reactivate prior trauma in one in two personnel. Psychological debriefing was reported to reduce stress symptoms in almost all personnel who reported stress response. The effectiveness of the debriefing was found to derive, in large part, from talking and in particular from talking with others who had experienced the same situation.

Work with traumatized children — psychological effects and coping strategies

Work with traumatized children has a profound effect on emergency personnel and other health care providers. It is hypothesized that work with seriously ill or injured children potentiates motivating factors in the helpers personality, brakes down natural defenses and leads to strong identification with the victims. In this paper various psychological effects on the rescuer are outlined. Coping strategies used by health care personnel in the acute phase of an emergency are identified. Mental preparation, suppression of emotions, distancing from certain aspects of the event, and dehumanizing were frequently utilized coping strategies. Other coping mechanisms were regulating the amount of exposure, activities to restrict reflection, developing a sense of purpose, and self-reassuring comments. Postexposure response to child trauma include helplessness, fear and anxiety, existential insecurity, rage, sorrow and grief, intrusive images, self-reproach, shame and guilt, and changes in values. Emotional distancing and other self-protective strategies seem important at the scene; self-disclosure by talking about impressions and reactions is most helpful afterwards. However, carefully timed and executed interventions are necessary to break through the defensive barriers which are established by health care and other emergency personnel.

Critical Incident Stress Debriefing (CISD) and the Prevention of Work-Related Traumatic Stress among High Risk Occupational Groups

The impact of post-traumatic stress upon society is most floridly apparent through the process of warfare. Indeed, it is hard to imagine a more destructive and psychologically debilitating process than warfare. Had there not been a Vietnam conflict, post-traumatic stress disorder (PTSD) may never have found its way into the official psychiatric taxonomy of the third edition (DSM-III) of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 1980). Yet warfare is not the only set of conditions, by far, capable of engendering post-traumatic stress.

Psychological debriefing: Critical Incident Stress Management and Critical Incident Stress debriefings: evolutions, effects and outcomes

This chapter describes and reviews the comprehensive Critical Incident Stress Management (CISM) system. The components of critical incident stress management include preincident education/mental preparedness training, individual crisis intervention, support/on-scene support, demobilization after disaster or large-scale events, defusing, critical incident stress debriefing, other significant support services for families and children, and follow-up services and professional referrals as necessary. The concepts and mechanisms that are thought to serve as a foundation for CISM as a crisis response system are: early intervention, the provision of psychosocial support, the opportunity for expression, and crisis education. These factors are the four cornerstones of CISM. The studies reviewed in the chapter indicate that a comprehensive, systematic and multicomponent crisis intervention approach to traumatic stress, namely CISM, has an excellent potential for mitigating critical incident stress and restoring people to normal life functions.

Traumatic Stress in Disaster Workers and Emergency Personnel

It has long been known that victims of disasters and other smaller, but still painful, life events suffer significant short- and/or long-term psychological sequelae. The focus of most psychosocial interventions and follow-up services or research during the last three or four decades has been on the actual victims and survivors of the distressing events. Those who came to help others (e.g., emergency medical service personnel) were thought to be trained not to react to human carnage and destruction or to the pain of the survivors. They were considered exempt from the psychological sequelae which befell the victims and survivors. However, recent research and experience with emergency personnel, such as firefighters, paramedics, police officers, and disaster workers, clearly indicates that these helpers are subjected to Stressors which can produce an array of psychological, social, and physical reactions that may be extremely stressful.

Experimentation in computer science: an empirical view

In many disciplines, scientific inquiry relies heavily on experimentation. Computer science is compared to other scientific disciplines in its use of experimentation by classifying articles in professional journals as experimental or non-experimental. The results of the classification suggest that experiments occur less frequently in computer science than in many other disciplines.

Life after the Emergency Services: An Exploratory Study of Well Being and Quality of Life in Emergency Service Retirees

Much is known about the negative impact of emergency services work, but no studies, to date, have investigated its long-term consequences. This cross-sectional study assesses the possible long-term effects on quality of life, of trauma exposure and emergency work in a sample of retirees from the Irish emergency services (n = 169) and a comparison group of non-emergency service retirees (n = 140). A multi-questionnaire postal survey was administered to assess quality of life (QoL; WHOQOL-BREF), experiences of trauma, and trauma symptoms (PSS-SR). QoL was significantly better in non-emergency retirees, whilst this group also had significantly fewer trauma symptoms. Incidents involving children were identified by a large proportion of emergency retirees as being particularly difficult to manage. The findings address a significant gap in our knowledge around the possible longer-term effects of emergency services work in an often neglected sub-group. Factors associated with increased QoL and reduced symptoms of PTSD are discussed, as are some possible recommendations for the future.

Retirement Policies and Support for Emergency Service Personnel: The Transition to Retirement

RÉSUMÉ:L’objectif principal de cette étude a été d’examiner les politiques et les procédures pour soutenir les employés prenant leur retraite de leur travail aux services d’urgence. On a mené des entrevues avec les participants qui connaissaient bien les politiques et les procédures actuelles d’un grand ambulance (n = 8) et le service d’incendie (n = 6) en Irlande. Quatre thèmes principaux ont été révelés: (1) «Je ne pense pas que ce soit un bon travail d’etre ambulancier d’urgence quand on a 65 ans»; (2) “ils se sentent véritablement un tout petit peu isolé”; (3) l’amélioration du «choc culturel»; et (4) «Je continue a m’avancer en espérant que tout aille pour le mieux. » Les conclusions indiquent que la retraite est un changement majeur de la vie, et mettent en évidence la nécessité pour une préparation de pré-retraite plus structurée et efficace. Les éléments uniques au personnel des services d’urgence comprennent: le stress physique et émotionnel intense impliqué dans les services d’urgence; une forte identification avec ce service; et un manque de clarté sur les règles et les droits, exigeant meilleure renseignements et préparation pour prendre sa retraite.ABSTRACT:The aim of this study was to explore policies and procedures to support employees who retire from the emergency services. Interviews were conducted with participants who were familiar with existing policies and procedures in a large ambulance (n = 8) and fire (n = 6) service in Ireland. Four key themes were identified: (1) “I don’t think it’s a job at 65 to be running out on an emergency ambulance”; (2) “They do genuinely feel a wee bit isolated”; (3) improving the “cultural shock”; and (4) “I just keep going and hope for the best”. Findings point towards retirement as a major life change and highlight a need for more structured, effective pre-retirement preparation. Factors unique to emergency service personnel include the physical and emotional stress involved in emergency service; a strong identification with the service; and a lack of clarity about rules and entitlements, requiring better information and preparation.

Stress in Emergency Personnel

Abstract Police, firefighters, emergency medical technicians, paramedics, emergency communications personnel, emergency department and critical care workers, and military personnel involved in life-saving missions are in high intensity and high-risk professions. From the alert tones to the direct efforts to serve and save others, emergency operations personnel contend with a great deal of stress. The rates of posttraumatic stress disorder in emergency personnel rival, and sometimes, surpass those of combat veterans. Stress impacts their personal and professional lives. Frequent exposure to traumatic stress contributes to marital and relationship discord, premature retirements, and excessive use of sick time. The psychological impacts of emergency services stress can also produce alterations in personality, chronic emotional distress, panic attacks, substance abuse and stress-related disorders. There is obviously a need to provide a comprehensive, integrative, systematic, and multicomponent staff support program to alleviate distress in these populations.