Post ambulance call emotional stress experienced by Irish emergency ambulance workers: a new tool


A recent study by Stephen O Connell, a Paramedic in the Army Medical Corps and a Master of Science graduand in Occupational Health at UCC, brings an interesting focus on the emotional feelings experienced after a critical ambulance call by frontline EMS personnel in Ireland. Among its main findings were that rural Advanced Paramedics (AP) are more vulnerable to post incident emotional sequelae pertaining to peri-traumatic stress after a critical incident than their city based AP colleagues. Also, rural APs reported driving to the scene alone as twice as stressful as driving to hospital afterwards with patient. He reckons that a new critical incident stress tool used in Toronto can be utilised by CISM teams in Ireland to measure post incident emotions. 
Using a study group comprising of city and rural based Advanced Paramedics, Paramedics and EMTs he distributed a questionnaire survey among ambulance bases in a large Irish city and a separate large provincial region to form a cohort of paramedics working in rural and city areas.

Previous studies

A number of studies have taken place in Ireland around work related stress among ambulance personnel. The National Ambulance Service Stress Study in 2008 (NASSS 2008) formed the largest examination to date. Further studies by the Dept of Psychology at NUIM Maynooth (Gallagher and McGilloway, 2003, 2007 and 2009) have centred on the prevalence of critical incident stress among ambulance personnel in Ireland. Recent international studies of ambulance personnel in Toronto Canada have centered on the “emotional sequelae” arising after a particularly difficult ambulance call (Halpern et al 2012). Bearing this in mind the UCC student obtained the required permissions and constructed a questionnaire set. This included questions about the general characteristics of the group and questions to compare the stress reporting of city and rural EMS staff in Ireland. Crucially, he used a questionnaire measurement tool from Toronto to assess emotional feelings, post event, called the Critical Incident Inventory©. A cross sectional study design was chosen to gather his quantity of evidence. 


One of the more interesting findings of the survey was reported by advanced paramedics from rural areas. Of those who stated yes to working alone on a rapid response vehicle (RRV) in rural areas, 65% reported driving to the scene as been more stressful than driving afterwards to the hospital with the patient.  

This suggests that a number of factors could increase stress for the rural lone worker. Trying to find an address in a rural area when driving to an unfamiliar scene! Driving alone to an accident scene as an AP! Unfamiliarity with local geography and roads can all raise the stress levels for those new to a work location. Also, stress on the advanced paramedic\ paramedic in anticipation of having to work a shift as a lone responder can lead to a number of psychosocial work-related illnesses which could lead on to periods of absence from work. 

Pre education courses around post event emotions and feelings; and also driving stressors need to be introduced, particularly for rural APs during training to negate the impact of critical calls on this higher grade of EMS professional. Use of the new Critical Incident Inventory© tool  in its various sizes of questionnaires combined with further mixed method surveys would supplement the existing studies to date and find broader considerations around health and safety of EMS personnel. This would provide a platform for integrating  post incident emotional  identification to personal in training so as to fore arm them of the emotions that will likely arise in the course of their careers. 

The monitoring and evaluation of health surveillance procedures among exposed populations of EMS workers can be supplemented by the use of the Critical Incident Inventorys©.
The lone worker recommendations for AP deployment and RRV activation (NASRI) should include pre event stress education and self-identification of what emotions and feelings that can arise post call for the EMS professional. . “Educating paramedics about identifying emotions may offer a new approach to preventing adverse effects of occupational stress” (Halpern et al 2012c) 


This article is based on a thesis that was produced as part of the Master of Science Occupational Health degree at University College Cork, Department of Epidemiology and Public Health. The thesis was supervised by Dr John Gallagher, Occupational Health Physician HSE South


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