As a professional group, paramedics experience disproportionate levels of stress and burnout compared with other healthcare professionals and emergency workers. Evidence suggests that stressors include lack of control over decision-making and tensions with management, as well as the more traditional stressors, such as witnessing pain and distress, and being vulnerable to abuse.
Shepherd and Wild’s pilot study aimed to investigate possible links between how a situation is appraised at the time and how well that situation is coped with afterwards. This is important because the degree to which a person remains objective during a difficult event, and their ability to reappraise negative perceptions is strongly associated with recovery from post traumatic stress disorder (PTSD).
Forty-five participants (18 paramedics; 27 emergency medical technicians) were recruited to this study, which used a within-subjects design. They completed various scales including the post traumatic stress diagnostic scale; the Beck depression inventory; and a trauma screener exploring 19 different categories of traumatic events. After this, participants completed a ‘responding to difficult call-outs’ questionnaire. The participants had to identify two different but challenging calls: one where they felt they coped well, and one where they felt they coped poorly.
They were asked to rate their degree of objectivity during these calls on a scale of 0–100%. Finally, they had to identify which of 13 cognitive appraisal statements applied to them during those situations. The appraisal statements were either positive (e.g. ‘I imagined the event/people getting better’) or negative (e.g. ‘I imagined the situation getting worse’) in nature.
The researchers found an association between the type of cognitive appraisal made at the time and the degree of subsequent coping. As predicted in the study’s hypotheses, in patient encounters where participants perceived they had coped well, they reported more positive and fewer negative appraisals (using Pearson’s correlation coefficient, a small to moderate effect (r=0.23) was demonstrated); and where participants felt they had not coped so well they reported fewer positive and more negative appraisals (r=0.45—demonstrating a moderate to large effect).
These findings could have relevance for ambulance staff’s health when considering how to enhance and develop individuals’ coping strategies. For example, teaching ambulance crews some effective techniques in cognitive reappraisal could be useful in reducing any effects of associated negative appraisals of traumatic events. It may be that paramedics could be trained to become more resilient, which could be of value not only to the profession but also to the wider health economy if this reduces PTSD and other negative consequences of stress.
The authors discuss several limitations with the study. For example, participants were recruited from only one ambulance station and they were self-selecting. Therefore, this group of staff may not be representative of the wider paramedic population.
A more significant limitation is that the research relied on memories of past events which may be unreliable. This difficulty leads the researchers to highlight a potential alternative explanation for their findings. It is possible that participants made more positive and less negative appraisals in calls where they thought they coped well (and vice-versa in calls where they coped poorly) because their actual perception of coping well or poorly may have driven their selection of which of the 13 cognitive appraisal statements were true for them at the time. Additional prospective research is advocated to explore this potential effect further.
Any research that can contribute to the psychological wellbeing of ambulance staff is very welcome. As workload increases and diversifies, adaptive coping mechanisms can only become more relevant to the paramedic profession.