References
Paramedics at risk? How responding to a terror attack affects mental wellbeing

Abstract
Background:
Terror attacks have a significant impact on first responders’ wellbeing, with an associated risk of post-traumatic stress disorder (PTSD).
Aims:
To improve understanding of how responding to terror attacks affects paramedics’ mental health.
Methodology:
A literature search was carried out on databases using the PRISMA strategy. Critical appraisal tools were used alongside thematic analysis to appraise and synthesise the literature.
Findings:
Ten papers were identified. Themes arising regarding risks to responders included: the level of exposure, with the amount related to the risks of developing PTSD and psychopathology; and level of preparedness, with responders carrying out unfamiliar tasks and working outside the scope of practice as well as lacking education on the psychological impact of terror attacks.
Conclusion:
If paramedics are deployed into terror attack warm zones, policy needs to consider the associated psychological risk. Training should incorporate stress management techniques and education on the extreme emotions these practitioners may experience. More research specifically with the paramedic population is required to understand the risk posed to them and how this may be managed.
A terrorist attack (TA) is a violent threat designed to intimidate the public, creating feelings of fear and vulnerability (HM Government, 2000). In the past decade, North America and Europe have seen a growing number of violent TAs associated with racial or ethnically motivated extremism targeting police and civilians (Global Terrorism Trends and Analysis Centre, 2021). These attacks present unique challenges to the emergency services, from managing an ongoing threat to navigating the numbers and types of casualties (Wesemann et al, 2022).
Global learning from previous TAs has influenced the evolution of organisational preparedness and operational procedures (Gates et al, 2014; Rathore, 2016; Kerslake, 2019; Lucraft, 2019). This includes the introduction of the Joint Emergency Services Interoperability Programme (JESIP) and hazardous area response teams (HARTs) (Price, 2016; HM Inspectorate of Constabulary and Fire and Rescue Services, 2024). These changes are intended to enhance the capabilities of ambulance services to provide life-saving treatment at the site of a TA. However, there is criticism that this learning and development fall short regarding the psychological impact of these events on first responders (Thompson et al, 2014; Wilson, 2015; Moran et al, 2017).
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