title: The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics.
abstract: BACKGROUND
  Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms.
  
  
  METHODS
  EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed.
  
  
  RESULTS
  Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory.
  
  
  CONCLUSIONS
  Emotional sequelae are associated most strongly with EMT/paramedics' personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.
authors.affiliation: Department of Psychiatry, Mt, Sinai Hospital and University of Toronto, 244 Dupont Street, Toronto, ON M5R 1V7, Canada. Janice.halpern@utoronto.ca
authors.forename: Janice
authors.initials: J
authors.lastname: Halpern
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
authors.forename: Maria
authors.initials: M
authors.lastname: Gurevich
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000523:psychology; D002055:Burnout, Professional / Q000209:etiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology; D004190:Disasters; D004630:Emergencies / Q000523:psychology*; D004634:Emergency Medical Technicians / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects; D011594:Psychometrics / Q000295:instrumentation; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology; D040701:Stress Disorders, Traumatic, Acute / Q000209:etiology* / Q000523:psychology