title: Downtime after critical incidents in emergency medical technicians/paramedics.
abstract: Effective workplace-based interventions after critical incidents (CIs) are needed for emergency medical technicians (EMT)/paramedics. The evidence for a period out of service post-CI (downtime) is sparse; however it may prevent posttraumatic stress disorder (PTSD) and burnout symptoms. We examined the hypothesis that downtime post-CI is associated with fewer symptoms of four long-term emotional sequelae in EMT/paramedics: depression, PTSD, burnout, and stress-related emotional symptoms (accepted cut-offs defined high scores). Two hundred and one paramedics completed questionnaires concerning an index CI including downtime experience, acute distress, and current emotional symptoms. Nearly 75% received downtime; 59% found it helpful; 84% spent it with peers. Downtime was associated only with lower depression symptoms, not with other outcomes. The optimal period for downtime was between <30 minutes and end of shift, with >1 day being less effective. Planned testing of mediation of the association between downtime and depression by either calming acute post-CI distress or feeling helped by others was not performed because post-CI distress was not associated with downtime and perceived helpfulness was not associated with depression. These results suggest that outcomes of CIs follow different pathways and may require different interventions. A brief downtime is a relatively simple and effective strategy in preventing later depression symptoms.
authors.affiliation: Department of Pychiatry, Mt. Sinai Hospital and the University of Toronto, Toronto, Canada M5G 1X5.
authors.forename: Janice
authors.identifier: 0000-0001-9518-6984
authors.initials: J
authors.lastname: Halpern
authors.affiliation: Department of Pychiatry, Mt. Sinai Hospital and the University of Toronto, Toronto, Canada M5G 1X5.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.affiliation: Public Health Ontario and Departments of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada M5G 1V2 ; Sunnybrook Osler Centre for Prehospital Care, Toronto, Canada M4N 3M5.
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
authors.affiliation: Department of Psychology, Ryerson University, Toronto, Canada M5B 1X5.
authors.forename: Maria
authors.initials: M
authors.lastname: Gurevich
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D004634:Emergency Medical Technicians / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires