Adherence to a psychological first-aid intervention in an EMS organization.

Why was the study done?

Emergency medical service (EMS) workers suffer from higher rates of PTSD, Depression, Anxiety, and general psychological distress than the general population. Many programs have been developed to work as early interventions for trauma, but there is no standard program used in EMS.

Psychological First Aid (PFA) can be a peer-led, early intervention designed to reduce initial distress and foster short- and long-term coping strategies. However, no studies have been done to evaluate the effectiveness of PFA in public safety organizations. Studies on the topic of implementation and program adherence are also rare. Adherence means EMS peer helpers and recipients following the organizational recommendations to be involved in PFA after a traumatic incident.

The current study aimed to identify factors that influence the adherence of peer helpers and recipients to PFA in one organization that recently instituted the program. Adherence was evaluated through the perspectives of the peer helpers.

What was done in the study?

The researchers interviewed 11 peer helpers (37% of the organization’s peers) from Urgence-santé, a large EMS organization in Quebec. Each peer helper was an active EMS worker trained during a 14 hr course provided by the in-house psychologist. Researchers conducted all semi-structured interviews a year after implementing the program with peer helpers that had completed at least 3 PFA interventions.

What did we find out?

The interviews identified four main themes surrounding adherence.

• Individual perceptions and attitudes about PFA intervention:
  1. Peer helpers all described positive PFA perceptions (e.g. it was simple and easy to provide and well suited to EMS worker needs.)
  2. Most helpers were mindful to follow the directives of the PFA intervention. However, some reported being flexible with the directives, which allowed them to take ownership of the intervention.
  3. Helpers indicated that most recipients had a positive perception of PFA. However, they also reported some negative perceptions because of concern over organizational buy-in and potential breaches of confidentiality.
• Perceived impacts of PFA:
  1. Most helpers reported that PFA created an additional workload for them and infringed on their personal time.
  2. Some helpers were overworked due to an uneven distribution of the PFA workload.
  3. Many helpers believed the PFA training positively influenced how they interact with co-workers and patients, making them more prevention-focused.
  4. Some participants indicated that PFA had lowered stigma and allowed workers to feel comfortable to seek mental health support.
• Essential that the organization endorse and support the PFA program:
  1. Participants indicated that symbolic (change in job title) or financial recognition for their peer-helper role is needed.
  2. Participants valued the clinical support, but some wanted more regular supervision and feedback on the impact of their interventions.
  3. The majority of helpers expressed a willingness to maintain, or even develop, skills as PFA helpers.
  4. Participants highlighted the crucial support of the organization in making PFA a priority. However, some noted that some managers still had interfered, which made providing PFA difficult at times.
• Match with EMS culture:
  1. The vast majority of participants believed PFA was compatible and relevant to EMS culture.
  2. Some found their peer-helper role conflicted with their EMS role. For example, when a co-worker was experiencing a physical reaction to trauma and refused help.
  3. Some indicated that the organization’s previous responses to workers’ distress had made it difficult for some co-workers to accept PFA since there was bitterness and lack of trust in the organization.

Where do we go from here?

For an intervention like PFA to be sustainable after implementation, those involved in the program must maintain their participation over time. This study provides insight into how PFA was viewed by peer helpers one year after implementation. It suggests a few ways that adherence can be supported: recognition for the peer helpers, continued organizational support, and regular feedback on the impact and outcomes of the program. Implementation cannot be the last step in providing a mental health intervention. Instead, organizations must be willing to refine the program over time to increase adherence and buy-in from everyone.

The original wording of the study was changed and condensed for the current research summary.

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Original Study

Tessier, M., Lamothe, J., & Geoffrion, S. (2021). Adherence to psychological first aid after exposure to a traumatic event at work among EMS workers: A qualitative study. International Journal of Environmental Research and Public Health, 18(21), 11026.  https://www.mdpi.com/1660-4601/18/21/11026

Summary prepared by Kossick, E. Edited & reviewed by Barootes, B. & Tessier, M.

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