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What makes an incident critical for ambulance workers? Emotional outcomes and implications for intervention
Abstract
Ambulance workers use the term “critical incident” to refer to a category of workplace stressor. Developing an evidence-based approach to critical incident stress begins with identifying what makes incidents critical. The aim of this qualitative study was to characterize critical incidents as well as elicit suggestions for interventions. We interviewed 60 ambulance-based workers, both front-line and supervisors, and analysed interview transcripts. Having presented their suggestions for interventions more fully elsewhere (Halpern et al, 2009), here we characterize the incidents that emerged as critical and the emotional responses evoked by them. We found they suffered considerable distress from critical incidents and would welcome interventions. Incidents that were identified as critical commonly involved patient death, often combined with poignancy. These events appeared to evoke vulnerable feelings of inability to help and intense compassion, which led to further emotional, cognitive, and behavioural responses. Difficulty in acknowledging distress and fear of stigma presented significant barriers to accessing support. These barriers may be overcome by educating both ambulance personnel and their supervisors to recognize and tolerate the vulnerable feelings often evoked by critical incidents. While gender and length of service did not seem to impact on evoked emotions, recent recruits may be more open to this type of education.
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“Other symptoms can manifest following chronic exposure to stress and common occupational challenges (extended shift times), such as fatigue, headaches, and gastrointestinal disturbances (E. Donnelly & Siebert, 2009; Halpern, Gurevich, Schwartz, & Brazeau, 2009; Klimley, Van Hasselt, & Stripling, 2018; Knutsson & B¿ggild, 2010; Rice, Glass, Ogle, & Parsian, 2014; Sterud et al.,”
From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Halpern, Gurevich, Schwartz, & Brazeau, 2009
In the citing paper
“and PSP concerns with stigma may have contributed to underreporting.74–76”
From Mental Disorder Symptoms among Public Safety Personnel in Canada (2018) · cites this paper as [76]
In the citing paper
“Emergency responders report stigma and privacy concerns regarding seeking care for mental health symptoms related, at least in part, to occupational stress (16, 71–74).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [73]
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Provincial Correctional Service Workers: The Prevalence of Mental Disorders
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Occupational stress, paramedic informal coping strategies: a review of the literature
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“Excellent supervisors intuit methods of effectively responding to even hard‐to‐reach individuals, and their wisdom and best practices should be harnessed in supervisor training programmes (Halpern et al., 2009b).”
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Anxiety-related psychopathology and chronic pain comorbidity among public safety personnel
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Self-citationDowntime after Critical Incidents in Emergency Medical Technicians/Paramedics
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“For example, although there is a high level of exposure to traumatic accidents, only a minority of these accidents are identified by POs as stressful or traumatic [18,19].”
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“In any case, further investigation is warranted to determine whether the pattern generalizes to other large samples that facilitate comparisons across PSP.”
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Tehrani, N., & Hesketh, I. (2018) · International Journal of Emergency Services · doi:10.1108/ijes-04-2018-0021 · Cited by 30
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“Preserving and improving the emotional health of out-of-hospital emergency health care workers is critical not only for the professionals themselves but also for the community to which they provide health care (Halpern et al., 2009).”
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“…first responders in various relationships (Rowe & Regehr, 2010; Tracy, Myers, & Scott, 2006) including relationships with other first responders (Alexander & Klein, 2001; Halpern et al., 2009), romantic relationships (Horan, Bochantin, & BoothButterfield, 2012) and family members (Bochantin, 2017).”
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“Surprisingly, given the depth of literature that espouses the need for health professionals to receive such support (Lunn 2000, Wagner 2005, Barnett et al. 2007, Ireland et al. 2008, Halpern et al. 2009, Smith 2012), it was incongruous when no forms of support were forthcoming.”
Witnessing Acute Stress Reaction in Team Members
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“Among civilian medical personnel, desensitization and taskoriented problem-focused coping (30, 32–34) along with (black) humor (32, 35, 36) have been regularly reported.”
BackgroundPositive mental health and sense of coherence among emergency medical service professionals
Mantas‐Jiménez, S., García, G. R., Roqueta-Vall-llosera, M., Cámara-Liebana, D., Masià‐Plana, A., Lluch‐Canut, T., & Canal, D. J. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1344872 · Cited by 11
“This imperative extends beyond the well-being of healthcare professionals themselves; it encompasses the well-being of the communities they serve as well (39).”
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“However, the difficulties in identifying and implementing appropriate care plans to facilitate a ‘good death’ can also be traumatic (Costello 2006) and may manifest as either emotional or physical reactions (Rich 2005, Moores et al. 2007, Halpern et al. 2009).”
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“Frequent exposure to critical incidents may has a negative impact on the mental health [1–3, 5 ] and increases A 2018 systematic review of EMS nurses reported a prevalence of 15% for anxiety, 15% for depression, and 11% for post-traumatic stress disorder (PTSD) [8].”
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When the Bells Go Down: Resilience and Vulnerability in Firefighters
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The impacts of leadership behaviours on the mental well-being of public safety communicators
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Peer support in prehospital emergency: the first responders' point of view
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“This is in contrast to previous, qualitative fi ndings that managerial support was not preferred and could be considered a source of stress instead (38).”
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Personality, social support, stress, and coping in a sample of Canadian paramedics
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“A second Toronto-based coalition, led by Janice Halpern, added the construct of secure attachment and developed a paramedic-speci fi c critical-incident scale (for example Halpern et al., 2009; Halpern & Maunder, 2011; Halpern et al., 2012abc).”
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The Paramedic Preceptor Experience: Improving Preparation and Support
Carver, H. (2016) · Charles Sturt University Research Output (CRO) · Cited by 4
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Self-citationUnderstanding the Occupational Factors that Influence Paramedic Health and Wellbeing
Betts, C., Stoneley, A., Anderson, J., & Sutton, C. (2024) · International Journal of Paramedicine · doi:10.56068/mnrg8307 · Cited by 2
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“Learning how to recognize the signs of critical incident stress in co-workers was acknowledged as a valuable tool in being able to provide these supports (Halpern et al. 2009).”
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Metadata
- Authors
- Halpern, J., Gurevich, M., Schwartz, B., & Brazeau, P.
- Affiliations
- Mount Sinai Hospital (CA)
- Toronto Metropolitan University (CA)
- University of Toronto (CA)
- Corresponding author
- Halpern, Janice
- ORCID
- Halpern, Janice
- Venue
- Work & Stress
- Publisher
- Informa UK Limited
- Published
- 2009-04
- Volume
- 23
- Issue
- 2
- Pages
- 173-189
- ISSN
- 0267-8373 (ISSN-L)
- 1464-5335
- OpenAlex
- W1970644865
- Cited by
- 124
- References
- 30
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 11 · 2023: 9 · 2022: 15 · 2021: 13 · 2020: 13 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 3 · 2014: 6 · 2013: 6 · 2012: 6
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Work & Stress (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
- Keywords
- critical incidents, ambulance personnel, emergency medical services, occupational stress, emotional responses, compassion, patient death, stigma, helplessness, distress, supervisor education, workplace interventions
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