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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
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“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]
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“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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Cited by
Sorted by citations
Mental Disorder Symptoms among Public Safety Personnel in Canada
Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., et al. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717723825 · Cited by 558
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Sonnentag, S., & Grant, A. M. (2012) · Personnel Psychology · doi:10.1111/j.1744-6570.2012.01251.x · Cited by 212
“These jobs offer considerable opportunities to experience prosocial impact, but at the same time, they are highly stressful (Brough, 2004; Halpern et al., 2009) and therefore require that employees capitalize on the positive experiences they encounter in their daily work (see Folkman & Moskowitz,…”
BackgroundSuicidal ideation, plans, and attempts among public safety personnel in Canada
Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., LeBouthillier, D. M., Duranceau, S., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., et al. (2018) · Canadian Psychology / Psychologie canadienne · doi:10.1037/cap0000136 · Cited by 151
“PSP concerns with stigma may have facilitated underreporting of suicidal behaviors (Halpern et al., 2009; Henderson et al., 2016; Karaffa & Koch, 2016); however, the anonymous research design may have also improved accuracy (Ashbaugh et al., 2010).”
BackgroundExploring the nature of resilience in paramedic practice: A psycho-social study
Clompus, S. R., & Albarran, J. W. (2016) · International Emergency Nursing · doi:10.1016/j.ienj.2015.11.006 · Cited by 113
“For instance, staff resilience can be augmented by having periods offroad, debriefing sessions and performance appraisals (Essex and Benz-Scott, 2008; Halpern et al., 2009; Jonsson and Segesten, 2004; Regehr, 2005; Regehr and Millar, 2007).”
Background
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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