A cross-sectional study of mental health-, posttraumatic stress symptoms and post exposure changes in Norwegian ambulance personnel

Background Posttraumatic stress disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5% (n = 479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8% (n = 253) were male. Of the respondents, 80.6% (n = 386) were married or had a partner, and 91.6% (n = 439) reported having access to a peer support programme, with 34.9% (n = 167) reporting that they had utilized peer support. In this study, 5% (n = 24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6% (n = 41) reported moderate to severe depression and 2.9% (n = 14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2% (n = 370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.

Abstract 12233: Comparing EMS Witnessed Cardiac Arrest in Germany and Norway

Introduction: Health registries are a unique source of information about current practice and can describe the burden of disease in a population. However, comparing data from different countries/states we are not always sure if we are comparing patients from similar populations. Method: The aim of this study was to gain a better understanding of the information in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) through a cross-sectional comparative-study of these two population-based public registries. We included all out-of-hospital cardiac arrest patients witnessed by ambulance personnel, between 1 st January 2015 and 31 st December 2019. Proportions were assessed with Chi-square tests. Results: A total of 3,688 cases from Germany and 2,016 cases from Norway were included in the analysis, resulting in an incidence of 8.6 ambulance witnessed cardiac arrests per 100,000 inhabitants in Germany and 7.8 in Norway. A higher proportion of patients had resuscitation terminated on scene in Norway, 43% vs 30% (p<0.01), while the proportion of patients arriving to hospital with spontaneous circulation was higher in Germany, 49% vs 40% (p<0.01). However, 24-hour survival and the overall survival was higher in Norway, with 24-hour survival of 36% vs 31% (p<0.01), and the overall survival of 28% vs 19% (p<0.01). Conclusion: The incidence of cardiac arrests observed by ambulance personnel was higher in Germany, but survival was higher in Norway. We speculate that the major difference between countries is in the post-resuscitation care after admission to hospital.

A Cross-sectional Study of Mental Health, Posttraumatic Stress Symptoms and Post Exposure Changes in Norwegian Ambulance Personnel

Background Posttraumatic Stress Disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5 % (n=479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8 % (n=253) were male. Of the respondents, 80.6% (n=386) were married or had a partner, and 91.6% (n=439) reported having access to a peer support programme, with 34.9% (n=167) reporting that they had utilized peer support. In this study, 5 % (n=24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6 % (n=41) reported moderate to severe depression and 2.9 % (n=14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2 % (n=370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.

Immobilization and evacuation of accident victims by first responders in Delhi, India: a survey

Background: Despite many improvements, pre-hospital care is known to be inconsistent and inefficient across India. This contributes to high mortality and morbidity of accident and medical emergency victims. Pre-hospital care may be provided by bystanders, but they are known to hesitate due to multiple reasons. The first aiders (ambulance staff or police personnel) who are responsible for providing appropriate initial care are not adequately trained to manage all aspects of emergency situations including extrication, cardiopulmonary resuscitation, management of bleeding, and protection of the spine evacuation and transfer. The current study was conducted to gauge the knowledge of first aid among bystanders and first aiders in Delhi national capital region.Methods: Two separate surveys with closed-ended questions were formulated for the bystanders and first aiders in english and hindi. A sample of 511 bystanders and 309 first aiders (108 ambulance and 201 police personnel) completed the survey between February 2019 and April 2019. Data was analysed descriptively. Comparison were made across demographic variables for the bystanders. For first aiders, comparisons were made between ambulance staff and police personnel, and between emergency medical technicians and drivers.Results: The average total scores for the bystanders were 38.5±14.2%. Slight differences across age and educational qualifications were found. The average total score for the first aiders was 34.3±12.3%. Ambulance personnel scored significantly better than police personnel in evacuation (70.3±26.6% versus 42.6±26.5%) and CPR subdomains (37.6±19.4% versus 21.9±14.7%). The emergency medical technicians scored better than the driver in their total and first aid subdomain scores.Conclusions: The knowledge amongst first responders including bystanders and first aiders was low and efforts to educate and train them would improve the much-needed quality of pre-hospital care.

A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest

Background Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. Methods All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD’s. Results Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. Conclusions Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.