A multi-agency approach to reducing harms from violence and aggression directed towards ambulance services staff in Wales (UK)

Purpose Ambulance services staff worldwide have long been at risk of encountering violence and aggression directed towards them during their work. Verbal forms of violence and aggression are the most prevalent form, but sometimes incidents involve physical injury, and on rare occasions homicides do occur. Exposure to such violence and aggression can have a lasting negative impact upon ambulance staff and has been associated with increased levels of stress, fear, anxiety, emotional exhaustion, depersonalisation and burnout syndrome. Despite the significance of this issue, little progress has been made to tackle it. The purpose of this paper is to describe this multi-agency approach being taken in Wales (UK) to reduce such harms from violence and aggression directed towards ambulance services staff. Design/methodology/approach An interpretative post-positivist narrative methodology and policy analysis approach was followed. Snowball methods of gathering data were used to construct this narrative involving meetings, telephone calls, review of policy documents, legislation and academic literature. Findings The authors report how tackling violence and aggression directed towards emergency workers has become a priority within Wales (UK), resulting in policy developments and initiatives from groups such as the UK and Welsh Government, the Welsh Ambulance Services National Health Services (NHS) Trust, Health Boards, the NHS Wales Anti-Violence Collaborative and the Joint Emergency Services Group (JESG) in Wales. This has included changes in legislation such as the Assaults on Emergency Workers (Offences) Act 2018 that came into force on 13th November 2018 and policy changes such as the obligatory responses to violence in health care and the JESG #WithUsNotAgainst Us campaign. Our study however reflects the complexity of this issue and the need for further high-quality research. Originality/value The experiences and activities of Wales (UK) reported in this paper adds to the international body of knowledge and literature on violence and aggression directed towards ambulance services staff.

First Responder Safety in the Event of a Dirty Bomb Detonation in Urban Environment

The malevolent dispersion of radioactive material, with the aim of contaminating people and the environment, is considered a credible terroristic threat. This article analyzes a hypothetical Dirty Bomb detonation in an urban area, estimating the radiological consequences to the involved population and to first responders. The dispersion of radioactive material is simulated using the HOTSPOT code, considering the explosion of devices containing (alternatively) 60Co, 137Cs, 192Ir, 238Pu or 241Am sources, frequently used in medical or industrial settings. Each source is evaluated separately. The resulting ground deposition is used to calculate the effective dose received by first responders in two different scenarios. Based on the dispersed radionuclide, the influence of the use of personal protective respirators is analyzed. Confirming previous published results, this article illustrates that the radioactive material is diluted by the detonation, resulting in relatively low doses to the general public. However, the emergency workers’ stay time in the most contaminated area must be carefully planned, in order to limit the received dose. Due to the general fear of radiation, extensive psychological effects are expected in the public, irrespective of the evaluated radiation dose.

Protective Factors against Emergency Stress and Burnout in Healthcare and Emergency Workers during Second Wave of COVID-19

Working as healthcare workers (HCWs) and emergency workers (EWs) during the first wave of COVID-19 has been associated with high levels of stress and burnout, while hardiness, coping strategies and resilience have emerged as protective factors. No studies have so far investigated these psychological factors during the second wave. We aimed to verify the trend of stress levels, burnout, coping strategies and resilience during the pandemic in Italian healthcare and emergency workers by comparing a first sample recruited from the first COVID-19 wave (N = 240) with a second sample relating to the second wave (N = 260). Through an online platform we administered questionnaires to measure stress, burnout, resilience, hardiness and coping strategies. The results showed that in the two waves the total stress levels of HCWs and EWs did not differ, while the physical stress and hardiness scores in the second wave were greater. No differences were found in the coping strategies used. An analysis of burnout levels in the second wave sample found that stress showed a high predictive power in the emotional exhaustion and depersonalization scales. Hardiness and resilience emerged as protective factors in reducing stress. The implications for the need to provide support and to improve hardiness for HCWs and EWs are discussed.

Radiological consequences and lessons of the Chernobyl NPP and «Fukushima-1» NPP radiation accidents

35 years have passed since the Chernobyl NPP accident, 10 years – since the «Fukushima-1» NPP accident. At the present time extensive activities on the remediation of the consequences of two major large-scale radiation disasters are performed in the Belorussia, Russian Federation, Ukraine, and Japan. Releases of radiologically significant radionuclides after the Chernobyl NPP accident correspond to 14 exaBecquerel – higher up to an order of magnitude compared to 3 emergence power units of the «Fukushima-1» NPP. The significantly lower release rate and deposition of 80% of the radionuclides released into the atmosphere on the surface of the Pacific Ocean lead to lower up to several orders of magnitude radioactive contamination of the Japanese territory compared to the territories of the former USSR and neighboring countries after the Chernobyl NPP accident. Collective dose to the public due to the Chernobyl NPP accident is higher up to several orders of magnitude compared to the dose to the Japanese population after the «Fukushima-1» accident. No statistically reliable long-term medical consequences are expected for all groups of the Japanese public, additionally exposed due to «Fukushima-1» accident. 134 emergency workers have developed acute radiation sickness due to the Chernobyl NPP accident. Emergency workers with doses higher than 150 mSv had increased radiation-induced morbidity with leukemia and solid cancers. Among the individuals, that were kids or adolescents in the exposure period after the Chernobyl NPP accident and residing on the territories of Belorussia, Ukraine and four most radioactively contaminated regions of the Russian Federation, morbidity with thyroid cancer is increase by a factor of 10 compared to the pre-accidental levels. The following lessons of the Chernobyl NPP and «Fukushima-1» NPP can be derived: faults in the NPP design and lack of response after the recognition of the faults; lack of timely full-scale prophylactic with iodine; unjustified resettlement of the residents of the radioactively contaminated territories several years after the accident.