Role Identity, Dissonance, and Distress among Paramedics

Role identity theory describes the purpose and meaning in life that comes, in part, from occupying social roles. While robustly linked to health and well-being, this may become, however, when an individual is unable to fulfil the perceived requirements of an especially salient role in the way that they believe they should. Amid high rates of mental illness among public safety personnel, we interviewed a purposely selected sample of 21 paramedics from a single service in Ontario, Canada to explore incongruence between an espoused and able-to-enact paramedic role identity. Situated in an interpretivist epistemology, and using successive rounds of thematic analysis, we developed a framework for role identity dissonance wherein chronic, identity-relevant disruptive events cause emotional and psychological distress. While some participants were able to recalibrate their sense of self and understanding of the role, for others, this dissonance was irreconcilable, contributing to disability and lost time from work. In addition to contributing a novel perspective on paramedic mental health and well-being, our work also offers a modest contribution to the theory in using the paramedic context as an example to consider identity disruption through chronic workplace stress.

Why Do Public Safety Personnel Seek Tailored Internet-Delivered Cognitive Behavioural Therapy? An Observational Study of Treatment-Seekers

First responders and other public safety personnel (PSP) experience elevated rates of mental disorders and face unique barriers to care. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment that has demonstrated good treatment outcomes when tailored specifically for PSP. However, little is known about how PSP come to seek ICBT. A deeper understanding of why PSP seek ICBT can inform efforts to tailor and disseminate ICBT and other treatments to PSP. The present study was designed to (1) explore the demographic and clinical characteristics, motivations, and past treatments of PSP seeking ICBT, (2) learn how PSP first learned about ICBT, and (3) understand how PSP perceive ICBT. To address these objectives, we examined responses to online screening questionnaires among PSP (N = 259) who signed up for an ICBT program tailored for PSP. The results indicate that most of our sample experienced clinically significant symptoms of multiple mental disorders, had received prior mental disorder diagnoses and treatments, heard about ICBT from a work-related source, reported positive perceptions of ICBT, and sought ICBT to learn skills to manage their own symptoms of mental disorders. The insights gleaned through this study have important implications for ICBT researchers and others involved in the development, delivery, evaluation, and funding of mental healthcare services for PSP.

Effectiveness of a Workplace Reintegration Facilitator Training Program on Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: A Pilot Study (Preprint)

BACKGROUND The demands and stressful nature of police work, unpredictability of the calls, and exposure to traumatic events in the line of duty can contribute to the development of operational stress injuries (OSIs) in Public Safety Personnel (PSP). Those impacted by work-related injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return-to-work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP return to work as soon as possible following a critical incident, illness, or injury, while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through three interrelated components: 1) Reintegration Program Facilitator Training (RPFT) Program; 2) a short-term Critical Incident RP; and 3) a long-term RP. There is a dire need for research that incorporate strong study designs to determine long-term effectiveness of these components. The purpose of this quasi-experimental pre/post pilot cohort study is to evaluate the effectiveness of the EPS RPFT course at influencing mental health knowledge and attitudes of RPFT attendees. OBJECTIVE This pre/post cohort study collected data via two questionnaires from RPFT participants (N=60). METHODS This pre/post cohort study collected data via two questionnaires from RPFT participants (N=60). Descriptive, parametric, and non-parametric statistics were utilized to compare pre and post RPFT results as well as analyzing results by gender and profession. RESULTS Statistically significant changes were observed in pre/post questionnaire scores in the domains of mental health attitudes and knowledge. CONCLUSIONS The RPFT may facilitate positive changes in mental health attitudes, knowledge, and stigma among PSP.

Experiences of families of public safety personnel: a systematic review protocol of qualitative evidence

Background Public safety occupations are well-recognized to be dangerous and stressful. Despite recent attention on post-traumatic stress injuries among public safety personnel, there has been considerably less attention paid to the ongoing ways in which the risks and requirements associated with those occupations shape family life, and how families respond and adapt to those lifestyle dimensions. This systematic review aims to understand how day-to-day family life is affected and shaped when a family member works in a public safety sector, such as fire, police, paramedic, corrections, and emergency communications. Methods Qualitative studies that examine the experiences of families or family members of public safety personnel will be included in this review, with no date or language restrictions. An initial search of Embase and CINAHL will be conducted, followed by an analysis of text words contained in the title and abstract, and of the index terms used to describe the articles. Databases to be searched for published studies include MEDLINE, Embase, Web of Sciences, CINAHL, PsycINFO, and Sociological Abstracts. Titles and abstracts will be screened by two independent reviewers. The full texts of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer. Further analysis of the synthesized findings will be informed by family systems theory. Discussion The ways that occupational risks and requirements shape family life have been better investigated within other high-risk occupation groups, which has led to productive advancements in organizational policies and supports in the respective sectors. An understanding of the experiences which typify family life ongoing within PSP sectors is a critical gap in the development of meaningful family-informed occupational initiatives and supports. Systematic review registration Submitted to PROSPERO for systematic review registration: CRD42020208126

Evaluation of Before Operational Stress: A Program to Support Mental Health and Proactive Psychological Protection in Public Safety Personnel

Public safety personnel (PSP; e.g., communications officials, corrections workers, firefighters, paramedics, and police officers) are at risk of developing mental health problems due to experiencing potentially psychologically traumatic events during their career. Research examining evidence-based treatments for psychological injuries resulting from operational duties (also known as operational stress injuries) has not yielded robust results that would indicate ongoing interventions as the best solution for managing PSP mental health injuries; as such, proactive psychological interventions designed to bolster resilience are being considered potentially beneficial for mitigating the impact of occupational stress on PSP. Despite the growing popularity of resilience programs, most are delivered in a single session after an event deemed particularly problematic with no follow-up. Longer interventions may better support sustained resiliency, mitigate the impact of operational stress, and increase positive PSP workplace outcomes. The current article introduces the Before Operational Stress (BOS) program, which was designed for delivery early in a PSP career to enhance self-awareness and healthy relationships. The year-long program is derived from cognitive behavior therapy and group therapeutic techniques to meet program objectives. The current BOS program evaluation demonstrated small, statistically significant improvements in symptoms of PTSD, quality of life, stigma, and perceived social support from baseline (Time 1) to 6 months (Time 4). There were also non-significant improvements observed in symptoms of depression, anxiety, stress, alcohol use, as well as in emotional regulation and resilience. Qualitative results indicated participants positively perceived the BOS program, with participants reporting specific improvements in self-awareness, avoidant behaviors, and relationships with family and colleagues. The BOS program content (e.g., functional disconnection and functional reconnection) and processes (e.g., psychoeducation within a supportive learning structure; mutually empowering group interactions) appear unique relative to other PSP resilience programs, with promising initial results in support of PSP mental health. Recommendations for future research and program development are provided.

MAPPING BUILDING INTERIORS WITH LIDAR: CLASSIFYING THE POINT CLOUD WITH ARCGIS

Accurate maps of building interiors are needed to support location-based services, plan for emergencies, and manage facilities. However, suitable maps to meet these needs are not available for many buildings. Handheld LiDAR scanners provide an effective tool to collect data for indoor mapping but there are no well-established methods for classifying features in indoor point clouds. The goal of this research was to develop an efficient manual procedure for classifying indoor point clouds to represent features-of-interest.We used Paracosm’s PX-80 handheld LiDAR scanner to collect point cloud and image data for 11 buildings, which encompassed a variety of architectures. ESRI’s ArcGIS Desktop was used to digitize features that were easily identified in the point cloud and Paracosm’s Retrace was used to digitize features for which imagery was needed for efficient identification. We developed several tools in Python to facilitate the process. We focused on classifying 29 features-of-interest to public safety personnel including walls, doors, windows, fire alarms, smoke detectors, and sprinklers.The method we developed was efficient, accurate, and allowed successful mapping of features as small as a sprinkler head. Point cloud classification for a 14,000 m2 building took 20–40 hours, depending on building characteristics. Although the method is based on manual digitization, it provides a practical solution for indoor mapping using LiDAR. The methods can be applied in mapping a wide variety of features in indoor or outdoor environments.