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Randomized, Controlled Trial of Three Levels of Critical Incident Stress Intervention

Published online by Cambridge University Press:  28 June 2012

Andrew Macnab ,
Charles Sun  and
John Lowe
Andrew Macnab*
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada British Columbia Ambulance Service
Charles Sun
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada British Columbia Ambulance Service
John Lowe
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada British Columbia Ambulance Service
*
Room 2D19, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4, E-mail: amacnab@cw.bc.ca
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Abstract

Background:

Stress debriefing following exposure to a critical incident isbecoming more prevalent. Its aim is to prevent or minimize the development of excessive stress response symptoms that lead to loss of productivity or effectiveness in the workplace or at home. There is little evidence that any form of psychological debriefing is effective. This study evaluated the effectiveness of three intervention strategies, and attempted to correlate the symptoms with the severity of the incidentand level of intervention.

Methods:

A randomized, controlled trial of three levels of critical stress intervention was conducted in the British Columbia Ambulance Service (BCAS), in British Columbia, Canada, among paramedics and emergency medical technicians (EMTs), reporting critical incident stress. Outcomes were measured at one week (Stanford Acute Stress Reaction Questionnaire (SASRQ), the Life Impact Score (LIS), and Schedule of Recent Events (SRE)), and at three months and six months following the intervention (Impact of Events (IE), Coping Mechanisms, LIS, and SRE).

Results:

Fifty calls were received during the 26-month study period (<1 per 10,000 BCAS response calls): 23 were by third parties, but the involved EMT did not call;nine were placed by crew unwilling to participate in the study; 18 subjects enrolled, but six completed no forms. No correlation was found between severity of the incident and scores on the SASRQ, IE, or LIS, or between any of these scores. There was no consistent pattern in the stress scores over time.

Conclusion:

Requests for critical incident stress intervention were uncommon. The need for intervention may not be as great as generally is assumed. Further randomized trials, ideally multicenter studies, are indicated.

Keywords

debriefingemergency medical technicianpost-traumatic stress disorderstress
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 4 , December 2003 , pp. 367 - 371
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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References

1. Mitchell, J: Emergency Services Stress, Guidelines for Preserving the Health and Careers of Emergency Services Personnel. Brady Publishing, Englewood Cliffs, New Jersey, 1990.Google Scholar
2. Boudreaux, E, Mandry, C: Sources of stress among emergency medical technicians (Part I): What does the research say? Prehosp Disast Med 1996;11(4): 296–301.Google Scholar
3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (3rd ed) (DSM-III), Washington, DC. APA, 1980.Google Scholar
4. Koopman, C, Classen, C, Spiegel, D: Predictors of post-traumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm. Am J Psychiatry 1994;151(6):888–894.Google ScholarPubMed
5. Mitchell, J: Stress: The history, status and future of critical incident stress debriefings. J Emerg Med Services 1988 (Nov);47–52.Google Scholar
6. Deahl, MP, Gillham, AB, Thomas, J, Searle, MM, Srioivasan, M: Psychological sequelae following the Gulf War: Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. Br J Psychiatry 1994;165:60–65.CrossRefGoogle ScholarPubMed
7. Suzanna, RO, Jonathan, BI, Simon, WE: Psychological debriefing for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2001;3:CD000560.Google Scholar
8. Fontana, A, Rosenheck, R: Effectiveness and cost of the inpatient treatment of post-traumatic stress disorder: Comparison of three models of treatment. Am J Psychiatry 1997;154:6.Google ScholarPubMed
9. Bisson, JI, Deahl, MP: Psychological debriefing and prevention of post-traumatic stress. More research is needed. Br J Psychiatry 1994;165:717–720.CrossRefGoogle ScholarPubMed
10. Raphael, B, Meldrum, L: Does debriefing after psychological trauma work? Br Med J 1995; 310(6993):1479–1480.Google Scholar
11. van Emmerik, AAP, Kamphuis, JH, Hulsbosch, AM, Emmelkamp, PMG: Single session debriefing after psychological trauma: A meta-analysis. Lancet 2002;360:766–771.CrossRefGoogle ScholarPubMed
12. Boudreaux, E, Mandry, C: Effects of stressors on emergency medical technicians (Part II): A critical review of the literature, and a call for further research. Prehosp Disast Med 1996;11(4):30–38.CrossRefGoogle Scholar
13. Macnab, AJ, Russell, JA, Lowe, JP, Gagnon, F: Critical incident stress intervention after loss of an air ambulance: Two-year follow-up. Prehosp Disast Med 1999;14(1):8–12.Google Scholar
14. Dillman, D: Mail and Telephone Surveys: The Total Design Method. John Wiley and Sons, New York, 1978.Google Scholar
15. Holmes, TH, Rahe, RH: The Social Readjustment Rating Scale. J Psychosomatic Research 1967;11:213–218.Google Scholar
16. Horowitz, M, Wilner, N, Alvarez, W: Impact of Events Scale: A measure of subjective stress. Psychosomatic Med 1979;41(3):209–218.CrossRefGoogle Scholar
17. Smith, A, Roberts, K: Interventions for post-traumatic stress disorder and psychological distress in emergency ambulance personnel: A review of the literature. Emerg Med J 2003;20:75–78.CrossRefGoogle ScholarPubMed
18. Seaward, BL: Managing Stress in Emergency Medical Services. A monograph. AmericanAcademy of Orthopedic Surgery. Jones and Bartlett Publishers, Sudbury, Massachusetts, 2000.Google Scholar