Occupational stress, paramedic informal coping strategies: a review of the literature

Abstract

Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.

‘We’re the First Port of Call’ – Perspectives of Ambulance Staff on Responding to Deaths by Suicide: A Qualitative Study

“…While qualitative approaches have previously examined paramedic experiences of providing care for people who selfharm (Rees et al, 2017), to the authors' knowledge this study is the first to illuminate in depth the first-hand perspectives of ambulance staff in relation to attendance at a suicide, including interaction with bereaved families and individuals at the place of death. These qualitative insights therefore build on and extend existing knowledge to reveal how multiple and intense sources of strain and experiences of attending cumulative traumatic events such as suicides may contribute to the raised levels of mental health morbidity, distress, suicidality, and sickness absence among first responders seen in existing quantitative studies and survey data (Beaton et al, 1995;Clohessy and Ehlers, 1999;Alexander and Klein, 2001;Bennett et al, 2004;Mildenhall, 2012;Pitman et al, 2014;Kimbrel et al, 2016;Stanley et al, 2016;Milner et al, 2017;Jones et al, 2018;Vigil et al, 2019).…”

“…Unsurprisingly, it has been known for some time that levels of sickness absence among ambulance staff are higher than among other groups of National Health Service (NHS) staff (Bennett et al, 2004) and indeed, five times the national average (NHS Information Centre for Health and Social Care, 2012). Work-related stress has been indicated as a potential reason (Mildenhall, 2012).…”

Exploring the nature of resilience in paramedic practice: A psycho-social study

“…Other evidence indicates that frontline paramedics have one of the highest sickness absence rates 361 (Mildenhall 2012). So, while the attraction of a career in paramedic practice among study 362 participants seems to have been motivated by altruistic values, it would seem important to harness 363 and sustain this through clear role expectations and access to a supportive culture and structure.…”

Secondary traumatic stress and resilience among EMS

“…When trying to remedy stress among EMS, typical programmes like support groups, debriefing, and counselling are beneficial. However, the EMS culture is a more influential factor (Cydulka et al, 1997;Mildenhall, 2012). In a review of literature, most paramedics preferred to manage feelings of distress informally within their own work environment (Mildenhall, 2012).…”

“…However, the EMS culture is a more influential factor (Cydulka et al, 1997;Mildenhall, 2012). In a review of literature, most paramedics preferred to manage feelings of distress informally within their own work environment (Mildenhall, 2012). Likewise, findings from a 2016 UK study (Clompus and Albarran) reported that both formal and informal methods of support enhanced resilience; yet paramedics relied more heavily on peer networks to deal with everyday pressures as formal methods involving management and debriefing were less available.…”