College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
BMC Psychiatry. 2020 Jul 3;20(1):348. doi: 10.1186/s12888-020-02752-4.
High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce.
This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being.
Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.
Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
大量定量研究报告表明，急救人员的心理困扰、精神疾病以及由此导致的心理创伤的身体影响的发生率很高。然而，人们对急救工作的性质如何导致这一问题、紧急医疗响应对个人造成的巨大影响，特别是在一线急救人员中，工作相关的压力是如何随着时间的推移而逐渐累积的，这些方面的理解还很有限。
本研究通过审查 2000 年至 2018 年期间发表的同行评议定性研究，概述了紧急医疗响应工作对护理人员、救护人员、救护志愿者和呼叫中心人员的心理、心理社会和身体健康的影响。搜索的数据库包括：Ovid Medline、CINAHL、Ovid EMcare、PsychInfo 和 Scopus。系统综述围绕以下五个关键领域组织：工作对心理健康的影响；心理压力对身体健康的影响；工作相关的幸福感需求如何表达；工作流程和工作性质对幸福感的影响；以及组织结构对心理和身体健康的影响。
有 39 篇文章符合入选标准。在急救人员的日常工作中，以及在组织管理部门如何承认和应对这些问题方面，发现了一些对心理健康和幸福感有重大影响的因素，或增加了患创伤后应激障碍、抑郁和焦虑等疾病的风险。急救人员在四个关键领域表达了他们的幸福感需求：组织支持；非正式支持；使用幽默；以及个体应对机制，如超脱和外部支持。
突发事件与工作场所文化和需求之间的相互作用对急救人员的心理、生理和社会福祉产生了压倒性的影响。这些影响包括日常管理行为和反应、轮班工作的影响、管理不善的轮班表、长时间工作且恢复时间很少、对创伤性事件的暴露以及管理者和同事对工人压力的反应。由于工作相关的压力而导致心理健康问题的急救人员在生病、重返工作岗位和退休后，感到被同事、管理层和服务机构抛弃。政策、计划和干预措施以及教育需要在个人、同行、组织和政府层面上开展。
