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Supporting paramedic mental health and resiliency at BC Emergency Health Services

BC Emergency Health Services (BCEHS) provides out-of-hospital emergency care, community paramedicine patient support, and inter-facility transfer in British Columbia, and is the largest emergency medical service in Canada.

On any given day, paramedics, emergency medical call-takers and dispatchers can be exposed to abnormal, shocking critical incidents or traumatic events while on the job, leaving them exposed to critical incident stress.

Occupational stress injuries have become high profile concerns for emergency medical service organizations, including BCEHS. Those affected feel overwhelmed and shocked by what they have just experienced at work. They experience strong emotional, physical, behavioral or cognitive reactions that are out of their control—normal responses to an abnormal event or situation. Acknowledging that the call or situation is causing some level of distress can often be the first step in a healthy recovery.

BCEHS has asked the question, “Are we doing enough to help our paramedic crews and our call-takers and dispatch teams?”

Peer-to-peer support

In 2015, BC Emergency Health Services revised its Critical Incident Stress Management Program to a model that focuses on peers helping front-line staff cope with potential occupational stress injuries.

The Peer Critical Incident Stress (CIS) Management Program consists of BCEHS peer volunteers trained by the International Critical Incident Stress Foundation, an organization that trains individuals to be a part of crisis management teams. These peer volunteers located around the province understand and relate to occupational stressors, and they care about the well-being of their colleagues. The peer volunteers, who are supported by peer coordinators, are trained to defuse over the phone, to listen to their colleagues and offer support and referrals following those tough calls.

The program uses an uncommon system of peer selection because research has shown that emergency service workers in distress prefer to talk with a colleague who, like them, has really walked their walk. A “perceived peer support,” and not just a “support,” is a critical part of effective post-event stress reduction.

“Peer support helps to normalize people’s reactions and decrease the stigma,” says Lindsay Kellosalmi, one of the Lead Coordinators for the Peer CIS Management Program. “And then links them to the appropriate resources.”

CIS peers are uniquely matched to their colleagues seeking help: paramedics are matched to paramedics (by license level, whether they work in an urban or a rural station, and by years of experience), dispatchers to dispatchers, and call-takers to call-takers.

Staff can access a CIS peer or professional support by calling the toll-free 1-855 number 24 hours a day, 365 days a year.

When anyone in the dispatch centre, on car (either the paramedic or their partner) calls the CIS support line, they leave a message on the CIS coordinator’s pager app. They are then contacted directly by the coordinator within half an hour and the process for support begins. All coordinators have additional training in responding to any employee in crisis.

Group debriefings, when necessary, are supported by CIS peers and a trained counselor. Referrals to a trauma-informed and occupationally appropriate clinical psychologist or trauma/addictions counsellor are also provided as needed (the Peer CIS Management Program uses a network of 73 psychologists and clinical counsellors throughout the province). Confidentiality is an essential component of the program for the employees, peers and the counsellors.

Currently, the Peer CIS Management Program has more than 145 CIS peers and is supported by four leads and six after-hours coordinators for 24/7 coverage. At the time of writing, the program has had approximately 1,400 activations of the CIS support line in 2019. The program has shown a 33 per cent increase in activations each year since inception.

Enhancing resiliency in front-line staff

Besides providing emotional support to paramedics, call-takers and dispatchers who have experienced a critical incident, BCEHS is also taking a proactive approach to helping staff deal with workplace stress and subsequently prevent stress-related psychological problems.

With funds from a WorkSafe BC grant, Peer CIS Management Program manager Marsha McCall and co-investigators Dr. Dan Bilsker, Dr. Merv Gilbert, Dr. Ingrid Sochting and Dr. Lynn Alden conducted research on psychological resilience training. The team wanted to determine if this kind of training could further enhance a person’s ability to cope with highly stressful workplace situations throughout their career by developing their skills to anticipate, manage and recover from those situations.

The team surveyed 700 BCEHS paramedics, call takers and dispatchers to learn what coping strategies worked to help maintain their resilience. From the study, the team gained a deeper understanding of what constitutes resilient coping strategies and concluded there are five factors important for all BCEHS staff:

1. Balance: Balancing work and personal involvement, being able to unwind in personal time and let go of work pressures.

2. Self-acceptance: Not being harshly self-critical of one’s performance or personal qualities.

3. Meaningful work: Viewing one’s work as providing a sense of purpose and as compatible with one’s personal strengths and values.

4. Trusted support: Maintaining a supportive social network composed of individuals whom you trust.

5. Physical self-care: protecting one’s own physical health through exercise and fatigue management.

(For more detailed information about the five resilient coping factors, please read the team’s research findings in the February/March 2019 issue of Canadian Paramedicine.)

What’s next

To augment the support provided by the peer team, the Peer CIS Management Program has created orientation materials, an evidence-based psychological resiliency training program, and is currently developing an app with Telus and the BC Ministry of Health (for launch in 2020) to help staff to not only preserve but improve their mental resilience.

“Developing a resiliency program needs to be an evidence-based, thoughtful process,” says Dr. Bilsker. “The program needs to be effective, and it needs to be a part of the culture at BCEHS.”

“Paramedics, call-takers and dispatchers are immensely courageous,” he adds. “They deserve the best possible treatment and outcomes.”

Dr.Dan Bilsker

Dr.Dan Bilsker

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