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PubMed2003

Interventions for post-traumatic stress disorder and psychological distress in emergency ambulance personnel: a review of the literature.

A literature review was carried out to establish the extent of the literature on interventions for psychological distress and post-traumatic stress disorder in emergency ambulance personnel. A total of 292 articles were identified. Of these, 10 were relevant to this review. The primary intervention used with this population was critical incident stress debriefing, although there was some debate in the literature about the effectiveness of this intervention and the quality of the research conducted. More high quality research is needed on critical incident stress debriefing before being confident of its effectiveness.

Crisis Intervention↗
PubMed2005

Crisis management during anaesthesia: recovering from a crisis.

Preventing harm to the patient is the priority during a crisis. After a major incident, and especially when a patient has been harmed, there are a number of matters to be addressed: the ongoing care of the patient; documentation of the incident; investigation of the root causes; completion of reports; interviews with the patient and/or the next of kin, together with apologies and expression of regret; updates and ongoing support for friends and relatives; a word of thanks to the staff involved for their assistance; formal debriefing of staff for quality assurance and possibly ongoing support and a separate debriefing for psychological purposes; ensuring that the recommendations of the root cause analysis are carried out; or, failing that, that the issues are logged on a risk register. The extent and depth of the follow up protocol depends on what, if any, harm may have been done. This may constitute completion of an incident report; notification of an equipment failure to a federal regulatory authority; arranging consultations with a mental health professional to manage psychological sequelae (especially following an awareness episode); follow up during weeks of intensive care treatment; or, when a death has occurred, a full medico-legal and/or coronial set of procedures. A precis is appended in an action card format.

Algorithms↗
PubMed2001

The World Trade Center attack. Helping the helpers: the role of critical incident stress management.

Healthcare and prehospital workers involved in disaster response are susceptible to a variety of stress-related psychological and physical sequelae. Critical incident stress management, of which critical incident stress debriefing is a component, can mitigate the response to these stressors. Critical incident stress debriefing is a peer-driven, therapist-guided, structured, group intervention designed to accelerate the recovery of personnel. The attack on the World Trade Center, and the impact it may have on rescue, prehospital, and healthcare workers, should urge us to incorporate critical incident stress management into disaster management plans.

Aircraft↗
PubMed2006

Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome.

INTRODUCTION: During the 2003 severe acute respiratory syndrome (SARS) crisis, we proposed and tested a new protocol for cardiac arrest in a patient with SARS. The protocol was rapidly and effectively instituted by teamwork training using high-fidelity simulation. METHODS: Phase 1 was a curriculum design of a SARS-specific cardiac arrest protocol in three steps: planning the new protocol, repeated simulations of this protocol in a classroom, and a subsequent simulation of a cardiac arrest on a hospital ward. Phase 2 was the training of 275 healthcare workers (HCWs) using the new protocol. Training involved a seminar, practice in wearing the mandatory personal protection system (PPS), and cardiac arrest simulations with subsequent debriefing. RESULTS: Simulation provided insights that had not been considered in earlier phases of development. For example, a single person can don a PPS worn for the SARS patient in 1 1/2 minutes. However, when multiple members of a cardiac arrest team were dressing simultaneously, the time to don the PPS increased to between 3 1/2 and 5 1/2 minutes. Errors in infection control as well as in medical management of advanced cardiac life support (ACLS) were corrected. CONCLUSION: During the SARS crisis, real-time use of a high-fidelity simulator allowed the training of 275 HCWs in 2 weeks, with debriefing and error management. HCWs were required to manage the SARS cardiac arrest wearing unfamiliar equipment and following a modified ACLS protocol. The insight gained from this experience will be valuable for future infectious disease challenges in critical care.

Canada↗
PubMed1991

A confederate's perspective on deception.

In this article, I outline my position regarding the use of deception in psychology experiments, based on my experience as a confederate. I describe an experiment I participated in and the problems resulting from the study: subjects' differing responses to the deception; angry reactions of some subjects to the experiment; and the general discomfort of both the subjects and the confederates, in particular, who had their doubts concerning the external validity of the study and the ethics involved in running it. Issues of informed consent and debriefing are also addressed; it is argued that the success of deception depends on the subject being misinformed as to the experiment's true nature and that debriefing itself sometimes angers subjects. I encourage a decrease in the use of deception and the reexamination of a system that attempts to balance the pain of experimental participants with anticipated benefit to scientific knowledge.

Behavioral Research↗
PubMed1992

"Little rapes," specious claims, and moral hubris: a reply to Korn, Huelsman, Reed, and Aiello.

Because they failed to include our informed consent, guided imagery scenarios, and debriefing, the relevance of Koren, Huelsman, Reed, and Aiello's (1992) data remains unknown. The design of their Study 1 did not test the greater objectivity of role taking over involved participation. The design of their Study 2 did not demonstrate the effects of demand characteristics. The older "personal acquaintances" were not at higher risk of rape as they claimed. Properly gathered data from the University of Connecticut's laboratory demonstrated that participants regarded the guided imagining of rape to be personally and scientifically beneficial, educating them about the crime and the experience of the rape victim. Prior research had demonstrated that exposure to rape stimuli in combination with debriefing had an educational effect on the decreased endorsement of rape myths. Previously published ethical principles for balancing the rights of scientists, subjects, and society explicate our ethical stance. Informed consent precludes the occurrence of wrongful harms. This poorly designed and poorly reasoned "ethical" critique was unfounded; yet, it might produce a chilling effect on both the use of guided imagery and freedom of inquiry into politically sensitive topics.

Behavioral Research↗
PubMed1995

Deception methods in psychology: have they changed in 23 years?

To learn whether criticism and regulation of research practices have been followed by a reduction of deception or use of more acceptable approaches to deception, the contents of all 1969, 1978, 1986, and 1992 issues of the Journal of Personality and Social Psychology were examined. Deception research was coded according to type of (non)informing (e.g., false informing, consent to deception, no informing), possible harmfulness of deception employed (e.g., powerfulness of induction, morality of the behavior induced, privacy of behavior), method of deception (e.g., bogus device or role, false purpose of study, false feedback), and debriefing employed. Use of confederates has been partly replaced by uses of computers. "Consent" with false informing declined after 1969, then rose in 1992. Changes in the topics studied (e.g., attribution, socialization, personality) largely accounted for the decline in deception in 1978 and 1986. More attention needs to be given to ways of respecting subjects' autonomy, to appropriate debriefing and desensitizing, and to selecting the most valid and least objectionable deception methods.

Behavioral Research↗
PubMed1997

Duty-related stressors and PTSD symptoms in suburban police officers.

This study examined the effects of duty-related stress on police officers. Using a sample of 100 suburban police officers, an anonymous questionnaire requested demographic information and included a measure of duty-related stressors, SCL-90-R, the Posttraumatic Stress Disorder scale of the Impact of Events Scale-Revised, and a locus of control scale. Also assessed was whether Critical Incident Stress Debriefing was experienced. The results showed significant correlations between scores on duty-related stress, somatization, and symptoms of PTSD. 13% of the sample met the DSM-IV (1994) diagnostic criteria for PTSD. Results of the regression analysis showed the best predictors for the diagnosis of PTSD were associated with the factor of Exposure to Death and Life Threat, which corresponds to the DSM-IV AI criteria. Finally, 63% of the respondents stated that a critical incident debriefing would be beneficial following an extremely stressful event related to duty.

Adult↗
PubMed2004

Incidence of psychiatric disorders after extended residence in Antarctica.

OBJECTIVES: The incidence of psychiatric disorders and depressive symptoms was examined in a cohort of American men and women who spent an austral winter at two different research stations in Antarctica to determine whether extended residence of nonindigenous inhabitants in a polar region is associated with psychiatric morbidity. STUDY DESIGN: Debriefings interviews with 220 men and 93 women were conducted by 3 psychiatrists and 1 clinical psychologist at McMurdo Station and South Pole Station at the end of the austral winter between 1994 and 1997. Crewmembers were assigned a DSM-IV diagnosis if they satisfied diagnostic criteria. Debriefed crewmembers also completed the Structured Interview Guide for the Hamilton Depression Inventory-Seasonal Affective Disorders version (SIGH-SAD). RESULTS: Thirty-nine (12.5%) crewmembers presented with symptoms that met the criteria for one or more DSM-IV disorders. After weighting the prevalence to account for the low participation rate of civilian personnel, the incidence of DSM-IV disorders was 5.2%. Mood disorders were the most common diagnoses, accounting for 30.2% of all diagnoses, followed by adjustment disorders (27.9%), sleep-related disorders (20.9%), personality disorders (11.6%), and substance-related disorders (9.3%). Depressive symptoms as measured by the SAD-SIGH were significantly associated with female gender, military occupation, station, year of expedition, and DSM-IV diagnosis. CONCLUSION: Differences in the distribution of symptoms and diagnoses by demographic and expedition characteristics suggests that the social environment may be a more powerful determinant than the physical environment of psychiatric disorders in a polar region.

Adult↗
PubMed2005

Barriers to physician identification and reporting of child abuse.

Physicians systematically underidentify and underreport cases of child abuse. These medical errors may result in continued abuse, leading to potentially severe consequences. We have reviewed a number of studies that attempt to explain the reasons for these errors. The findings of these various studies suggest several priorities for improving the identification and reporting of child maltreatment: Improve continuing education about child maltreatment. Continuing education should focus not only on the identification of maltreatment but also on management and outcomes. This education should include an explanation of the role of CPS investigator and the physician's role in an investigation. The education should provide physicians with a better understanding of the overall outcome for children reported to CPS to help physicians gain perspective on the small number of maltreated children they may care for in their practice. This education should emphasize that the majority of maltreated children will benefit from CPS involvement. New York is the only state that mandates all physicians, as well as certain other professionals, take a 2-hour course called Identification and Reporting of Child Abuse and Maltreatment prior to licensing. Cited studies in this article suggest that such a mandate might be expected to improve identification and reporting, thereby encouraging other states to adopt similar regulations. Give physicians the opportunity to debrief with a trained professional after detecting and reporting child abuse. The concept of child abuse and the gravity of the decision to report can be troubling to the reporter. The debriefing could include discussions of uncomfortable feelings physicians may experience related to their own countertransference reactions. Provide resources to assist physicians in making the difficult determination of suspected maltreatment. The role of accessible telephone consultation should be evaluated, along with formalized collaborations with local Emergency Departments with pediatric expertise. Improve the relationship between CPS and medical providers. For example, CPS workers should systematically inform the reporting physician about the progress of their investigation and the outcome for the child and family. Several past reports have made specific suggestions to improve the working relationship. Warner and Hanson recommended that positive outcomes be programmed into the reporting process. They suggested that CPS have special phone lines staffed by well-trained employees for mandated reporters to call. Finkelhor and Zellman proposed a more radical change to improve the working relationship between CPS and mandated reporters. They suggested that certain professionals, with demonstrated expertise in the recognition and treatment of child abuse and registered as such, should have "flexible reporting options." Options include the ability to defer reporting, if there are no immediate threats to a child, or to make a report in confidence and defer the investigation until necessary. Finkelhor and Zellman emphasized that this model would improve physician-reporting compliance and enhance the role of CPS while reducing the work burden for CPS. Improve interaction with the legal system. Child abuse pediatric experts who have courtroom experience could provide education and support to physicians who have little preexisting experience with the legal system. Reimbursement for time spent supporting legal proceedings should be equitable and may reduce physician concerns about lost patient revenue. Retrospective studies and vignette analyses provide much information about some of the barriers to child maltreatment reporting and describe many of the reasons why physicians do not identify and report all child maltreatment. Future prospective examinations of physician decision-making may further explain the physician's decision-making process and the barriers he or she faces when identifying and reporting child abuse.

Child↗
PubMedDate not supplied

Using a head-mounted video camera to explore current conceptualizations of clinical reasoning in occupational therapy.

OBJECTIVE: The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy. METHOD: Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework. FINDINGS: Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists' debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of "generalization reasoning" is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance. CONCLUSION: This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.

Adult↗
PubMedDate not supplied

Written disclosure: a way of coping with traumatic stress.

Verbal debriefing after a traumatic incident may interrupt the natural adaptive processes that help people to deal with such incidents. This article examines the effectiveness of written interventions to help people experiencing distress after trauma experienced at work. As an alternative to critical incident debriefing, the authors recommend a staff education programme in tandem with written disclosure.

Adaptation, Psychological↗
PubMed2000

Changes in functional status related to health maintenance visits to family physicians.

BACKGROUND: Physicians do not provide preventive care at the level recommended by national organizations. This may be because of physicians' lack of training or low level of confidence or because of patients' fears, beliefs, and lack of health knowledge. METHODS: We used an observational prospective cohort study in an academic family practice office to investigate changes in patients' functional status associated with receiving recommendations to change behavior from family physicians. Patients 18 years and older presenting for health maintenance visits to family physicians completed a functional status instrument and a brief intake questionnaire by telephone before their visit. After the visit patients were randomized to a debriefing interview or an observation-only group. The interview included the Patient/Doctor Interaction Scale and an assessment of whether patients received a recommendation to change behavior. RESULTS: One hundred thirty-two patients were randomized to the debriefing group, and of those, 92% completed assessments at 3 months. Patients reporting recommendations to change behavior had lower scores at 1 and 3 months for mental health, social health, and self-esteem and higher anxiety and depression scores than patients not receiving these recommendations. CONCLUSIONS: There are declines in social and emotional functional status in patients presenting to family practice clinicians for health maintenance visits during which recommendations for behavioral change were made. Such declines may inhibit physicians from making recommendations for behavioral change or patients from accepting them.

Adaptation, Psychological↗
PubMed2001

Survey of Israeli Air Force line commander support for fatigue prevention initiatives.

BACKGROUND: Sustained and continuous high intensity military operations have increased in scope in recent years. These mandate ever more sophisticated efforts to prevent and ameliorate aviator fatigue. Successful implementation of new fatigue countermeasures requires thorough pretesting among experienced aviator opinion leaders: base and squadron commanders. METHODS: An anonymous and voluntary survey questionnaire containing background material and Likert-scale questions regarding 14 primary through tertiary fatigue prevention initiatives current in the aeromedical literature or unique to the IAF was distributed to all base and flight squadron commanders in the IAF. RESULTS: Of the commanders, 38% returned fully completed questionnaires. The most popular primary prevention initiatives (garnering 87% support) dealt with reservist aviators: 1.) requiring reserve pilots to arrive at the squadron at least 3 h before night flights to facilitate napping time, and 2.) improving scheduling coordination of those reservists employed as civilian aircrew. The chief (88% support) secondary prevention countermeasure endorsed was to utilize stimulant drugs such as caffeine or amphetamines to sustain the alertness of fatigued aviators. Leading the list of tertiary prevention initiatives (75% support) was the suggestion that squadrons debrief the incidence of aviator fatigue, as well as their success in the area of time-management when debriefing high tempo exercises and operational missions. CONCLUSIONS: Commanders differentially supported a wide range of fatigue countermeasures. Use of stimulant drugs achieved the broadest support. Instituting specific measures to facilitate alertness in reservist aviators was also a priority. Surveying the degree of commander support for new fatigue prevention initiatives provides the basis for prioritization of scarce resources, should improve line cooperation, and provides important experience-proven feedback for researchers and policy-makers.

Aerospace Medicine↗
PubMed2002

Meeting the patients where they are: consultation-liaison response to trauma victims of the Pentagon attack.

The Psychiatry Consultation-Liaison Service at Walter Reed Army Medical Center provided an immediate mental health response to hospitalized victims of the Pentagon attack on September 11. This article reviews our experience with this population and the lessons learned. Successful intervention required a flexible and innovative approach that included export of our services to the patient's location, liaison with involved facilities and treatment teams, and modification of therapeutic contact. Our debriefing approach was adapted to accommodate the victims' vulnerable psychological state in the wake of the trauma. Clinically effective interventions were implemented with the goals of reducing psychological symptoms, facilitating compliance with medical care, supporting rapid recovery of social and occupational functioning, and integrating social supports. This unique method, which we call "therapeutic debriefing," can serve as a model for future interventions after catastrophic events.

Aircraft↗
PubMed2003

[Advanced patient simulators in pre-hospital trauma management training--the trainees' perspective].

BACKGROUND: Computerized Human Patient Simulators (HPS's) have been increasingly utilized to improve and assess medical performance during critical scenarios. AIMS: To evaluate the utilization of advanced HPS's for trauma management training in pre-hospital setting. METHODS: Four scenarios representing frequent critical events in the pre-hospital trauma treatment were developed using the METI (Medical Education Technologies Inc, Gainesville, Florida) and SimMan (Laerdal, Stavanger, Norway) HPS's. Reserve and regular army medical teams encountered the scenarios, which were all fully videotaped. The A-V recording of the training sessions was used in the debriefing session conducted by experts in trauma care immediately after the encounters. At the end of the workshop, all participants filled in a personal feedback questionnaire. RESULTS: Sixty-six physicians and 16 emergency medical technicians participated in the study. Seventy-eight members (95%) of this group had participated in a previous Advanced Trauma Life Support course, 63 (77%) during the two years before the study. Only 6 (7.3%) of the participants treat trauma cases daily, and 7 (8.5%) more treat such cases at least once in two weeks. Seventy-two (82.8%) of the participants pointed out that the scenarios represent true trauma cases, and the same number reported that the video-based debriefing was excellent or very good. Sixty-four participants (78%) reported that the simulator training improved their decision-making, 54 (65.8%) claimed that it improved their manual skills, and only 47 (57.5%) believed they gained new knowledge. Eighty participants (97.5%) recommended simulator-based training as part of future training and performance assessment. CONCLUSIONS: According to this preliminary subjective study, simulator-based training may be used as a tool in improving the competency of medical teams in treating trauma victims in pre-hospital settings.

Computer Simulation↗
PubMed1992

Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents.

The authors have developed a course in Anesthesia Crisis Resource Management (ACRM) analogous to courses in Crew (Cock-pit) Resource Management (CRM) conducted in commercial and military aviation. Anesthesiologists do not typically receive formal training in crisis management although they are called upon to manage life-threatening crises at a moment's notice. Two model demonstration courses in ACRM were conducted using a realistic anesthesia simulation system to test the feasibility and acceptance of this kind of training. Anesthesiologists received didactic instruction in dynamic decision-making, human performance issues in anesthesia, and in the principles of anesthesia crisis resource management. After familiarization with the host institution's operating rooms and with the simulation environment, they underwent a 2-h simulation session followed by a debriefing session which used a videotape of their simulator performance. Participants rated the course as intense, helpful to their practice of anesthesiology, and highly enjoyable. Several aspects of the course were highly rated, including: videotapes of actual anesthetic mishaps, simulation sessions, and debriefing sessions. Scores on written tests of knowledge about anesthesia crisis management showed a significant improvement following the first course (residents) but not the second course (experienced anesthesiologists). Although the ultimate utility of this training for anesthesiologists cannot easily be determined, the course appeared to be a useful method for addressing important issues of anesthesiologist performance which have previously been dealt with haphazardly. The authors believe that ACRM training should become a regular part of the initial and continuing education of anesthesiologists.

Anesthesiology↗
PubMed2005

A pilot study of the impact of the Asian Tsunami on a group of Asian media workers.

The Asian Tsunami that struck on December 26, 2004, claimed tens of thousands of lives. To bring up-to-date news to the public, many media workers raced to the frontline. Singapore journalists were among the first to arrive at the devastated scenes of the affected countries. Critical Incident Stress Debriefing (CISD) was offered to these media personnel about a week after they returned from assignment. Twelve of the media workers participated in the CISD and also completed the General Health Questionnaire (GHQ-28), The Impact of Events Scale (IES), and a feedback questionnaire on what was helpful to them during the debriefing. Twenty-five percent of the respondents displayed psychiatric symptoms (GHQ-28 score > or = 5) with highest scorings being in the somatic domain. One third had IES > 30 with higher scores on the avoidance scale. Seventy-five percent of the participants indicated moderate (8.6-19) to high (> 19.0) total scores on the IES. All the participants reported that CISD was valuable. This pilot study provides support for the need to address the emotional aftermath of impacted media workers in the wake of disasters.

Adult↗