Ginny Kaplan
Doctorate
Doctorate Title: Secondary Trauma Response in Emergency Services Systems (STRESS).
Doctorate Description: In recent years, the profession of emergency medical services (EMS) has seen a meteoric rise in the rate of suicide—a number that is 10 times higher than the national civilian rate. It is plausible that there is a relationship between the rate of suicide and the rates of secondary traumatic stress (STS) syndromes, such as compassion fatigue (CF) and vicarious trauma (VT) in this profession. However, our understanding of this unique population of caregivers is nebulous, mainly as it pertains to occupational exposure to traumatic stress and prior history of traumatization, including previous military and combat-oriented service. This study was designed to quantify the rates of STS syndromes in the EMS population while exploring potential predictors and controlling for confounders. This was a prospective, crosssectional survey study of EMS personnel in North Carolina who were recruited at monthly training evolutions offered by their employers. IRB approval was obtained from Rush University. Nine EMS agencies from across the state agreed to participate and were chosen based on their geographic location and size. After providing informed consent, agency leadership completed an Agency Information Questionnaire (AIQ) to determine the types of emergency services provided, annual call volume, and the annual number and type of critical stress events. Each respondent also provided informed consent and completed a 105-item survey that included: (1) a sociodemographic questionnaire; (2) a military history questionnaire; (3) the Adverse Childhood Experiences (ACEs) questionnaire to quantify rates and types of childhood trauma; (4) the Professional Quality of Life (ProQOL) to quantify CF; (5) the Impact of Events Scale-Revised (IESR) to quantify VT; and (5) the Life Events Checklist-DSM V (LEC-5) to quantify rates and types of potentially traumatic experiences (PTEs). Chi-square tests were used to analyze categorical variables, while unpaired t-tests and analysis of variance (ANOVA) were used (as appropriate) to analyze continuous variables. Variables significant in univariate analyses were used to construct multivariate logistic and hierarchical linear regression models to determine unique predictors of STS in EMS personnel after controlling for potential confounders. A total of 40.9% of EMS professionals had VT, while 47.1% had CF. Nearly one in four had considered suicide at some point, and half knew another EMS provider who had committed suicide. EMS personnel were 2 times more likely to have VT if they had suffered emotional neglect during childhood, while the prevalence of other types of childhood trauma was 1.5-4 times higher in those providers with any STS syndrome. EMS providers were 2.3-4.7 times more likely to have either VT or CF when they had other stress syndromes. EMS personnel with STS syndromes had experienced PTEs at a rate 2-4 times higher than those without. Factors related to prior military service accounted for 14.6% of the variance of EMS professionals with VT (∆R 2 = 0.146, ∆F (5,62) = 3.31, p=0.010). Neither military experience nor a history of combat deployment was significant; however, the performance of combat patrols or other dangerous duty was uniquely predictive (sr2=0.061, p=0.011), which is consistent with previous reports. STS syndromes are a genuine threat to EMS personnel and additional research should focus on education, causation, and mitigation strategies for EMS professionals individually and their employers. Further study should also explore the intricate interconnection of how adversity during childhood and exposure to PTEs affect the working lives of today’s EMS professional. The results of this project may provide information useful for intervention strategies that focus on strengthening infrastructural support for a healthier EMS system.
Details:
Type: PhD
University: Rush University
Primary Supervisor: Dr. Douglas Kuperman
Category: Mental Health
Funding: No funding for this project
Start Date: 2015
End Date: 2019
Status: Complete
Thesis
ThesisResearch Interests
mental health, EMS, critical care, prehospital medicine, JEDI, traumatic stress, childhood trauma.
Publications
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