Abstract
Introduction
The September 11, 2001 terrorist attacks, otherwise known as 9/11, on the World Trade Center in New York City killed 2753 people, including approximately 413 first responders. Some 7000 responders are currently enrolled in the World Trade Center Health Program with illnesses related to their exposure to 9/11, and over 2000 have had to retire on 9/11-related disability. The impact of 9/11 is extensive and ongoing.
Methods
This research used qualitative methods to interview a cohort of 54 paramedics and emergency medical technicians who responded to 9/11. These interviews occurred around the 15-year anniversary of the terrorist attacks. The objective of the research was to explore the long-term physical and mental health impact on the responding paramedics and emergency medical technicians and to investigate key influences on wellness. Information pertaining to ongoing impact, wellness and ideas for effective ambulance wellness programs were extrapolated through thematic analysis.
Results
Seven key lessons for paramedic wellness were identified. These included: the need to understand the paramedic workforce and the key influences on their health and wellbeing; the importance of engaging staff in the development-phase of wellness strategies; avoiding silo-approaches to physical and mental health; providing ongoing professional development opportunities; providing tools for effective peer-to-peer communication; including family members in wellness initiatives; and not forgetting the retiring workforce.
Conclusion
This research makes an important new contribution to the existing knowledge base at a time when Australian ambulance services are currently developing wellness strategies to improve the physical and psychosocial wellness of the pre-hospital workforce.
References
Smith E, Burkle FM Jr. Working towards wellness: lessons from the 9/11 medics for Australian ambulance services. Presented at the Paramedics Australasia Survive and Thrive Conference, Melbourne, Australia June 2017.
World Trade Center Health Panel. Addressing the health impacts of 9/11: report and recommendations to Mayor Michael Bloomberg. Available at: www.nyc.gov/html/om/pdf/911_health_impacts_report.pdf [Accessed 19 February 2016].
CNN. September 11th Fast Facts. 2016. Available at: http://edition.cnn.com/2013/07/27/us/september-11-anniversary-fast-facts/index.html [Accessed 9 August 2017].
Smith EC, Burkle FM Jr. The disaster after 9/11: The long-term health and psychological impact on paramedics and emergency medical technicians. Under review by Disaster Med Public Health Prep, August 2017.
Fire Department, City of New York: Bureau of Health Services WTC Medical Monitoring and Treatment Program. World Trade Center health impacts on FDNY rescue workers. Available at: http://home2.nyc.gov/html/fdny/html/publications/wtc_assessments/2007/wtc_2007.shtml [Accessed 19 February 2016].
Wisnivesky JP, Teitelbaum SL, Todd AC, et al. Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet 2011;378:888–97.
Smith E, Burkle FM Jr. Are you ok? Recounting the long-term physical and mental health impacts of 9/11 medics. Presented at the Australian and New Zealand Disaster and Emergency Management Conference, Gold Coast, Australia May 2016.
Sott T. Evaluation of firefighter health and wellness programs. Available at: www.usfa.dhs.gov/pdf/efop/efo38040.pdf [Accessed 12 July 2017].
Baum J, Hendricks SM, Lanier D. A holistic review of the health and wellness programs of Victorian emergency services. Available at: www.esf.com.au/documents/WPI_Report_Final_2011.pdf [Accessed 19 July 2017].
U.S. Department of Transportation National Highway Traffic Safety Administration. The emergency medical services workforce agenda for the future. Available at: www.ems.gov/pdf/2011/EMS_Workforce_Agenda_052011.pdf [Accessed 10 August 2017].
Bennett P, Williams Y, Page N, Hood K, Woollard M. Levels of mental health problems among UK emergency workers. Emerg Med J 2004;21:235–6.
Bentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg Care 2013;17:330–8.
Courtney JA, Francis AJP, Paxton SJ. Caring for the carers: fatigue, sleep, and mental health in Australian paramedic shiftworkers. Australian and New Zealand Journal of Organisational Psychology 2010;3:32–41.
Courtney JA, Francis AJ, Paxton SJ. Caring for the country: fatigue, sleep and mental health in Australian rural paramedic shiftworkers. J Community Health 2013;38:178–86.
Hegg-Deloye S, Brassard P, Jauvin N, et al. Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics. Emerg Med J 2014;31:242–7.
Rice V, Glass N, Ogle K, Parsian N. Exploring physical health perceptions, fatigue and stress among health care professionals J Multidiscip Health 2014;7:155–61.
Kleim B, Westphal M. Mental health in first responders: a review and recommendation for prevention and intervention strategies. Traumatology 2001;17:17.
Sterud T1, Ekeberg Ø, Hem E. Health status in the ambulance services: a systematic review. BMC Health Serv Res 2006;6:82.
Sofianopoulos S, Williams B, Archer F, Thompson B. The exploration of physical fatigue, sleep and depression in paramedics: a pilot study. Australasian Journal of Paramedicine 2011;9(1).
Sterud T, Hem E, Lau B, Ekeberg O. Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel. J Occup Health 2008;50:406–14.
Sofianopoulos S, Williams B, Archer A. Paramedics and the effects of shift work on sleep: a literature review. Emerg Med J 2012;29:152–5.
van der Ploeg E, Kleber RJ. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 2003;60(Suppl 1):i40–6.
Alexander DA, Klein S. Ambulance personnel and critical incidents: impact of accident and emergency work on mental health and emotional well-being. Br J Psychiatry 2001;178:76–81.
Brough P. Comparing the influence of traumatic and organizational stressors on the psychological health of police, fire, and ambulance officers. Int J of Stress Manage 2004;11:227–44.
Sparks K, Cooper CL. Occupational differences in the work-strain relationship: towards the use of situation-specific models. J Occup Organ Psychol 1999;72:219–29.
Jonsson A, Segesten K, Mattsson B. Post-traumatic stress among Swedish ambulance personnel. Emerg Med J 2003;20(1).
Morren M, Dirkzwager AJE, Kessels FJM, Yzermans CJ. The influence of a disaster on the health of rescue workers: a longitudinal study. CMAJ 200;176(9).
Perlman SE, Friedman S, Galea S, et al. Short-term and medium-term health effects of 9/11. Lancet 2011;378:925–34.
Courtney JA, Francis AJP, Paxton SJ. Caring for the carers: fatigue, sleep, and mental health in Australian paramedic shiftworkers. Australasian Journal of Organisational Psychology 2010;3:32-41.
Knowles L. New figures reveal high suicide rates amongst emergency workers; experts warn PTSD sufferers not getting needed treatment. Available at: www.abc.net.au/news/2015-06-03/new-figures-reveal-high-suicide-rates-amongst-emergency-workers/6518250 [Accessed 14 August 2017].
Ambulance Victoria. Ambulance Victoria and beyondblue join forces to improve staff mental health. Available at: www.ambulance.vic.gov.au/ambulance-victoria-and-beyondblue-join-forces-to-improve-staff-mental-health/ [Accessed 14 August 2017].