Stress-Management Programs

Many emergency medical services and transport teams have developed pro­grams based on the Critical Incident Stress Management model. Although well accepted in the emergency medical culture, the effectiveness of this intervention has been questioned.

Devilly & Cotton² offer broad guidelines to address stress in the work­place. First, have an organizational critical incident management policy that reflects current evidence. This policy may address unique stressors to the team. Define what constitutes a critical incident for your team and update it as necessary. For example, a hospital merger may be more appropriately addressed by a consultant in organizational structure and change, whereas a patient or team member death would be addressed as a critical incident. Second, facilitate access to immediate and practical support, as the situa­tion warrants, including food and shelter to timely expressions of concern and support from managers or peers. Third, provide access to employee assistance or wellness programs. This initial contact is not to be considered clinical intervention but social support, an opportunity for screening and familiarity if symptoms appear and intervention is indicated. Most transport programs have access to wellness programs, employee assistance programs, or other support that may also include professionals such as clergy, social workers, psychologists, or other mental health care professionals. Fourth, provide factual information when incidents occur. Fifth, promote ongoing conflict resolution and problem solving skills, with one of the aforemen­tioned programs or something similar. Last, monitor and screen for “at-risk” behaviors and provide support as indicated by current evidence and reflected in the policy. Talk to other transport teams; attend presentations of teams who have not only survived but learned from tragic experiences building a stronger and more resilient team.

Every team is different, and each transport is different. The stress from some calls can be neutralized by a conversation with a supportive colleague. Others may be resolved participating in social activities after the shift has ended, and some may benefit from professional support, as mentioned previ­ously. Ideally, a variety of voluntary resources are available to team members. Transport situations triggering a quality review, such as patient instability, equipment failure/malfunction may also provide opportunities for team members to discuss stressful incidents or stresses within the team.