Post Critical Incident Stress and Debriefings
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The level of fear and anxiety that EMTs felt when responding varied considerably. For 52%, the experience ' was very or somewhat frightening and upsetting. An additional 28% found it either "somewhat" or "not at all frightening or upsetting." Finally, 20% said that they enjoyed the experience. Los Angeles County Fire Department conducted critical stress debriefing about two or three weeks after the event. This was a massive undertaking requiring continuous efforts by numerous psychologists to reach each of the 1,700 firefighters who needed it (Askin, 1992). It met with a mixed reception. Dr. Pratt felt that if it was provided in the field before termination of the incident, that it would have been better received and more effective. Of those responding to the EMS survey, 65% said they bad an opportunity to have a critical incident stress debriefing. About half of the private ambulance responders reported that they would like such an opportunity. The Frederick Reaction Index was used to evaluate the level of disaster related stress that remained with the responders about three months after the event. David Wee and Dawn Mills, evaluated the scores at the request of EMSA. Frederick Reaction Index scores ranged from I to 29, with a mean of 12 and a standard deviation of 7.45. A score of less than 12 indicates doubtful post traumatic stress, a score of 12-24, mild and 25-39 indicates moderate post traumatic stress. Fifty-five percent (n=22) of the respondents fall into the doubtful category, thirty-five percent (n=22) qualify as mild and ten percent (n=6) as moderate. The two most commonly checked items on the Frederick Reaction Index were: "I believe my exposure to the Los Angeles civil disturbance was an extreme stressor that could cause emotions problems in most people," (n=63, 95%)." Most of the respondents falling into the doubtful post traumatic stress category (91 %) endorsed this item. The second most commonly selected item (43 or 65 %) was "Fears of personal experiences with the Los Angeles civil disturbance continue in my mind." Other questions on the survey, in combination with the Frederick Reaction score, made it possible to. investigate various hypothesis. These findings are (Wee and Mills, 1993): The greater the level of exposure to the disturbance, as measured by the number of dispatches into the event, the higher the level of post incident stress. This relationship is statistically significant (regression of .039) but does not account for a large portion of the stress. Those who experienced direct threats or attacks (throwing rocks or similar activity) from crowds when providing medical care scored significantly higher on the Frederick Reaction scale than those that didn't. Those workers who were given an opportunity to participate in a critical stress incident debriefing sessions scored significantly... lower on the Frederick Reaction Index, with an average score of 10.7, compared to a mean of 14.3 for those not offered this service. No relationship was found between injury to themselves or their partner, or damage to equipment, and Frederick Reaction Index. Wee and Mills concluded that: "emergency medical service personnel providing pre-hospital care to patients during the south Central Los Angeles civil disturbances experienced stress responses three months following the event (Wee and Mills, 1993)." |
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Medical Care for the Injured