Needing a back-up plan

Due to the nature of their work and the recognition of post-traumatic stress disorder as a diagnosis for front-line emergency workers (Alden et al, 2008. Fullerton et al, 2004. Jonsson et al, 2003. Jonsson &

Segesten, 2003), it is assumed that psychological preparation is part of each stage of emergency preparedness and response. This is in contrast to Harry, a paramedic who has worked in the ambulance service for over twenty-five years, who implies that they, as paramedics, attend an incident and have to hope that a psychological “back-up plan” is in place.

“I think, probably as I am a little bit older then most of the people here [laughs] I have a sort of… ok it is going to happen you know and we have just got to deal with it whereas perhaps it will affect me later on, it wouldn’t affect me… or I feel that it wouldn’t affect me too much at that time and as I say I have not dealt with it, I don’t know what it is going to like in the future or any-thing like that so I would be hopeful that there would be a back up sort of plan for us, if you know what I mean, to sort us out after”. Harry, L127 – 136.

Examining the post-incident perspective, Harry implies that the

paramedic’s individual professional experience and time in the service impacts on how each person deals with the psychological component of their role. He also takes on the stoic attitude that if it does happen, you just need to get on with it. The presumption that the more experienced paramedic will cope better after an event is in contrast with the view that an increase in exposure time may create a psychological overload. Interestingly, his quote suggests that there is no forward thinking in terms of psychological support; rather he hopes that there is an imaginative healing ‘back-up plan’ for after an event

Mary implies that post-incident discussion is voluntary and includes both formal and informal support, as per the following extract:

“we have got things in place if we need to talk to any-body after an incident. We’ve got the team-leaders and every-one else in the group. We’ve got SALS, which is a liaison service who we can ring up and talk through the incident and they can give advise and refer us on if we need any other specialist help”. Mary, L64 -66.

The analysis suggests that firstly, practitioners are stoic about their emotional response to incidents. Secondly, that psychological support needs to be individualised and be present in all stages of preparedness (pre, during and post incident) and thirdly, there is limited

consideration to the psychological preparation of individuals, as highlighted by Edward:

“[when asked about how paramedics cope] {long pause}. If I’m honest, I don’t think the ambulance service considers your mental status at all, I think there is a big thing at the moment about traumatic depression and things like that and it is usually factored around the armed services, which you can understand but I think being in the.... {pause}I don’t know. That is a difficult one. Every-one works differently and I think that you have your own mechanism of dealing with things, emergency services, regardless of which one it is, you will probably see and deal with a lot more nastier things over a longer period of time and I think that is maybe not considered as much as it should be. But then I honestly think that it is part and parcel of the job as well. I came into the job knowing that I am going to see and deal with things, that the normal every-day jobs would never see. So I think you just learn to accept things better but again that only comes with time, doesn’t it?”. Edward, L140 – 158.

The focus for psychological support currently appears to be on the post incident perspective, with Edward acknowledging that individuals need time to reflect and process what they have seen. Edward also links this to work from the armed services, and how they cope with the trauma that they have been exposed to. It is not clear from these transcripts what knowledge and evidence, if any, from the armed services is used in the psychological preparation of these individuals. As an alternative to a

‘back-up plan’, Edward suggests that psychological support emerges as

an individualised, personal resilience response.

Sally focuses on debriefing post incident and suggests that this occurs in an informal manner. This links with the data analysis sections on role (6.1.1), action hero (6.1.2), language (6.1.3) and story-telling (8.1).

“some team leaders debrief after every job, some don’t. I think a lot of it comes from banter in the mess room. Some-times if you have been to quite a serious job, it doesn’t happen straight away, sometimes it is like tea and toast for a little bit and then someone will start chatting about it and it will turn into a debrief session where we just chat about things. I always find that better, you can sit better with it”. Sally L180 – 188.

In this instance, debriefing occurs in an informal manner, but a formal debrief could also be utilised as a psychological back-up and support post incident, promoting the individuals personal, psychological resilience.

In this section, four subthemes related to personal resilience, in the context of emergency preparedness have been explored. These are ‘we

are not robots’, ‘coping mechanisms’, ‘psychological preparation’ and ‘needing a back-up plan’. The next section offers a summary of this