Ambulance Union Literature Review Report Final May 2019
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978-0-9943050-5-3 2 ABBREVIATIONS................................................................................................................. 5 EXECUTIVE SUMMARY................................................................................................................................7 INTRODUCTION ................................................................................................................ 11 METHODS.......................................................................................................................... 15 Peer-reviewed literature search strategy............................................................................. 15 Grey literature search strategy............................................................................................ 16 Google advanced search................................................................................................ 17 Dissertations/theses ....................................................................................................... 17 Current research ............................................................................................................ 18 Submissions to inquiries................................................................................................. 18 Ambulance Service annual reports................................................................................. 19 RESULTS ........................................................................................................................... 20 Peer-reviewed literature results........................................................................................... 20 Section 1: Impacts and work-related psychological and physical well-being needs ........ 22 Section 2: Help-seeking and access to supports ............................................................ 28 Section 3: Impacts of organisational and systems parameters ....................................... 30 Grey literature results.......................................................................................................... 35 Google advanced search................................................................................................ 35 Dissertations................................................................................................................... 36 Current research ............................................................................................................ 37 Submissions to inquiries................................................................................................. 38 Ambulance Service annual reports................................................................................. 47 DISCUSSION...................................................................................................................... 49 REFERENCES ................................................................................................................... 55 APPENDICES..................................................................................................................... 67 Appendix 1: Systematic literature review search strategies................................................. 67 Appendix 2: Description of studies included in systematic literature review (peer-reviewed literature)................................................................................. 70 Appendix 3: Peer-reviewed literature - Impacts and work-related psychological and physical well-being needs ................................................................................ 84 Appendix 4: Peer-reviewed literature - Help-seeking and access to supports ................... 102 Appendix 5: Peer-reviewed literature - Impacts of organisational and systems parameters109 Appendix 6: Peer-reviewed literature - CASP quality ratings of primary research and non-systematic literature reviews ................................................................... 127 Appendix 7: Peer-reviewed literature - CASP quality ratings of systematic reviews .......... 145 Appendix 8: Grey literature – Summary of Google advanced search results ..................... 149 Appendix 9: Grey literature – Summary of dissertation literature....................................... 170 3 Appendix 10: Grey literature - Table of current research................................................... 177 Appendix 11: Grey literature (submissions) – What is the problem, what causes the problem and what is missing?...................................................................... 182 Appendix 12: Grey literature (submissions) – Programs and resources ............................ 218 Appendix 13: Grey literature (submissions) – Legislation, policies, retirement, and financial stability .......................................................................................... 235 Appendix 14: Grey literature – Ambulance service annual reports .................................... 241 LIST OF FIGURES Figure 1. PRISMA 2009 Flow Diagram ............................................................................... 21 Figure 2. Conceptual model of paramedics’ work-related stress…………………………. ..... 32 Figure 3. Four themes emerging from the literature review on paramedic well-being…....... 50 LIST OF TABLES Table 1: Inclusion and exclusion criteria for peer-reviewed literature................................... 15 Table 2: Inclusion and exclusion criteria for the Google advanced search........................... 17 Table 3: Inclusion and exclusion criteria for dissertations.................................................... 18 Table 4. Results retrieved from database searches ............................................................ 20 4 ABBREVIATIONS AEASA Ambulance Employees Association of South Australia AMBNZ Ambulance New Zealand ANZCP Australian and New Zealand College of Paramedicine AV Ambulance Victoria CAA Council of Ambulance Australia CALD Culturally and Linguistically Diverse CASP Critical Appraisal Skills Program CBT Cognitive Behaviour Therapy CI Critical incident CID Critical incident debriefing CISD Critical incident stress debriefing CISM Critical incident stress management CVD Cardiovascular disease EAP Employment Assistance Program ESFR Emergency service first responders EM Emergency medical callers EMAS Emergency Medical Ambulance Service EMD Emergency medical dispatch EMS Emergency Medical Service EMT Emergency Medical Technician EPSP Employee Peer Support Program FUM Frequent User Management Program HACSU Health and Community Service Union HLM Hierarchical linear modelling HS Health service provider IPA Interpretive Phenomenological Analysis IR Industrial relations LGBTQI Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex MeSH Medical Subject Headings MHAAT Mental Health Acute Assessment Team 5 NCAU National Council of Ambulance Unions NCIS National Coronial Information System NPM New Public Management OHS Occupational Health and Safety PA Paramedics Australasia PFA Psychological First Aid PTG Post-traumatic growth PTSD Post-traumatic stress disorder PTSS Post-traumatic stress symptoms QAS Queensland Ambulance Service RAAV Retired Ambulance Association of Victoria SD Standard deviation SDM Service development model SJAANT Saint John Ambulance Australia Northern Territory TRiM Trauma Risk Management VAOs Volunteer Ambulance Officers 6 EXECUTIVE SUMMARY The scoping literature review of peer-reviewed and grey qualitative literature addressed the psychological, physical, and social well-being of paramedics, ambulance officers, ambulance volunteers and call-takers. The following questions were generated to address these issues: Focus questions for peer-reviewed literature 1. What impact does emergency service work have on psychological well-being, and psycho-social health of paramedics, ambulance officers, ambulance volunteers, and ambulance call-takers? 2. What impact does the psychological stress linked to the workplace have on physical well- being for paramedics, ambulance officers, ambulance volunteers, and call-takers? 3. What role does stigma and self-stigma play in the utilisation and willingness to access mental health support for paramedics and call-takers? 4. How do paramedics, ambulance officers, ambulance volunteers, and call-takers articulate their work-related well-being needs? 5. How are symptoms of workplace fatigue, post-traumatic stress disorder (PTSD), critical incident stress and work-related stress reported and identified (either self-reported, peer- reported, or reported by the organisation)? 6. What other factors influence the utilisation and willingness to access mental health support by paramedics, ambulance officers, ambulance volunteers, and call-takers? 7. How is the mental health and well-being of paramedics, ambulance officers, ambulance volunteers, and call-takers affected by workflow, the nature of the work, and their changing roles? 8. What effects do organisational structures addressing respite, debriefing (both formal and informal), and workload have on paramedics, ambulance officers, ambulance volunteers, and call-takers’ psychological and physical well-being? Focus question for grey literature What policies, processes, or resources (e.g. interventions/programs/legislation/industrial working conditions) are in place to manage work-place stress, psycho-social, and physical work-related stress? Specifically: 1. What formal programs and resources are currently provided that support mental healthcare and well-being for