Paramedics' experiences of potentially traumatic events and their coping styles: an interpretative phenomenological analysis

Introduction: Existing literature on trauma and coping with traumatic events in paramedics has often concentrated on the concept of posttraumatic stress disorder (PTSD), using quantitative pre-defined self-report measures to investigate symptoms and coping strategies, thereby preventing elaboration of these concepts. The concept of positive adaption or posttraumatic growth (PTG) has also largely been ignored. Furthermore, research has often focussed on emergency workers (EWs) within disaster situations, ignoring the impact of their day-to-day experiences, e.g. cardiac arrests and road traffic accidents. Moreover, paramedics have been investigated alongside emergency medical technicians (EMTs) in some studies, and other EWs (e.g. fire-fighters and police) in other studies, despite different occupational roles. This means that focussed research on the experience of individual paramedics in their day-to-day roles is missing. Objectives: Therefore, this study aimed to carry out a qualitative, phenomenological exploration of the impact of multiple work-related potentially traumatic experiences on paramedics, alongside their ways of coping. Therefore, providing a deeper more individualised and nuanced account of their experiences than has been reported previously. Design: A semi-structured qualitative interview was used to conduct a retrospective study of seven full-time qualified paramedics, working for an ambulance service NHS Trust. Methods: Ethical and Research and Development approval was granted. Interpretative Phenomenological Analysis (IPA) was used to analyse the interview transcripts. Results: Four inter-related super-ordinate themes were generated: ‘The salience of memories,’ ‘the process of reflection and making sense,’ ‘the impact of context on coping’ and ‘emotional management and control. ’ The first theme discusses the vivid memories experienced by the participants and the types of circumstances that make these memories more vivid and potentially distressing. The remaining themes focus on coping, including factors that impact on the individual’s ability to cope and their particular ways of coping with their job demands. All the themes consider the psychological impact of the job on the participants. Discussion: The results build upon the existing literature providing a more individualised and nuanced account of the lived experience of paramedics who are exposed to multiple work-related potentially traumatic events. A more detailed and exploratory account of the types of incidents paramedics find stressful or traumatic is provided, indicating the impact of such events on memories. In addition, an account of the ways in which these paramedics cope is provided, particularly the process of reflection and meaning making, which has been referred to in previous studies but not as extensively elaborated upon. The study will be of interest to professionals involved in training paramedics and/or providing occupational health support. Study limitations include the omission of objective assessments of PTSD and PTG and these should be included alongside qualitative data in future research, to gain a fuller understanding of responses following cumulative trauma. Using mixed research methods might help to ascertain the types of coping strategies associated with PTSD and/or PTG, something the current study has been unable to comment on, thereby indicating avenues for preventing PTSD and encouraging PTG within paramedics.