68616 Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 

Patient Safety PSO, P0197, was delisted 

effective at 12:00 Midnight ET (2400) on 

October 1, 2023. 

More information on PSOs can be 

obtained through AHRQ’s PSO website 

at http://www.pso.ahrq.gov. 

Dated: September 29, 2023. 

Marquita Cullom, 

Associate Director. 

[FR Doc. 2023–22076 Filed 10–3–23; 8:45 am] 

BILLING CODE 4160–90–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Supplemental Evidence and Data 

Request on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Request for supplemental 

evidence and data submissions. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is seeking 

scientific information submissions from 

the public. Scientific information is 

being solicited to inform our review on 

Mental Health and Occupational Stress 

in the Emergency Medical Service and 

911 Workforce, which is currently being 

conducted by the AHRQ’s Evidencebased Practice Centers (EPC) Program. 

Access to published and unpublished 

pertinent scientific information will 

improve the quality of this review. 

DATES: Submission Deadline on or 

before November 3, 2023. 

ADDRESSES: 

Email submissions: epc@

ahrq.hhs.gov. 

Print submissions: 

Mailing Address: Center for Evidence 

and Practice Improvement, Agency for 

Healthcare Research and Quality, 

ATTN: EPC SEADs Coordinator, 5600 

Fishers Lane, Mail Stop 06E53A, 

Rockville, MD 20857 

Shipping Address (FedEx, UPS, etc.): 

Center for Evidence and Practice 

Improvement, Agency for Healthcare 

Research and Quality, ATTN: EPC 

SEADs Coordinator, 5600 Fishers 

Lane, Mail Stop 06E77D, Rockville, 

MD 20857 

FOR FURTHER INFORMATION CONTACT: 

Kelly Carper, Telephone: 301–427–1656 

or Email: epc@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: The 

Agency for Healthcare Research and 

Quality has commissioned the 

Evidence-based Practice Centers (EPC) 

Program to complete a review of the 

evidence for Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce. 

AHRQ is conducting this review 

pursuant to Section 902 of the Public 

Health Service Act, 42 U.S.C. 299a. 

The EPC Program is dedicated to 

identifying as many studies as possible 

that are relevant to the questions for 

each of its reviews. In order to do so, we 

are supplementing the usual manual 

and electronic database searches of the 

literature by requesting information 

from the public (e.g., details of studies 

conducted). We are looking for studies 

that report on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce. The 

entire research protocol is available 

online at: https://effectivehealthcare.

ahrq.gov/products/ems-911-workforcemental-health/protocol. 

This is to notify the public that the 

EPC Program would find the following 

information on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce 

helpful: 

D A list of completed studies that 

your organization has sponsored for this 

topic. In the list, please indicate 

whether results are available on 

ClinicalTrials.gov along with the 

ClinicalTrials.gov trial number. 

D For completed studies that do not 

have results on ClinicalTrials.gov, a 

summary, including the following 

elements, if relevant: study number, 

study period, design, methodology, 

indication and diagnosis, proper use 

instructions, inclusion and exclusion 

criteria, primary and secondary 

outcomes, baseline characteristics, 

number of patients screened/eligible/ 

enrolled/lost to follow-up/withdrawn/ 

analyzed, effectiveness/efficacy, and 

safety results. 

D A list of ongoing studies that your 

organization has sponsored for this 

topic. In the list, please provide the 

ClinicalTrials.gov trial number or, if the 

trial is not registered, the protocol for 

the study including, if relevant, a study 

number, the study period, design, 

methodology, indication and diagnosis, 

proper use instructions, inclusion and 

exclusion criteria, and primary and 

secondary outcomes. 

D Description of whether the above 

studies constitute ALL Phase II and 

above clinical trials sponsored by your 

organization for this topic and an index 

outlining the relevant information in 

each submitted file. 

Your contribution is very beneficial to 

the Program. Materials submitted must 

be publicly available or able to be made 

public. Materials that are considered 

confidential; marketing materials; study 

types not included in the review; or 

information on topics not included in 

the review cannot be used by the EPC 

Program. This is a voluntary request for 

information, and all costs for complying 

with this request must be borne by the 

submitter. 

The draft of this review will be posted 

on AHRQ’s EPC Program website and 

available for public comment for a 

period of 4 weeks. If you would like to 

be notified when the draft is posted, 

please sign up for the email list at: 

https://www.effectivehealthcare.

ahrq.gov/email-updates. 

The review will answer the following 

questions. This information is provided 

as background. AHRQ is not requesting 

that the public provide answers to these 

questions. 

Key Questions (KQ) 

KQ 1: What are the incidence, 

prevalence, and severity of mental 

health issues (depression, anxiety, 

PTSD, suicidality, and substance use 

disorders) and occupational stress 

issues (burnout, stress, and moral 

injury) among the EMS and the 911 

workforce? 

a. Are the incidence, prevalence, and 

severity modified by: 

i. Agency composition including 

workflow, regulations, financing? 

ii. Characteristics of EMS and 911 

personnel (e.g., education/training, 

proficiency, experience, trauma 

exposure)? 

iii. Physical and mental health 

resources? 

KQ 2: What are the effectiveness and 

comparative effectiveness, including 

benefits and harms, of interventions 

addressing mental health issues 

(depression, anxiety, PTSD, suicidality, 

and substance use disorders) and 

occupational stress issues (burnout, 

stress, and moral injury) among the EMS 

and 911 workforce? 

a. Are the effectiveness of the 

interventions modified by: 

i. Intervention type? 

ii. Characteristics of EMS and 911 

personnel (e.g., education/training, 

proficiency, experience)? 

iii. EMS/911 agency characteristics 

including workflow, regulations, 

financing? 

iv. Physical and mental health 

resources? 

KQ 3: What are the context and 

implementation factors of studies with 

effective EMS/911 workforce practices 

to prevent, recognize and treat mental 

health issues (depression, anxiety, 

PTSD, suicidality, and substance use 

disorders) and occupational stress 

issues (burnout, stress, and moral 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 68617 

injury)? This description might include 

distinguishing factors such as workforce 

training, surveillance, resilience 

training, occupational health services, 

peer-to-peer support, preparedness for 

trauma exposure, and program funding. 

KQ 4: What future research is needed 

to close existing evidence gaps 

regarding preventing, recognizing, and 

treating mental health issues 

(depression, anxiety, PTSD, suicidality, 

and substance use disorders) and 

occupational stress issues (burnout, 

stress, and moral injury) in the EMS/911 

workforce? 

BILLING CODE 4160–90–P 


lotter on DSK11XQN23PROD with NOTICES1EN04OC23.000</GPH>

PICOTS (Populations, Interventions, Comparators, Outcomes, Timing, and 

Settin 

r=====i~t\11,,,,_,~11~i1.l,~:,,:,:-t~1s7J7J~~=1,,-;;:,1f"""""~ 

Population EMS/911 workforce 

o Field responders ( either ground or air personnel, either civilian or 

military personnel, based either in the field [e.g., street comers] or 

non-field (e.g., station, hospital) 

■ Paramedics, including firefighter paramedics, flight medics, 

critical care paramedics 

■ Firefighters, including firefighter-non-transport 

■ Emergency medical technicians (EMTs), including advanced 

EMTs (AEMTs) and firefighter-EMTs, flight EMTs 

■ Emergency medical responders (EMRs) 

■ Field response physicians 

■ Field response nurses 

■ Field response advance practice providers (APPs) 

■ EMS medical directors 

o Public safe telecommunicators 911 call takers and dis atchers 

Interventions Not applicable • Interventions intended to address mental health 

Comparators Not applicable 

issues (depression, anxiety, PTSD, suicidality, 

and substance use disorders) and occupational 

stress issues (burnout, stress, and moral injury) 

in the EMS/911 workforce 

• Interventions must target promotion of at least 

one of the following 

o Resistance 

o Resilience 

• Interventions can be any of the following: 

o Individual-level, organizational, systemwide (local/state/national), or combined 

o Critical incident stress management 

(CISM), subacute coping/stress 

management, or long-term stress 

mana ement interventions 

• Other interventions 

• Less intensive version of the same intervention 

• Standard of care (as defined in individual 

studies) 

• No intervention 
68618 Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 


lotter on DSK11XQN23PROD with NOTICES1EN04OC23.001</GPH>

Outcomes • Incidence of 0 Social connection or support 

behavioral 0 Coping mechanisms 

health issue 0 Help-seeking behaviors: Use of mental 

or health counselors, Employee Assistance 

occupational Program (EAP), or peer support 

stress 0 Hospitalizations 

• Prevalence of 0 Complaints from patients 

behavioral 0 Burnout 

health issue 0 Sleep deprivation 

or 0 Overtime or excessive hours worked 

occupational 0 Resistance 

stress 0 Resilience 

• Severity of 0 Relationship or family issues 

behavioral 0 Anxiety 

health issue 0 Depression 

or 0 PTSD 

occupational 0 Substance use 

stress 0 Suicidality 

0 Withdrawal from EMS/911 workforce 

(e.g., job/job location changes) 

0 Unintended harms of intervention 

Study • Cross- • Randomized • RCTs 

Designs sectional controlled trials • Non-randomized 

studies (RCTs) comparative studies 

• Cohort • Non-randomized 0 Nonstudies comparative studies randomized 

0 Non- controlled trials 

randomized 0 Observational 

controlled trials cohort studies 

0 Observational with a 

cohort studies comparison 

with a group 

comparison 0 Pre-post studies 

group Implementation 

• Pre-post studies studies without a 

comparison group 
Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 68619 

Dated: September 28, 2023. 

Marquita Cullom, 

Associate Director. 

[FR Doc. 2023–21915 Filed 10–3–23; 8:45 am] 

BILLING CODE 4160–90–C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project 

‘‘TeamSTEPPS 3.0 Training 

Assessment.’’ In accordance with the 

Paperwork Reduction Act of 1995, 

AHRQ invites the public to comment on 

this proposed information collection. 

DATES: Comments on this notice must be 

received by December 4, 2023. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

TeamSTEPPS 3.0 Training Assessment 

In 2006 the Agency for Healthcare 

Research and Quality (AHRQ) and the 

Department of Defense developed 

Strategies & Tools to Enhance 

Performance and Patient Safety, or 

TeamSTEPPS®, an evidence-based 

patient safety program. The main 

objective of the TeamSTEPPS program 

is to improve patient safety by training 

health care staff in various teamwork, 

communication, and patient safety 

concepts, tools, and techniques and 

ultimately helping to build national 

capacity for supporting teamwork-based 

patient safety efforts in health care 

organizations. Given the advancements 

in health information technology, 

changes in how care is delivered and a 

recent emphasis on engaging patients 

and families as members of the 

healthcare team, the TeamSTEPPS 

curriculum was significantly refreshed 

in 2023 and made into a singular 

comprehensive program to better 

support teams in improving their 

communication skills and collaboration. 

The updated TeamSTEPPS training 

will now be implemented in different 

settings of various large and small 


lotter on DSK11XQN23PROD with NOTICES1EN04OC23.002</GPH>

Contextual • Individual-level factors 

Factors 0 Demographics (e.g., age, sex, race, ethnicity) 

0 Workforce type (EMS vs. 911) 

0 Education/training, proficiency, experience/career stage, 

trauma exposure 

0 People with self-identified burnout, occupational stress, moral 

injury, or who may be at increased risk for mental or 

behavioral health issues 

• Agency factors 

0 Agency size 

0 Agency location (urban vs. suburban vs. rural) 

0 Shift characteristics (e.g., duration, frequency, timing, 

predictability) 

0 Workflow (e.g., role conflict, role ambiguity, warnings before 

psychological exposures) 

0 Regulations 

0 Financing 

0 Availability of mental health resources 

• Intervention factors 

0 Intervention level (individual, organizational, system-wide 

[local/state/national], or combined) 

0 Intervention target (CISM, subacute coping/stress 

management, or long-term stress management) 

Timing • 2001 to current 

Setting • Prehospital 

• Public Safety Answering Point (PSAP) or Emergency 

Communication Center (ECC) 

• Emergency department 

• Any high-income country (according to World Bank Criteria)