UNASSIGNED: Social support is considered an important factor in prevention of mental illness. However, little is known about the association between ambulance personnel\'s use of multiple types of social support and post-traumatic stress symptoms (PTSS). This study aims to assess if number of used social support types predicts PTSS for ambulance personnel. Apart from assessing the main effect of social support utilization, we were interested in investigating if social support utilization moderated the effect of frequency of critical events on PTSS.
UNASSIGNED: A total of 383 ambulance personnel completed a survey consisting of validated questionnaires. Hierarchical multiple linear regression analyses were performed to assess the association between frequency of traumatic exposure and utilization of social support and PTSS as outcome variable.
UNASSIGNED: Higher number of utilized social support types was associated with higher levels of PTSS (β = 0.15, p <.001). When serving as a moderator of the association between frequency of exposure to critical incidents and PTSS, social support utilization had a significant and positive interaction effect (β = 0.26, p = .049). 307 participants had used 2 or 3 types of informal support during the past year, whereas 81 had used 2 or 3 types of formal support.
UNASSIGNED: To our knowledge, this is the first study investigating the relationship between utilization of multiple, concurrent social support types and PTSS. This study suggests that to understand the effects of social support among ambulance personnel, it is necessary to assess the utilization of multiple concurrent support types, contributing factors to social support use, and different patterns of social support utilization that constitutes professional life in ambulance work.

BACKGROUND: In 2022, suicide was the second leading cause of external death in Spain (the first among young people aged 15-29 years). This study aims to analyze the presence of myths among emergency first responders and identify the most prevalent false beliefs among them.
METHODS: The research is a observational and descriptive study carried out using a questionnaire composed of a total of 25 myths, with the response options being true or false. A total of 543 professionals took part in the study. All of them could intervene before, during, and after a suicide attempt.
RESULTS: The main finding of the study is that more than 50% of the participants accept as true the statement \"There are more serious and less serious problems\", underlining the idea that caring for patients could be related to the importance the health professional gives to the patients\' problem. Myths such as \"The suicidal person wants to die\" and \"The suicidal person is determined to die\" are also evident.
CONCLUSIONS: The subjective thought the first responder has about suicide could affect their acts, and there is a need to train first responders in suicidal behavior to be able to create an adequate approach.

First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges\' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.

UNASSIGNED: First responders are among the first to respond to hazards casualties. They might operate in volatile, uncertain, complex, and ambiguous (VUCA) environments. While they have underlined the need to improve their knowledge and training to face these environments, there are few data regarding the stress induced by these trainings. Chemical, biological, radiological, and nuclear (CBRN) hazards casualties\' trainings seem to be a good model of \"in vivo\" stress. First responders must operate in a hostile and encountered environment with a CBRN protective equipment that places demand on their psychological, cognitive, and physiological capacities. Current research recognizes that the activity of the parasympathetic system (PSS) can be used as an objective marker of stress adaptation, measured as heart rate variability (HRV).
UNASSIGNED: To compare between baseline and simulation the evolution of the parasympathetic activity (primary outcome), anxiety, emotions, cognitive load, and body posture awareness (secondary outcomes).
UNASSIGNED: A total of 28 first responders attended to three simulated scenarios requiring CBRN management of casualties. One day before simulation, we collected HRV data (baseline). The simulations\' day (pre-, post-simulation) we collected anxiety score (STAI-Y B), emotions (SPANE), cognitive load (NASA TLX), body posture awareness (PAS) and HRV. The morning after we collected the PAS score (recovery). We compare data\' evolution between different times of the simulation.
UNASSIGNED: (i) A high level of anxiety at baseline [Median 51 (46; 56)] which decreased between pre- and post-simulation (p = 0.04; F = 2.93); (ii) a post-simulation decrease in negative feelings (p = 0.03); (iii) a decrease in body awareness after simulation which returned to the initial level at recovery (p = 0.03; F = 3.48); (iv) a decrease in mean RR between baseline, pre- and post-simulation (p = 0.009; F = 5.11). There were no significant difference between times on others analysis of HRV.
UNASSIGNED: Prior to simulation, participants experienced anticipatory anxiety. Simulations training practiced regularly could be one way to combat anticipatory anxiety.

The fire service command structure encompasses recruit, incumbent firefighter, and officer positions. The purpose of this study was to quantify the effect of rank (recruits, incumbent firefighters, and officers) on health and physical ability characteristics within the fire service. Retrospective data from thirty-seven recruits (age = 29 ± 5 yrs, BMI = 26.5 ± 2.3 kg/m2); eighty-two incumbent firefighters (age = 30 ± 7 yrs, BMI = 28.8 ± 4.3 kg/m2); and forty-one officers (age = 41 ± 6 yrs, BMI = 28.6 ± 4.3 kg/m2) from a single department were used. Participants completed body composition tests (i.e., body fat percentage [%BF] and body mass index [BMI]), an air consumption test (ACT), and cardiopulmonary exercise testing. The ACT consisted of 10 standardized tasks. Five separate one-way analyses of co-variance (ANCOVA) were calculated, accounting for age. Partial eta squared statistics were calculated and Bonferroni-corrected post-hoc analyses were employed. The results demonstrated a significant effect of rank on %BF (F = 9.61, p < 0.001, η2 = 0.10); BMI (F = 3.45, p = 0.02, η2 = 0.05); relative VO2MAX (F = 12.52, p < 0.001; η2 = 0.11); and HRMAX (F = 18.89, p < 0.001, η2 = 0.03), but not on ACT time (F = 0.71, p = 0.55, η2 = 0.01). These outcomes suggest there are variations in anthropometric and physiological metrics of health across firefighter ranks. Administrators should be aware how these markers of health may vary across firefighter ranks.

During the COVID-19 pandemic, first responders faced significant biosafety challenges, especially while handling patient transport, potentially exposing them to infection. The PANDEM-2 (European project on pandemic preparedness and response) project, funded by the Horizon 2020 program, sought to investigate the challenges confronting Emergency Medical Systems throughout the EU. First responders from Portugal\'s National Institute of Medical Emergency (INEM) were considered as a representative operational model of the national first responder agencies of European member states because they played a critical role during the COVID-19 pandemic. As a result, they were asked to complete an online survey about their COVID-19 pandemic-related professional activities. The survey focused on their perspectives on current biosafety guidelines and their operational practices. It covered opinions on existing protocols, technical concerns during patient transport, and issues after the patients arrived at the hospital. The key findings revealed concerns about risk assessment, the inadequacy of guidelines, and disparities in equipment access. This survey emphasizes the importance of developing streamlined, adaptable biosafety protocols, better coordination between prehospital and in-hospital services, and the development of scalable, cost-effective biosafety solutions. Based on our findings, we propose improvements to national and European biosafety directives and advocate for streamlined adaptation during pandemics.

BACKGROUND: First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic.
METHODS: We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis.
RESULTS: The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF\'s 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences.
CONCLUSIONS: The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.
BACKGROUND: Les premiers répondants comme les autres membres du personnel de sécurité publique (travailleurs correctionnels, pompiers, ambulanciers paramédicaux, policiers, agents des communications en sécurité publique, etc.) sont souvent exposés à des événements potentiellement traumatisants sur le plan psychologique. Ces expositions sont susceptibles de contribuer à des problèmes de santé mentale et à un besoin accru en soins de santé mentale. Pourtant, aucune étude qualitative structurée et fondée théoriquement sur les obstacles aux comportements de recherche d’aide et sur les facteurs facilitant ces comportements n’a encore été entreprise auprès de cette population. Cette étude repose sur le cadre Theoretical Domains Framework (TDF) pour cerner et mieux comprendre les principaux obstacles et facteurs facilitants relatifs à la recherche d’aide et à l’accès aux soins de santé mentale dans le cadre d’une clinique de traitement des blessures de stress opérationnel pour premiers répondants.
UNASSIGNED: Nous avons mené des entretiens semi-structurés en personne avec 24 premiers répondants (11 pompiers, 5 ambulanciers paramédicaux et 8 policiers), recrutés à l’aide d’un échantillonnage raisonné et par boule de neige. Les entretiens ont été analysés à l’aide d’une analyse de contenu déductive. Le cadre TDF a guidé la conception de l’étude, le contenu des entretiens, la collecte et l’analyse des données.
UNASSIGNED: Les obstacles les plus signalés ont été des préoccupations concernant la confidentialité, le manque de confiance, le manque de connaissances des cliniciens sur la culture professionnelle, le manque de transparence quant à l’accès aux services et la stigmatisation au sein des organismes de premiers répondants. Les principaux thèmes influençant la recherche d’aide ont pu être classés au sein de 6 des 14 domaines du cadre TDF : le contexte environnemental et les ressources; les connaissances; les influences sociales; le rôle social/professionnel et l’identité; les émotions et enfin les croyances à l’égard des conséquences.
CONCLUSIONS: Nous avons pu cerner les principales mesures utilisables pour adapter les interventions afin d’encourager la participation à une clinique de traitement des blessures de stress opérationnel pour les premiers répondants : la transparence en matière de confidentialité, la présence de politiques visant à accroître les connaissances sur la culture professionnelle par l’ensemble du personnel de la clinique, des descriptions claires des modalités d’accès aux soins, la participation systématique des familles et la lutte contre la stigmatisation.
To the best of our knowledge, this is the first theoretically driven, structured qualitative study using an implementation science determinant framework to systematically examine barriers and facilitators facing first responders and other public safety personnel trying to access a mental health service. Concern regarding the cultural competency of clinicians was identified as a significant barrier. Responding to calls involving individuals with mental health disorders may inform first responder attitudes and stigma towards psychological difficulties. Our results can assist in developing a model of care that may be broadly applicable to other first responder and public safety service providers across Canada.
À notre connaissance, il s’agit de la première étude qualitative structurée et fondée théoriquement utilisant un cadre de la science de la mise en oeuvre pour analyser systématiquement les obstacles et les facteurs facilitants rencontrés par les premiers répondants ainsi que d’autres membres du personnel de la sécurité publique lorsqu’ils tentent d’accéder à un service de santé mentale. Les préoccupations concernant les connaissances des cliniciens sur le milieu professionnel constituent un obstacle important. Le fait de répondre à des appels concernant des personnes présentant des troubles de santé mentale semble avoir une incidence sur l’attitude des premiers répondants et accroître la stigmatisation à l’égard des troubles psychologiques. Nos résultats sont susceptibles de contribuer à la mise au point d’un modèle général de soins applicable à d’autres premiers répondants et fournisseurs de services de la sécurité publique à l’échelle du Canada.

Public safety personnel (PSP) face high rates of mental health problems and many barriers to care. Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated outcomes of PTSD-specific ICBT among PSP or PSP\'s preferences for transdiagnostic or PTSD-specific ICBT. The current paper presents the initial outcomes (N = 150) of a mixed-methods observational study designed to (a) investigate preferences for transdiagnostic or PTSD-specific ICBT among PSP with elevated symptoms of PTSD and/or a primary concern with PTSD symptoms and (b) explore potential differences in client engagement, satisfaction, and symptom changes between the two forms of ICBT. PSP completed questionnaires before and after their preferred ICBT program. Mixed-methods analyses included generalized estimating equations, descriptive statistics, and inductive conventional qualitative content analysis. More clients (n = 85; 57 %) selected transdiagnostic ICBT than PTSD-specific ICBT (n = 65; 43 %), but the difference in the number of clients who selected each course was not statistically significant. Clients in both ICBT programs reported similar and favorable treatment satisfaction (e.g., 98 % would recommend the course to a friend), treatment engagement (i.e., 69 % accessed at least four of the five lessons), and pre-post improvement in symptoms (e.g., Hedges\' g = 0.81 for reduction in PTSD symptom). Transdiagnostic ICBT resulted in greater reductions in symptoms of panic disorder than PTSD-specific ICBT. Qualitative analyses showed similarities across the ICBT programs in client feedback. The current study provides further evidence supporting the use and outcomes of ICBT for PSP in both transdiagnostic and disorder-specific formats. Implications for the literatures on PSP mental health and ICBT, as well as practical recommendations, are discussed.

Surf lifesavers and lifeguards have provided essential education, preventative, and rescue services to the Australian community for over 110 years. In this first responder role, surf lifesavers and lifeguards are inadvertently exposed to high risk and trauma related experiences, which may negatively impact mental well-being. To date however, there has been limited research into the mental health of surf lifesavers and lifeguards, and no studies at all on the mental health of adolescent surf lifesavers. The preliminary study aimed to measure the exposure of potentially traumatic events (PTEs), post-traumatic stress symptoms (PTSS), self-efficacy, social support, and attitudes towards mental health problems in Surf Life Saving (SLS) members.
An anonymous, online survey was developed (adolescent and adult versions) and created to measure the domain of mental health in surf lifesavers and lifeguards. Pearson\'s correlations investigated relationships between PTEs, PTSS, self-efficacy, social support, attitudes towards mental health problems, age, years as a SLS member, and years patrolling. Spearman\'s Rank was used for violations of normality.
A total of 57 surf lifesavers/lifeguards aged 13-59 years were included in the final analysis. There was a significant positive relationship between exposure to direct trauma and PTSS, which in turn, were associated with greater negative attitudes towards mental health problems towards the mental health of others, and lower levels of self-efficacy. Male and female adults with PTSS reported lower social support, whereas for adolescent males, a positive relationship between direct trauma and PTSS was observed.
This research is the first to explore the mental health of Australian surf lifesavers and lifeguards. The results highlight the potential risks to mental health and well-being associated with this first responder role. More research to protect the vulnerability of this population is warranted.

BACKGROUND: Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing.
METHODS: Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being-identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics.
RESULTS: The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing.
CONCLUSIONS: These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace.