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Canadian Public Safety Personnel (e.g., correctional workers, dispatchers, firefighters, paramedics, and police) are regularly exposed to potentially traumatic events, some of which are highlighted as critical incidents warranting additional resources. Unfortunately, available Canadian public safety personnel data measuring associations between potentially traumatic events and mental health remains sparse. The current research quantifies estimates for diverse event exposures within and between several categories of public safety personnel. Participants were 4,441 public safety personnel (31.7% women) in 1 of 6 categories (i.e., dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, and Royal Canadian Mounted Police). Participants reported exposures to diverse events including sudden violent (93.8%) or accidental deaths (93.7%), serious transportation accidents (93.2%), and physical assaults (90.6%), often 11+ times per event. There were significant relationships between potentially traumatic event exposures and all mental disorders. Sudden violent death and severe human suffering appeared particularly related to mental disorder symptoms, and therein potentially defensible as critical incidents. The current results offer initial evidence that (a) potentially traumatic event exposures are diverse and frequent among diverse Canadian public safety personnel; (b) many different types of exposure can be associated with mental disorders; (c) event exposures are associated with diverse mental disorders, including but not limited to posttraumatic stress disorder, and mental disorder screens would be substantially reduced in the absence of exposures; and (d) population attributable fractions indicated a substantial reduction in positive mental disorder screens (i.e., between 29.0 and 79.5%) if all traumatic event exposures were eliminated among Canadian public safety personnel.

Poor sleep quality is associated with numerous mental health concerns and poorer overall physical health. Sleep disturbances are commonly reported by public safety personnel (PSP) and may contribute to the risk of developing mental disorders or exacerbate mental disorder symptoms. The current investigation was designed to provide estimates of sleep disturbances among PSP and explore the relationship between sleep quality and mental health status. PSP completed screening measures for sleep quality and diverse mental disorders through an online survey. Respondents (5813) were grouped into six categories: communications officials, correctional workers, firefighters, paramedics, police officers, and Royal Canadian Mounted Police (RCMP). Many PSP in each category reported symptoms consistent with clinical insomnia (49&ndash, 60%). Rates of sleep disturbances differed among PSP categories (p &lt, 0.001, &omega, = 0.08). Sleep quality was correlated with screening measures for post-traumatic stress disorder (PTSD), depression, anxiety, social anxiety disorder, panic disorder, and alcohol use disorder for all PSP categories (r = 0.18&ndash, 0.70, p &lt, 0.001). PSP who screened positive for insomnia were 3.43&ndash, 6.96 times more likely to screen positive for a mental disorder. All PSP reported varying degrees of sleep quality, with the lowest disturbances found among firefighters and municipal/provincial police. Sleep appears to be a potentially important factor for PSP mental health.

Public Safety Personnel (PSP, e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps &lt, 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health, however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Background The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance. Objective Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates. Methods A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups. Results Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power. Conclusions Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43–60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial. R. Nicholas Carleton’s research is supported by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award [FRN: 322308] and research grants [FRN: 285489 and FRN: 411397]. T.O. Afifi’s research is supported by a CIHR New Investigator Award and Foundation Scheme Award. This research was also funded in part by the Ministry of Public Safety and Emergency Preparedness through the Policy Development Contribution Program. Faculty yes

Paramedics perform physically demanding job tasks related to patient care and transport; however, no data exists describing the physical demands exposure profile for a shift. The purpose of this research was to address this knowledge gap by characterizing the physical demands of paramedic work by gathering data from seven different services across Canada. Further, this investigation was extended to compare physical demand exposure frequencies between High-Populous (HP) and Low-Populous (LP) paramedic services. Using a participatory model, two paramedics from each of the seven services were trained how to conduct a physical demands description (PDD). Each trained paramedic observer then conducted PDDs while completing two ride-outs each, where they observed and recorded the physical demand exposures of their colleagues. Results support the belief that paramedics are routinely exposed to physical demands such as lifting, lowering, carrying, pushing, and pulling. In fact, attending paramedics identified stretcher loading and unloading (25.6% of respondents), carrying equipment (19.5%), and pushing and pulling the stretcher (13.4%) as the most physically demanding tasks. When considering differences in task frequency between services, the empty stretcher was loaded and unloaded more frequently in HP services (10.0 ± 4.1) than in LP services (5.6 ± 3.4). Additionally, medication bags were handled more frequently in HP services (21.4 ± 7.5) than in LP services (5.1 ± 3.6). These data confirm that paramedic work is a mix of prolonged sedentary time (on alert waiting for a call), interspersed with bouts of high physical demand exposures (when attending to a call).

Importance Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). Objective We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. Design Prospective cohort sub-study of a randomized trial. Setting The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. Participants Consenting survivors to discharge. Main outcome measures Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). Results Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed≥1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS≤3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE≥17), no severe impairment in health (71.6%, HUI3≥0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. Conclusions and relevance The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.

Paramedic services are considering moving towards the use of powered stretcher and load systems to reduce stretcher related injuries, but cost is perceived as a barrier. This study compared injury incidence rates, days lost, and compensation costs between Niagara Emergency Medical Service (NEMS) and Hamilton Paramedic Service (HPS) pre- (four years) and post- (one year) implementation of powered stretcher and load systems in NEMS. Prior to the intervention stretcher related musculoskeletal disorder (MSD) incidence rates averaged 20.0 (±6.8) and 17.9 (±6.4) per 100 full time equivalent (FTE), in NEMS and HPS respectively. One-year post intervention rates decreased to 4.3 per 100 FTE in NEMS, a 78% reduction. Rates modestly increased to 24.6 per 100 FTE in HPS in same period. Cost-benefit analysis estimated that the added cost to purchase powered stretcher and load systems would be recovered within their expected 7-year service life due to the reduction in compensation costs.

Paramedics represent a unique occupational group where the nature of their work, providing prehospital emergency care, makes workplace modifications to manage and control injury risks difficult. Therefore, the provision of workplace education and training to support safe lifting remains a viable and important approach. There is, however, a lack of evidence describing movement strategies that may be optimal for paramedic work. The purpose of this study was to determine if a strategy leveraging a greater contribution of work from the lower body relative to the torso was associated with lower biomechanical exposures on the spine. Twenty-five active duty paramedics performed 3 simulated lifting activities common to paramedic work. Ground reaction forces and whole body kinematics were recorded to calculate: peak spine moment and angle about the L4/L5 flexion-extension axis as indicators of biomechanical exposure; and, joint work, integrated from net joint power as a measure of technique inclusive of movement dynamics. Paramedics generating more work from the lower body, relative to the trunk, were more likely to experience lower peak L4/L5 spine moments and angles. These data can inform the development of workplace training and education on safe lifting that focuses on paramedics generating more work from the lower body.

Public safety related occupations including police, fire and military commonly apply physical employment standard (PES) to facilitate job matching, an approach to evaluate if candidates demonstrate acceptable physical capabilities as required to perform the job safely and effectively. In Canada, paramedics remain as one of the few public safety occupations without an evidence-based, validated PES. The purpose of this study was to document and describe the physical demands of paramedic work and to identify the most physically demanding tasks. These outcomes are essential to inform the design and development of an evidence-based PES for the paramedic sector. Physical demands of paramedic work were documented and described using a direct observation-based task analysis technique. Five paramedic's were trained to document the physical demands of their work, then applied their training to observe more than 90 calls over the course of 20 full 12-h work shifts. Physical demands data were then listed in a survey, administered service-wide, where 155 frontline paramedics identified critically demanding tasks and rank-ordered physical demands from not physically demanding to very strongly demanding. Critically important and physically demanding tasks were identified such as: transferring a patient; loading or unloading a stretcher in to or out of the ambulance; performing CPR; and, raising and lowering a stretcher. It is important that a paramedic-based PES evaluate a candidate's physical capabilities to perform the critical and physically demanding tasks identified in this study.

Background The purpose of this investigation was to examine if paramedics' frequency of being exposed to highly physically demanding activities, or their perception of physical, clinical, and emotional demands were altered by patients' acuity level, operationalized using the Canadian Triage and Acuity Scale (CTAS). Methods Physical demands descriptions (PDD) were compiled from thirteen services across Canada. The observation sessions took place during a minimum of two full-shift (12-h) ride-outs at each service. Data were obtained from 53 ride-outs, which included a total of 190 calls. Results Higher urgency calls (CTAS level I or II) required significantly more stretcher handling, equipment handling, and intravenous (IV) work, also prompting higher ratings of perceived clinical, physical, and emotional demand. Independent of CTAS level, stretcher loading with patient (15.0%), horizontal patient transfer (13.7%), and pushing/pulling the stretcher with patient (13.1%) were identified as the most physically demanding tasks. Conclusions Patient acuity is an important determinant affecting the frequency for which paramedics are exposed to work tasks with inherent ergonomic hazards (e.g., handling a stretcher with a patient). Patient acuity also affects paramedics' perceived clinical, physical, and emotional demands of a call.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs).Observational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF).Mean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p0.001).ROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement.

Background Fibromyalgia syndrome (FS) is characterized by the presence of widespread pain, fatigue, muscle weakness and reduced work capacity. Previous research has demonstrated that women with fibromyalgia have altered walking (gait) patterns, which may be a consequence of muscular pain. This altered gait is characterized by greater reliance on hip flexors rather than ankle plantar flexors and resembles gait patterns seen in normal individuals walking at higher speeds, suggesting that gait of individuals with fibromyalgia may be less efficient. This study compared rates of energy expenditure of 6 females with FS relative to 6 normal, age and weight matched controls, at various walking speeds on a motorized treadmill. Metabolic measurements including V02 (ml/kg/min), respirations, heart rate and calculated energy expenditures as well as the Borg Scale of Perceived Exertion scale ratings were determined at baseline and for 10 min while walking at each of 2, 4 and 5 km/hour on 1% grade. Kinematic recordings of limb and body movements while treadmill walking and separate measurements of ground reaction forces while walking over ground were also determined. In addition, all subjects completed the RAND 36-Item Health Survey (1.0). Findings Gait analysis results were similar to previous reports of altered gait patterns in FS females. Despite noticeable differences in gait patterns, no significant differences (p > 0.05) existed between the FS and control subjects on any metabolic measures at any walking speed. Total number of steps taken was also similar between groups. Ratings on the Borg Scale of Perceived Exertion, the RAND and self-reported levels of pain indicated significantly greater (p < 0.05) perceived effort and pain in FS subjects relative to control subjects during walking and daily activities. Conclusions The altered gait patterns and greater perceptions of effort and pain did not significantly increase the metabolic costs of walking in women with FS and hence, increased sensations of fatigue in FS women may not be related to alteration in metabolic cost of ambulation.