South African paramedics lived experience of critical incidents: an interpretative phenomenological

191 Pages·2013·2.21 MB·English

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SOUTH AFRICAN PARAMEDICS LIVED EXPERIENCE OF CRITICAL INCIDENTS:
AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS

by

JUSTIN ADRIAN SCOTT

MINOR DISSERTATION
Submitted in partial fulfilment of the requirements for the degree
MASTER OF ARTS IN CLINICAL PSYCHOLOGY
in the
FACULTY OF HUMANITIES
at the
UNIVERSITY OF JOHANNESBURG

Supervisor: Professor Christopher R. Stones
Date: February 2013
Acknowledgments
I would like to thank the following people for their contributions towards this study:
 My supervisor, Professor Christopher R. Stones, for his patience, sharing his
knowledge and providing valuable guidance.

 The participants in this study, for their cooperation and willingness to share their
experiences with me.

 Erica Ortlepp, for her generous emotional and financial support, without which I
would never have been able to follow my dream of completing this degree.

 My family and friends, for their constant support and encouragement.
Abstract
South African paramedics are thought to be exposed to a high number of critical
incidents as compared to paramedics elsewhere (Ward, Lombard & Gwebushe, 2006).
Therefore, South African paramedics are at particular risk of suffering from negative effects
associated from the exposure to critical incidents. This study aimed to gain an in-depth
understanding of the meaning which paramedics attach to the experience of “critical
incidents” (Mitchell, 1983). This information may be beneficial for those working in
Emergency Medical Services in South Africa to further understandings of paramedics’
experience of work related trauma.
Five paramedics, sourced from both public and private ambulance service, between
the ages of 27 and 36 years old, who have had between 8 to 12 years of working experience
were interviewed regarding their lived experiences of critical incidents. The semi-structured
interviews were transcribed and analysed based on the Interpretative Phenomenological
Analysis (IPA) framework suggested by Smith and Osborn (2008). The analysis of each of
the participant’s transcripts provided four master themes, some of which are supported by
superordinate themes. The master themes are: 1) Experiencing the trauma of critical
incidents, 2) Experiencing in the “World” of EMS, 3) Intrinsic factors and active attempts of
coping with stress, and 4)Personal consequence of being a paramedic.
For most of the participants, their narratives highlighted that the organisational
variables were considered to be more important than the nature of the critical incidents they
experienced. Critical incidents were deemed traumatic as there was a disparity between the
participant’s expectations of what was expected and what they were confronted with in
“reality”. In addition, the participants described forming an emotional bond with their
patients or the patient’s family, which added to their distress. The participants’ narratives
emphasised the importance of the role of the EMS organisation in influencing their
experiences. Despite employing a number of coping strategies to mediate the effects of
organisational as well as critical incident stress, the participants reported experiencing long-
term negative psychological symptoms that have impacted on their personal and familial
lives. These findings support the growing body of knowledge that demonstrates that
organisational variables play an important role in either mediating or exacerbating post-
trauma outcomes.
Table of Contents
CHAPTER 1: INTRODUCTION .......................................................................................... 1
1.1 Introducing the Paramedics World ............................................................................... 1
CHAPTER 2: LITERATURE REVIEW .............................................................................. 5
2.1 What is a Critical Incident?.......................................................................................... 5
2.2 Consequences of Critical Incident exposure ................................................................. 7
2.2.1 Critical incident stress ....................................................................................... 7
2.2.2 Post Traumatic Stress Disorder (PTSD). ........................................................... 8
2.2.3 Burnout ........................................................................................................... 10
2.3 Interventions arising from Critical Incident research .................................................. 11
2.3.1 Critical Incident Stress Debriefing (CISD) and Critical Incident Stress
Management (CISM). ..................................................................................... 11
2.3.2 For and against CISD/CISM ........................................................................... 12
2.4 Is it really all about Critical Incidents? ....................................................................... 13
2.4.1 Organisational stressors. ................................................................................. 13
2.4.2 Risk of violence and injury. ............................................................................ 14
2.4.3 Compassion fatigue. ........................................................................................ 14
2.5 The Paradox .............................................................................................................. 15
2.5.1 Compassion Satisfaction. ................................................................................ 15
2.5.2 Posttraumatic Growth. .................................................................................... 15
2.5.3 Salutogenesis. ................................................................................................. 16
2.6 Coping with Critical Incidents ................................................................................... 17
2.6.1 Dissociation or emotional detachment. ............................................................ 18
2.6.2 Black humour. ................................................................................................ 19
2.6.3 Substance abuse. ............................................................................................. 21
2.6.4 Support systems. ............................................................................................. 21
2.7 Help-seeking behaviour amongst ambulance personnel.............................................. 23
CHAPTER 3: METHODOLOGY ....................................................................................... 24
3.1 Interpretative Phenomenological Analysis ................................................................. 24
3.1.1 Sample. ........................................................................................................... 25
3.1.2 Data collection ................................................................................................ 26
3.1.3 Ethical considerations. .................................................................................... 27
3.1.4 Analysis. ......................................................................................................... 27
3.1.5 Trustworthiness............................................................................................... 28
3.1.6 Reflexivity ...................................................................................................... 29
3.1.7 Self reflexivity ................................................................................................ 29
CHAPTER 4: INDIVIDUAL ANALYSIS AND DISCUSSION OF THE PARTICIPANTS’
EXPERIENCE OF CRITICAL INCIDENTS .................................................... 33
4.1 Introduction: James’ EMS work experience ............................................................... 33
4.1.2. Analysis and Discussion of James’ lived experience .............................................. 34
4.1.2.1 Experiencing the trauma of Critical Incidents. .............................................. 34
4.1.2.2 Experiencing in the “World” of EMS. .......................................................... 36
1. EMS is a subculture. ................................................................................... 36
2. Negative experiences of the EMS organisation. ........................................... 36
3. Meaningful work environment. ................................................................... 39
4.1.2.3 Intrinsic factors and active attempts of coping with stress ............................. 40
1. Perceived need to be in control of the environment...................................... 40
2. Active attempts at reducing stress................................................................ 41
4.1.2.4. Personal consequences of being a paramedic. .............................................. 43
4.1.2.5 Summary. .................................................................................................... 44
4.2 Introduction: Paul’s EMS work experience ................................................................ 46
4.2.1 Analysis and Discussion of Paul’s lived experience ................................................ 47
4.2.1.1 Experiencing the trauma of Critical Incidents ............................................... 47
4.2.1.2 Experiencing in the “World” of EMS. .......................................................... 48
1. EMS is a subculture. ................................................................................... 48
2. Negative experiences of the EMS organisation. ........................................... 49
3. Meaningful work environment. ................................................................... 51
4.2.1.3 Intrinsic factors and active attempts of coping with stress ............................. 51
1. Perceived need to be in control of the environment ...................................... 51
2. Active attempts at reducing stress ................................................................ 52
4.2.1.4 Personal consequences of being paramedic. ................................................. 53
4.2.1.5 Summary. .................................................................................................... 54
4.3 Introduction: Sarah’s EMS work experience .............................................................. 56
4.3.1 Analysis and Discussion of Sarah’s lived experience .............................................. 56
4.3.1.1 Experiencing the trauma of Critical Incidents ............................................... 56
4.3.1.2 Experiencing in the “World” of EMS ........................................................... 57
1. EMS is a subculture. ................................................................................... 57
2. Negative experience of the EMS organisation. ............................................ 58
3. Meaningful work environment .................................................................... 58
4.3.1.3 Intrinsic factors and active attempts of coping with stress ............................. 60
1. Perceived need to be in control of the environment ..................................... 60
2. Active attempts at reducing stress................................................................ 61
4.3.1.4 Personal consequences of being a paramedic. ............................................... 63
4.3.1.5 Summary. .................................................................................................... 64
4.4. Introduction: André’s EMS work experience ............................................................ 66
4.4.1 Analysis and Discussion of André’s lived experience ............................................. 67
4.4.1.1 Experiencing the trauma of Critical Incidents. .............................................. 67
4.4.1.2 Experiencing in the “World” of EMS ........................................................... 69
1. EMS is a subculture. ................................................................................... 69
2. Negative experience of the EMS organisation ............................................. 70
3. Meaningful work environment. ................................................................... 72
4.4.1.3 Intrinsic factors and active attempts of coping with stress. ............................ 72
1. Perceived need to be in control of the environment ...................................... 72
2. Active attempts at reducing stress ................................................................ 73
4.4.1.4 Personal consequences of being a paramedic ................................................ 75
4.4.1.5 Summary. .................................................................................................... 76
4.5. Introduction: George’s EMS work experience .......................................................... 78
4.5.1 Analysis and Discussion of George’s lived experience ............................................ 79
4.5.1.1 Experiencing the trauma of Critical Incidents. .............................................. 79
4.5.1.2 Experiencing in the “World” of EMS ........................................................... 81
1. EMS is a subculture .................................................................................... 81
2. Negative experience of the EMS organisation ............................................. 81
3. Meaningful work environment .................................................................... 83
4.5.1.3 Intrinsic factors and active attempts of coping with stress. ............................ 84
1. Perceived need to be in control of the environment...................................... 84
2. Active attempts at reducing stress................................................................ 85
4.5.1.4 Personal consequences of being a paramedic ................................................ 86
4.5.1.5 Summary ..................................................................................................... 88
4.6 Integrated overview of the participants master themes ............................................... 90
4.6.7 Experiencing the trauma of Critical Incidents .................................................. 90
4.6.2 Experiencing in the “World” of EMS .............................................................. 92
4.6.3 Intrinsic factors and active attempts of coping with stress................................ 94
4.6.4 Personal consequences of being a paramedic ................................................... 96
CHAPTER 5: DISCUSSION .............................................................................................. 98
5.1 Overview. .................................................................................................................. 98
5.2 Discussion of the Master Themes .............................................................................. 98
5.2.1 Experiencing the trauma of Critical Incidents. ................................................. 98
5.2.1 Experiencing the “World” of EMS. ............................................................... 100
5.2.2 Intrinsic factors and active attempts at coping with stress. ............................. 103
5.2.3 Personal consequences of being a paramedic ................................................. 106
CHAPTER 6: CONCLUSION. ......................................................................................... 108
CHAPTER 7: LIMITATIONS AND RECOMMENDATIONS ......................................... 111
REFERENCES ................................................................................................................. 113
APPENDICES .................................................................................................................. 126
CHAPTER 1: INTRODUCTION
Research conducted on emergency medical workers has focused mainly on the effects
of exposure to traumatic scenes, and the resultant negative psychological symptomology
(Donnelly & Siebert, 2009; Holland, 2008; Jonsson & Segesten, 2004). Studies have also
investigated coping methods employed by emergency medical workers (Kirby, Shakespeare-
Finch & Palk, 2011) as well as the positive growth (Shakespeare-Finch, Smith, Gow,
Embelton & Baird, 2003) that emergency medical workers have experienced whilst
performing their duties. Compared to elsewhere in the world, South African paramedics are
thought to be exposed to the highest amounts of traumatic scenes (Ward, Lombard &
Gwebushe, 2006). Few studies have been done in South Africa focusing on paramedics lived
experience of traumatic scenes or critical incidents (Mitchell, 1983). This study aims to gain
an in-depth understanding of the meaning which South African paramedics attach to the
experience of “critical incidents” in order to add to the growing body of knowledge in this
field.
In order to explore in detail the paramedic’s subjective experience of critical incidents it
is important to gain an account of the experience as well as examine the participant’s world in
which this experience is embedded. The following section provides a brief introduction into
the “world” of paramedics in South Africa.
1.1 Introducing the Paramedics World
In order to introduce and contextualise the reader to the “world” of paramedics in South
Africa, the following topics will be briefly discussed: 1) The varied contexts in which
paramedics operate, 2) the prescribed training paramedics are required to undergo, 3) the
specific duties paramedics are required to perform, and 4) the working environment in which
paramedics operate.
Paramedics operate in a variety of contexts where there may be a need for emergency
medical assistance. These contexts may include the following: the event management arena,
such as local sporting events or concerts; pre-hospital settings such as public and private
ambulance services; law enforcement or military settings; as well as within the hospital
environment providing support to hospital staff.
1