Dealing with disaster: a qualitative exploration of the experiences of healthcare and emergency services staff following a mass casualty incident

Background – Globally there has been an increase in mass casualty incidents, which have a detrimental impact on the environment, community, and human life. Research following the 9/11 attacks identified the psychological toll on front line emergency workers and there has been an increased awareness of the prevalence of PTSD within this group. However, research to date has not focused on the UK perspective, nor used qualitative methods to explore the impact on front line emergency workers of being involved in mass casualty incidents (MCIs). Methods – This qualitative study was undertaken using semi-structured interviews with ten UK front line health care professionals (HCPs), who worked at the scene or in the accident and emergency department during an MCI. These participants were selected via purposive and snowball sampling between January 2020 to August 2021. Braun and Clarke’s six stage thematic analysis were used to analyse the data. Findings – Eight key themes were identified with three involving external factors, namely training, operational environment and media and these four were associated with both positive and negative perceived outcomes). Three further themes around job satisfaction, scrutiny and support involved both internal and external factors. Job satisfaction was protective for wellbeing, however scrutiny caused decreased motivation to work in the medical profession. In terms of support, most interviewees favoured informal approaches, due to formal support being associated with stigma or judgement. The final theme psychological effects were perceived negatively and involved burnout, insecurity, delayed emotions, avoidance, and difficulties with re-experiencing reminders within the community and during anniversaries of MCIs. These eight themes could be further organised across different aspects of time, place and organisation or agent. Discussion and Conclusion – This exploratory research has revealed unique new insights into experiences of HCPs involved in MCIs in the UK. Policy and practice implications relate to three key areas: tailoring ongoing HCP MCI training/preparedness, enhancing organisational support for staff involved in an MCI and finally reviewing the role of the media. Participant experiences of an MCI varied but revealed significant negative, but some rewarding, aspects which could be linked to different times, locations, and agencies.