Post-Traumatic Stress Disorder (PTSD) in Ambulance Personnel: An Investigation into risk factors and potential interventions

Ambulance personnel experience many critical events that may increase their risk of developing post-traumatic stress disorder (PTSD) and other mental health disorders. In the previous literature, some studies show that the prevalence of PTSD in ambulance workers is higher than that of other first responders and that ambulance personnel in developing countries have a higher prevalence of PTSD than those in developed countries (Berger et al., 2012). However, it is unclear whether facing a higher frequency of critical events puts ambulance personnel at greater risk of PTSD symptoms. There has also been a lack of cross-cultural research to explore the reasons for different PTSD prevalence rates between developed and developing countries, and to explore the kinds of support which paramedics would like to receive. Moreover, there is a need for further research to understand risk and protective factors in ambulance personnel, and the interventions which may be most effective for ameliorating symptoms of mental distress.
To address these gaps, this thesis aimed to understand the impact of critical incidents on ambulance personnel, the factors which may affect the relationship between incident exposure and symptoms of trauma, and the support which organisations should provide. The thesis addressed these questions with a particular focus on Saudi Arabian ambulance personnel who face high rates of critical incidents.
Altogether, one systematic review and meta-analysis and three original empirical research studies were completed. The systematic review was conducted to examine the effectiveness of psychological interventions to treat PTSD and other mental health disorders in first responders. The meta-analysis found that psychological interventions were associated with significant reductions in PTSD symptoms, depression and anxiety, but not stress. Moreover, Cognitive Behaviour Therapy (CBT)-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression.
In Study 1, I conducted a cross-cultural qualitative investigation among ambulance personnel in Saudi Arabia and the UK to explore the lived experience of potentially traumatic work events between Saudi Arabia and UK ambulance personnel. This study identified four themes. Some types of events were intrinsically more stressful than others (e.g., events involving threats to the paramedics themselves); organizational pressures increased the impact of stressful events; the use of sports activities was a common method for coping with painful events; and there was a preference for formal support over informal.
In Study 2, I conducted a survey to estimate the prevalence rate of PTSD symptoms in Saudi ambulance personnel and investigate whether passive and active coping strategies and social support were associated with PTSD symptoms. This study found that 46% of ambulance workers reported at least one symptom of PTSD and that reporting higher levels of passive coping and lower social support were associated with greater risk of reporting PTSD symptoms.
In Study 3 I used a daily diary method to investigate the association between daily PTSD symptoms and daily incident exposure, coping styles and social support in Saudi ambulance personnel. The study found that higher numbers of daily incidents were strongly associated with a greater number of daily PTSD symptoms, and passive coping moderated the association between daily incidents and daily PTSD symptoms.
In combination, these studies identified the importance of providing formal and confidential support that involves a CBT model for ambulance personnel and encouraging them to use active coping strategies rather than passive coping when facing traumatic incidents.