If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
This article explores the impact of mental health issues on paramedics in Australia, particularly Post-Traumatic Stress Disorder, caused by their exposure to high levels of stress. The prevalence of Post-Traumatic Stress Disorder is higher among paramedics than any other occupation, and this could be a cause for concern, especially for undergraduate student paramedics. The article examines the need to build resilience among student paramedics to help them handle the trauma they may experience during clinical placement.
Methods
This study conducted a two-step process to review literature and university handbooks to determine the level of education provided to paramedic students on Post-Traumatic Stress Disorder and resilience during clinical placement, due to the lack of research in this area. The first step involved a search for relevant articles, while the second step involved a search of the Australian Health Practitioner Regulation Agency website to identify paramedicine programs and a manual evaluation of each undergraduate pre-registration paramedicine curriculum in Australia.
Results
This study conducted a systematic search of national and international literature and Australian undergraduate pre-registration paramedicine programs to identify any studies pertaining to the education of paramedic students in resilience and Post Traumatic Stress Disorder. The search found that only 15 (5.95 %) of the 252 reviewed subjects had reference to mental health, resilience or Post-Traumatic Stress Disorder, with only 4 (1.59 %) of them discussing these topics in preparation for clinical practice. The study highlights the lack of emphasis on student paramedic self-care as an essential underpinning for clinical placement preparation in the curriculum.
Conclusion
This literature review concludes that appropriate training and support, teaching resilience, and promoting self-care are crucial in preparing paramedic students for the emotional and psychological demands of their work. Equipping students with these tools and resources can improve their mental health and well-being and enhance their ability to provide high-quality care to patients. Promoting self-care as a core value in the profession is essential in creating a culture that supports paramedics in maintaining their own mental health and well-being.
]. Post-traumatic stress disorder (PTSD) is a mental health condition that is classified as a Trauma and Stressor related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [
]. While PTSD is a specific diagnosis recognised by the psychiatric community, the term psychological injury is more broadly used to describe the negative emotional and psychological effects of traumatic experiences [
]. This can be attributed to their long working hours, shift work, repeated exposure to death, high levels of responsibility, difficult interactions, and ramping [
]. According to an article by The Conversation, paramedics in Australia have double the rate of PTSD and suicide, with over 8 % of paramedics suffering from PTSD, which is twice the national average [
Sawyer S., Boyle M., Lawn S. Paramedics have one of Australia’s most dangerous jobs — and not just because of the trauma they witness. The Conversation2020.
The prevalence of mental health issues among paramedics in Australia is a cause for concern, and it is crucial to promote positive mental health and well-being among student paramedics [
Commonwealth of Australia. The people behind 000: mental health of our first responders. In: Senate T, editor. 2018.
]. To help prepare students for the mental health challenges they may face during their clinical placement, one of the recommended approaches is to incorporate units in their undergraduate paramedic curriculum, which focus on providing strategies, detection, self-care, lifestyle, and resilience training.
Clinical placement provides an opportunity for student paramedics to experience real-life situations that will help them prepare for their future careers as paramedics. However, it is essential to equip them with the necessary tools and resources to manage their mental health and well-being during their placement. Paramedics are considered to have one of the most dangerous jobs in Australia, and this is not only due to the trauma they witness but also because they have the highest rate of workplace violence [
Sawyer S., Boyle M., Lawn S. Paramedics have one of Australia’s most dangerous jobs — and not just because of the trauma they witness. The Conversation2020.
]. In fact, paramedics have the highest injury rate of any profession, twice that of police, and are seven times more likely to be seriously injured at work than the national average. Notably, the fatality rates for paramedics are six times higher than the general population [
Sawyer S., Boyle M., Lawn S. Paramedics have one of Australia’s most dangerous jobs — and not just because of the trauma they witness. The Conversation2020.
Clinical placements are crucial for undergraduate students as they gain more knowledge and perception; however, students need to be supported to ensure their well-being [
]. In universities in Australia, limited numbers of student paramedics have knowledge or understanding of the mental health challenges they may suffer due to incidences while on clinical placement, affecting their well-being.
In student paramedics, evidence suggests student paramedics are also at risk of trauma exposure during clinical placements. Increased levels of resilience are known to be protection against the risks of trauma exposure, and both age and experience may impact resilience. The ability for paramedic students to show self-efficacy moderates their resilience, whilst examining the impact of self-efficacy training on resilience may be an important [
]. To ensure undergraduate student paramedics can handle the trauma whilst in clinical placement, resilience must be built to enable them to be prepared for what they may face. This study will investigate what strategies are being implemented to better prepare undergraduate paramedic students in Australia to manage their mental health and well-being while on clinical placement.
2. Method
Due to the paucity of research around student paramedic mental health education, a traditional narrative literature review that focuses on student paramedic mental health in clinical placement was conducted. The authors engaged in a two-step process to (1) review the current and previous peer reviewed literature (2) conduct a review of the grey literature (university handbooks) to try and answer the question, ‘What is the current level of engagement paramedic students are receiving in the Bachelor level studies to make them aware of PTSD?’.
2.1 Step One
A search was undertaken for articles in EBSCOhost, Emerald, CINAHL, Medline, ProQuest, PubMed, and MA Healthcare Complete. The search terms are included in Table 1:
The search was restricted to the last 22 years (2000–2022), as this reflected the most accurate and relevant data and conclusions. The search was undertaken to identify national and international literature, to identify any studies pertaining to the education of paramedic students in resilience and Post Traumatic Stress Disorder (PTSD). The use of MeSH terms and the terms used were related to most recent paramedic literature [
A search was conducted of the Australian Health Practitioner Regulation Agency (AHPRA) website for Australian undergraduate pre-registration paramedicine programs leading to registration [
]. To interpret the Australian curriculum against the education of paramedic students in resilience and Post Traumatic Stress Disorder (PTSD), data were entered into an excel spreadsheet and used the “find” command to identify the fields of ‘resilience’, ‘Post Traumatic Stress Disorder’ and ‘student paramedic mental health’. The researcher undertook a manual search and content analysis of each handbook entry and a more in-depth evaluation of the subjects. of each subject in every undergraduate pre-registration paramedicine curriculum in Australia.
3. Results
3.1 Step one
Original peer reviewed articles were selected and included in the screening of the articles. A number of articles were removed due to duplication (n = 13), leaving 34 articles to be screened. Articles not matching the key words, dissertations, books and book chapters, articles not pertaining to student paramedics and if the title or the abstract had no reference to paramedicine were excluded in the screening stage. There were six articles selected at this stage. The researcher then extracted data from each of the journal articles by reading the abstract, introduction, discussion and conclusion sections. The data search initiated was identifying the key theme of each article and matching this to the search terms. Finally, two Australian related articles and four United Kingdom related articles were selected and included for analysis in this study (Fig. 1).
To interpret the Australian curriculum against the education of paramedic students in resilience and PTSD, and student paramedic mental health, data were entered into an excel spreadsheet and used the “find” command to identify the fields mentioned above. The researcher undertook a manual search and content analysis of each handbook entry and a more in-depth evaluation of the subjects. Finally, a systematic search of each Australian curriculum compared the subjects taught against the specific terms used.
Curricula from the sixteen institutions were retrieved and subject titles, subject synopses and subject learning outcomes were obtained and analysed to assess their alignment with the terms mentioned above. Subjects clearly addressing categories pertaining to the terms (and variations on the wording) were assigned to the predesigned data extraction sheet. Where subjects had a non-descript paramedicine title such as ‘Ethics and the Good Life’ and a subject synopsis or learning outcomes were not available, the data was identified as invalid. The subjects where investigation of title and/or content synopsis failed to clearly identify a match with specified terms (for example those that provided foundational content only e.g. anatomy, physiology and pharmacology subjects), were also considered invalid.
Once the coding and analysis was completed, an analysis of the curricula then commenced to align the content identified by the subject description and learning outcomes of paramedicine programs [
]. The analysis was completed to identify paramedicine students educational experience of resilience and PTSD, and student paramedic mental health. Three hundred and seventy-seven subjects were reviewed across the curricula of 19 degrees from the 16 universities. One university did not have available online any information pertaining to their curricula. One hundred and twenty-five (125) subjects were coded as invalid leaving 252 subjects for analysis. Of the 252 subjects, 15 subjects (5.95 %) were identified as having reference to mental health, resilience or PTSD. Of these 15 subjects, only four subjects (26 %) identify topics that discuss PTSD, resilience, or paramedic student mental health care in preparation to clinical practice. Table 2 provides the percentage of units aligned to the specific terms as identified by the subject content.
Table 2PTSD, resilience, or paramedic student mental health care subjects’ percentage of all overall units.
The analysis of the overall percentage of subjects aligned to the specific terms being taught to paramedic students in preparation of clinical placement was 15 (5.95 %). The core principles of student paramedic self-care as essential underpinnings for the preparation of clinical placement have not been as emphasised in the curriculum n = 4 (1.59 %). An institutional breakdown of curriculum content was also conducted to highlight the institutions focusing paramedic students’ education and mental health preparation, with overall programs (n = 19) being the number of degrees offered in Australia (Fig. 2). Of the 19 degrees on offer, 12 degrees have a focus on mental health care of patients within their curriculum, one degree has a subject focussing on mental health of student paramedics and student paramedic resilience. While two university curricula discuss PTSD for paramedic students.
Fig. 2Number of university programs teaching student paramedics about self-care prior to work integrated learning.
Preparing paramedic students against developing PTSD is essential for addressing the mental health needs of the future paramedic workforce as this will have a knock-on effect on patients care. Paramedics are at a higher risk of developing PTSD than the general population due to the nature of their work, which involves exposure to traumatic events regularly [
]. Whilst in Australia there are over 8 % of paramedics suffering from PTSD, which is twice the national average. This underscores the need for appropriate training and support to prepare paramedic students for the challenges they will face in the field and to prevent or mitigate the impact of PTSD on their mental health.
One of the key findings from the literature review is that the lack of support and training for paramedics can exacerbate the risk of PTSD. One study suggested that paramedics who do not receive appropriate training to manage their emotional responses and who do not receive adequate support to deal with the aftermath of traumatic incidents are more likely to experience PTSD symptoms [
]. Therefore, providing paramedic students with adequate training and support is essential for promoting mental health and well-being.
There is a real need for early intervention to prevent the development of PTSD. Research has shown that early intervention from paramedic educators can reduce the risk of PTSD among paramedics [
]. Education programs can help students better understand the emotional and psychological effects of their work and how to recognise and manage symptoms of PTSD and other mental health conditions. By providing paramedic students with early intervention strategies and equipping them with the skills necessary to identify and manage the symptoms of PTSD, this approach can help reduce the impact of trauma on their mental health and improve their ability to stay in the job for a long period of time.
The literature review on the teaching of resilience to paramedic students highlights the importance of equipping them with the skills and strategies necessary to cope with the emotional demands of their future careers as paramedics [
]. The reviewed studies consistently found that paramedics are often exposed to highly stressful and traumatic situations, which can have significant emotional and psychological impacts on their mental health [
]. Research suggests that the development of resilience is essential to help paramedics cope with the demands of their work and to prevent the negative impacts of stress and trauma on their mental health [
]. Therefore, teaching resilience to paramedic students is essential in preparing them for the challenges they will face in their future careers.
One of the key findings from the literature review is that students can have a moderate level of resilience, however further levels of resilience can be taught and learned [
]. By teaching paramedic students’ strategies to manage stress, increase emotional regulation, and improve problem-solving skills, we can help them to develop resilience and improve their ability to cope with the emotional demands of their work.
Another important theme that emerges from the reviewed studies is the role of humour in the development of resilience. One study suggested that humour is essential for the development of resilience, however that a lack of education outlining the role of gallows humour can exacerbate the negative impacts of stress and trauma on mental health [
]. Therefore, providing paramedic students with opportunities to connect with others, including peers, experienced paramedics and mental health professionals, is important for understanding the role of gallows humour in the development of resilience.
The literature reviewed has emphasised the importance of embedding self-care into the bachelor level curriculum for paramedics. This highlights the importance of preparing paramedic students with the knowledge and skills necessary to maintain their own mental health and well-being, and reduce their capacity to cover up their emotions [
]. The reviewed studies consistently found that paramedics are exposed to highly stressful and traumatic situations, which can have significant emotional and psychological impacts on their mental health [
]. Research suggests that the development of self-care strategies is essential to help paramedics cope with the demands of their work and to prevent the negative impacts of stress and trauma on their mental health [
]. Therefore, teaching self-care strategies to paramedic students is essential in preparing them for the challenges they will face in their future careers.
An important theme that did not emerge from the reviewed studies is the importance of promoting self-care as a core value in the paramedic profession. Self-care is a core value of the paramedic profession and should be embedded in the curriculum to promote its importance. This can be achieved through national accreditation scheme requirements and by creating a culture that values self-care and by providing paramedic students with opportunities to practice and develop self-care strategies. By equipping students with the knowledge and skills necessary to maintain their own mental health and well-being, we can help to promote their mental health and well-being, and improve their ability to provide high-quality care to patients. Additionally, promoting self-care as a core value in the paramedic profession is important in creating a culture that values self-care and supports paramedics in their efforts to maintain their own mental health and well-being.
5. Conclusion
In conclusion, the literature review highlights several important themes related to the preparation of paramedic students for the emotional and psychological demands of their work. Firstly, the reviewed studies emphasise the importance of appropriate training and support to prepare students for the risk of PTSD, given the high exposure to stress and trauma in their work. Providing paramedic students with the tools and resources necessary to manage these demands can help to ensure that they are equipped to provide high-quality care to patients while also promoting their own mental health and well-being.
Secondly, the review highlights the importance of teaching paramedic students how to become more resilient. Equipping them with the skills and strategies necessary to cope with their work's emotional demands can help promote their mental health and well-being, and improve their ability to provide high-quality care to patients. Additionally, providing social support to paramedic students is crucial in the development of resilience and should be a key component of resilience training programs.
Finally, the review emphasises the importance of teaching self-care to paramedic students by embedding it in the bachelor level curriculum. By equipping them with the knowledge and skills necessary to maintain their own mental health and well-being, we can help to promote their mental health and well-being, and improve their ability to provide high-quality care to patients. Additionally, promoting self-care as a core value in the paramedic profession is essential in creating a culture that values self-care and supports paramedics in their efforts to maintain their own mental health and well-being.
Overall, the importance of preparing paramedic students for the emotional and psychological demands of their work through appropriate training and support, teaching of resilience, and the promotion of self-care cannot be overlooked. By equipping students with the necessary tools and resources, we can help to promote their mental health and well-being and improve their ability to provide high-quality care to patients.
Funding
There was no funding required for this project.
Provenance and Conflicts of Interest
The research team has no conflicts of interests and all authors have contributed significantly and are in agreement with the content of the manuscript. The authors report there are no competing interests to declare. The authors have no relevant financial or non-financial competing interests.
References
Mann K.L.
Delport S.
Stanton R.
Every D.
Exploring resilience in undergraduate and early career paramedics.
Sawyer S., Boyle M., Lawn S. Paramedics have one of Australia’s most dangerous jobs — and not just because of the trauma they witness. The Conversation2020.
00030-1&id=gr1.jpg){kind=link}
00030-1&id=gr2.jpg){kind=link}