Critical Incidents Scale for Ambulance Work – Denmark (CISAW-D): the development of a screening tool for work exposure to critical events in operative ambulance personnel

INTRODUCTION: Critical incidents in ambulance work are not easily compared to other risk occupations. Understanding types of incidents that can be considered critical in operational ambulance work is important to prevent work-related post-traumatic stress (PTS). AIM: This study aimed to develop a scale of critical incidents in ambulance work and assess its predictive validity in relation to the severity of PTS symptoms. METHODS: A total of 1092 open-ended descriptions from Danish ambulance personnel were content analysed to develop a categorical scale that identifies types of events perceived as critical to operative ambulance personnel. Multiple regression was used to assess whether the scale predicted PTS symptoms and to assess the cumulative effect of exposure to these events. RESULTS: The study found that the 1092 descriptions of critical events could be condensed into 28 categories of critical events. These ranged from life-threatening situations and deaths, to more daily events such as handling strong emotional reactions from patients’ relatives and working with terminally ill children. The frequency of events significantly predicted the severity of PTS symptoms with low to moderate effect (std beta = 0.2, t(375) = 3.7, p < .001), even when adjusting for known risk factors for post-traumatic stress disorder. CONCLUSION: This study showed that critical events in ambulance work included events that are not normally considered traumatic, and indicated that understanding the cumulative effect of these events is important when trying to prevent traumatic sequalae in ambulance personnel. The study highlighted the importance of increased focus on non-traumatic incidents that have an ongoing impact on paramedics’ mental health and well-being. The Critical Incidents Scale for Ambulance Work – Denmark (CISAW-D) is a promising tool for systematic screening for exposure to critical events in ambulance work.