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Tools in this section have been gathered and vetted for usefulness and relevance to a wide range of emergency medical services organizations. After completing the VT–ORG for EMS, use the VT–ORG Scoresheet and Action Plan to analyze the results and prioritize the areas of organizational health you identified as challenges. Then, use the resources and research literature in the toolkit to implement strategies to build your capacity as a vicarious trauma-informed organization.
To maintain EMS providers, to keep them in the field, we have to take care of them. There's already such a shortage of EMS providers that losing any because of things that we control—handling stress, managing the stressors of the job—it would be a downfall.
—Karen Owens, Emergency Operations Manager, Virginia Office of Emergency Medical Services
To address the impact of vicarious trauma, leaders in vicarious trauma-informed organizations proactively integrate strategies into workplace values, operations, and practices; maintain a clear vision that supports and articulates the agency's mission; and regularly model and promote open and respectful communication.
Voices From the Field
But you do have to keep aware of it [vicarious trauma]. I think not only do you have to engage the top brass, but then you have to start with the supervisors and then work it on down so it is in everybody's mind. [Make them] aware of what is going on. Start saying, "Okay, I need some help now," because most of us will just, like, push it down and 20 years later, you can remember to the minute...whatever the person's clothes were made of, what happened on this particular run... We have to [deal with it].
—Emergency Medical Technician, EMS/Medical
The organization has to be dedicated to trauma informed care first. Most hospital organizations have not formally adopted this.
—ER Trauma Nurse, EMS/Medical
What the Research Literature Tells Us
Open and transparent communication regarding the organization's mission, strategy, resources, and implementation of policies and procedures provides a strong foundation within the agency. It is important for leadership to provide clear information about the "why's and how's" of decision- and policymaking, and to encourage staff ownership in these efforts. Leadership is encouraged to foster a culture of openness across the agency, promoting the effective exchange of feedback and recognizing the contributions and accomplishments of staff (Brondolo et al. 2008).
Exploring a wide range of team-building opportunities, and having antidiscrimination and other policies that promote inclusion, play a critical role in ensuring the safety, well-being, and resilience of individual staff and the whole team. Building relationships with community partners and other first responders who share experiences and responses to vicarious trauma is critical in building a support network across professions. Community partners can provide needed resources and enhance an agency's ability to assist both victims and staff, sharing in the burden of cost and expertise.
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. (Remen 2006).
To fulfill their obligation to lessen the impact of vicarious trauma, managers and supervisors in vicarious trauma-informed organizations foster supportive relationships based on inclusivity, mutual respect, and trust; promote policies and practices that lessen the negative impact of the work; seek out and support staff following critical or acute incidents; and conduct performance evaluations that include discussions of vicarious trauma.
Voices From the Field
Our department manager has an open-door policy. Only one of our department staff is at work at a time so we rarely see each other. We can call the manager day or night. She listens and assists well. Knowing we have that support if we ever have a question or need to vent is helpful. Not all managers are so available or nonjudgmental.
—Sexual Assault Nurse Examiner, EMS/Medical
Critical Incident Stress Debriefing, if carried out correctly, is the most efficient means to identify responders who may be severely affected by the incident. Clearly, the followup for these individuals is critical and, in my experience, the place where most programs fail is due to lack of personnel to coordinate it and/or financial restrictions on providing mental health counseling.
—Non-Hospital Based EMT, EMS/Medical
EAP is a great tool for the chronic stresses of life and how to develop or improve coping skills. I have used it twice. Group debriefings, as a department, on incidents and performing analysis of the incident for areas of strength, weakness, and how to improve—these allow everyone to share thoughts and feelings. As a division chief now, I try to mentor company officers to take initiative and have company debriefs after incidents to ensure everyone is okay and has their concerns and thoughts heard and appreciated.
—Firefighter, EMS/Medical
What the Research Literature Tells Us
Supervisor and coworker support are important mechanisms for effective functioning and guidance. Peer support programming, critical incident stress management (CISM), and family support in the aftermath of critical incidents have proved effective in responding to posttraumatic stress disorder (PTSD) and vicarious trauma (Everly, Boyle, and Latting 1999). For example, emergency medical technicians who responded to the Los Angeles riots in 1992 reported fewer symptoms of PTSD after participating in a critical incident stress debriefing (CISD) (Wee et al. 1999).
Written policies and established programs help define the standard of practice that guides an organization's consistent response to its staff. They also remove stigma and feelings of subjectivity by delineating which staff will be asked to employ which strategies or programs and under what circumstances. In the first responder fields, standard orders and protocols such as CISD provide clear guidance and expectations for responding to staff in the aftermath of a critical incident. In their study, Bober and Regehr (2006) found that the primary predictor of vicarious trauma is the number of hours per week staff work with traumatized individuals. Therefore, organizations can reduce trauma exposure among their staff by developing strategies to distribute the workload.
To promote and maintain a healthy work environment, vicarious trauma-informed organizations foster teamwork; encourage collaboration both within and outside the organization; create formal and informal opportunities for staff to connect with one another; and offer opportunities to diversify job tasks.
Voices From the Field
The ability of personnel to express themselves freely (within reason) helps to maintain a free exchange of information and support of all individuals.
—Chief, EMS/Medical
Staff meetings to review cases and debrief after stressful cases help to have other eyes and to give objective help when you get in too deep. It helps to talk with people who I know understand what I am experiencing, because they experience it, too.
—Child Protection Team, EMS/Medical
Group discussion of difficult forensic cases is most helpful for me. Knowing that others find cases difficult lets me know that I am not practicing in a silo.
—Sexual Assault Nurse Examiner, EMS/Medical
We run in small, semi-permanent teams that come to represent familial units. As volunteers, financial incentives are not offered but recognition, support, and familial affection all help one another through difficult times.
—Volunteer, EMS/Medical
What the Research Literature Tells Us
Staff who have access to their organization's strategic plans and other relevant information experience lower levels of vicarious trauma (Choi 2011). Having a voice and some influence over decisionmaking fosters a sense of ownership and empowerment, a deeper commitment to the work, greater buy-in to the mission, and a sense of confidence that one matters in the organization.
Work culture describes the environment and tone of an organization. Work culture is an enormously influential factor in addressing vicarious trauma because it helps shape understanding of vicarious trauma as an expected and normal response to trauma exposure, which makes it easier for staff to openly seek and accept support. Feeling included, connected, accepted, and respected creates a safe and supportive environment that decreases the negative impact of vicarious trauma on staff (Bell, Kulkarni, and Dalton 2003; Slattery and Goodman 2009).
To strive for professional competency, capacity, and staff retention, vicarious trauma-informed organizations promote continuing education, professional development, and networking opportunities; provide thorough orientation and ongoing training; enable access to resources; and support staff participation in on- and offsite learning opportunities.
Voices From the Field
Lectures offering case studies, showing slides or videos, in my opinion, offer the greatest opportunity to learn.
—Volunteer, EMS/Medical
What the Research Literature Tells Us
Training on vicarious trauma benefits participants and the populations they serve and facilitates change in the organization (Gentry, Baggerly, and Baranowsky 2003; Mishara and Martin 2012).
To maintain the health and wellness of their staff, vicarious trauma-informed organizations recognize links between health/wellness and staff satisfaction and productivity; devote time and resources to promoting staff well-being; encourage and provide health and wellness activities; and incorporate wellness into policies and practices.
Voices From the Field
I appreciate having flexibility in my workplace and schedule. I know that if I put in a lot of time and emotional energy on a tough case, I can take time off, with flexible scheduling, to regroup and still get my work done. And I don't feel guilty about it.
—ER/Trauma Doctor, EMS/Medical
What the Research Literature Tells Us
Increasingly, organizations are recognizing that they can enhance overall staff health by providing access to wellness activities, such as fitness, yoga, and mindfulness programs; and by supporting boundaries between work and home. For example, mindfulness programs have been found to increase compassion satisfaction and decrease compassion fatigue (Thieleman and Cacciatore 2014). Also, in a study of U.S. Army Medical First Responders, 98 percent of respondents found mind-body programming to be helpful, and 96 percent planned to continue newly learned practices (Adams et al. 2010).
Each of the over 500 listings in the Compendium of Resources includes the resource title, source, and author or developer, as well as a general description identifying the category, discipline, organizational strategy, topic, and CDC code, if applicable. Research literature items include full bibliographical citations.
For a step-by-step guide to strengthening your organization's response to vicarious trauma by using this toolkit, see the Blueprint for a Vicarious Trauma-Informed Organization.
