Umeå University's logo

Purpose: The aim of this study is to analyse how recurrent health hindrance themes in the firefighter discourse, identified by firefighters themselves, relate to a set of policies about diversity, preventive work and education of firefighters. The intention is further to discuss the implications of these policy initiatives and the resistance against them in terms of firefighters’ health and well-being at work.

Method: Firefighters from three different rescue stations in Sweden, participated in either a focus group discussion or individual interviews. Different themes in firefighter discourse that were described as hindrances to the health and well-being of firefighters were identified. A strategic sample of policy documents that relate to the very same themes was also chosen for analysis and here we combined critical discourse analysis (CDA) with critical policy analysis.

Results: The health hindrance themes regarding diversity, preventive work and education that firefighters identified have in common that they relate to changes in work culture and the firefighter profession.

Conclusion: In conclusion, we argue that the most important challenge for the rescue service to tackle in the future, is how to transform firefighting to be more inclusive and yet maintaining the good health and well-being that exists among the vast majority of today’s firefighters.

Background: An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries(LMICs) occur in prehospital environments. Lay first responders such as police officers play an important role inproviding initial assistance to victims of road traffic injuries either alone or in collaboration with others. The presentstudy evaluated a postcrash first aid (PFA) educational program developed for police officers in Tanzania.

Method: A 16-h PFA educational program was conducted in Dar es Salaam, Tanzania, for 135 police officers. Participantscompleted training surveys before, immediately and 6months after the training (before, N = 135; immediately after, N=135;after 6 months, N=102). The primary outcome measures were PFA knowledge, perceived skills confidence, and skillsutilization. Parametric and nonparametric tests were used to analyse changes in outcome.

Results: The mean PFA knowledge score increased from 44.73% before training (SD = 20.70) to 72.92% 6months aftertraining (SD = 18.12), p < .001, N = 102. The mean PFA perceived skills confidence score (measured on a 1–5 Likert scale)increased from 1.96 before training (SD = 0.74) to 3.78 6months after training (SD=0.70), p < .001, N = 102. Followingtraining, application of the recovery position skill (n = 42, 46%) and application of the bleeding control skill (n = 45, 49%) werereported by nearly half of the responding officers. Less than a quarter of officers reported applying head and neckimmobilization skills (n = 20, 22%) following training.

Conclusion: A PFA educational program has shown to improve police officers’ knowledge and perceived skills confidenceon provision of first aid. However qualitative research need to be conducted to shed more light regarding reasons for lowutilization of trained first aid skills during follow-up.

BACKGROUND: In low and middle-income countries (LMICs), laypersons play a significant role in providing initial care to injured victims of traffic accidents. Post-crash first aid (PFA) training programmes for laypersons have become an important response to addressing knowledge and skills gaps in pre-hospital care. However, little is known about factors influencing effective implementation of such programmes from stakeholders' point of view. Therefore, this study aimed to explore views of stakeholders on potential factors that may facilitate or hinder successful implementation of a PFA training programme for lay persons.

METHODS: Twelve semi-structured qualitative interviews with leaders at a traffic police department and leaders of an association of city bus drivers, taxi drivers and motorcycle taxis in Tanzania were conducted. Interviews were audio-recorded and transcribed verbatim. A thematic analysis approach was used to identify themes and sub-themes.

RESULTS: Three themes pertaining to implementation of a PFA training programme were identified: Motivation for engaging in training, Constrains for engaging in training and Training processes. They consisted of a total of six sub-themes: "perceived benefits of first aid training" and "availability of incentives" were considered as facilitators to PFA training. "Availability of time to attend training" and "accessibility of training" were reported as a potential barriers to successful training. Finally, they felt that "methods of training delivery" and "availability of first aid training materials and equipment" could either facilitate or impede delivery of PFA training.

CONCLUSION: This study highlights potential facilitators and barriers to implementing a PFA training programme for lay persons from the perspectives of leaders from police department and associations of city bus drivers, taxi drivers, and motorcycle taxis. This may be useful information for other stakeholders, and may enable government-level leaders and persons higher up in the health service hierarchy to take action to meet WHO recommendations for emergency pre-hospital care.

The aim of this critical discourse analysis is to identify and discuss dominant and recurrent themes in firefighter discourse that promote and hinder firefighters' health and well-being. Using critical discourse analysis, the focus is directed toward routine work culture at the station, as well as how firefighters deal with extraordinary events. The empirical material was collected from rescue services in Sweden representing different geographical areas. In total, 28 firefighters participated in focus group discussions or individual interviews. We identified dominant themes in the discourse that promoted firefighters' health and well-being. We also identified recurrent themes that may serve as hindrances to health and well-being. We note that themes in the latter category also relate to changes in the profession and work culture, expressing external pressures on the rescue service. One reason for resistance toward change might be the health benefits that the current order of firefighter discourse brings.

Background: The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several training programmes have been implemented to build lay responder first aid skills. Findings show that most programmes significantly improved participants' first aid skills. However, there is a gap in knowledge of what factors influence the use of these skills in real situations. The current study aimed to describe police officers' views on and experiences of factors that facilitate or hinder their use of trained first aid skills at work.

Methods: Thirty-four police officers participated in five focus group discussions. A structured interview guide was used to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative content analysis.

Results: We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator; work situation and hospital atmosphere were considered hindrances; and the physical and social environments and the resources available for providing first aid could be either facilitators or hindrances.

Conclusion: Practical exposure during training is perceived to improve police officers' confidence in applying their first aid skills at work. However, contextual factors related to the working environment need to be addressed to promote this transfer of skills.

Background: The availability of prehospital trauma care is an important means of reducing serious injuries and fatalities associated with road traffic injuries (RTIs). Lay responders such as traffic police play an important role in the provision of prehospital trauma care to RTI victims, especially where there is no established prehospital care system. Therefore, the objective of the present study was to investigate knowledge, self-reported practice, and attitudes toward post-crash first aid among traffic police officers in Tanzania.

Method: A cross-sectional survey was conducted in Dar es Salaam, Tanzania between July-September 2017 to investigate knowledge, self-reported practice and attitude among traffic police officers during provision of post-crash care. We used simple random technique to recruit 340 traffic police officers, self -administered questionnaires were used to collect data. The researchers used descriptive statistics and Pearson's chi-square tests to analyze the data.

Results: A total of 340 traffic police officers were surveyed. Nearly two thirds (65.3%) reported having had post-crash first aid on-the job training; a slightly larger proportion (70.9%) reported that they had cared for RTI victims in the previous year. The survey responses showed that, generally, traffic police officers' level of knowledge about post-crash first aid to RTI victims was low-about 3% of the surveyed officers possessed knowledge at a level considered good. Also, there was a statistically significant correlation between higher educational attainment and greater knowledgeability (p = 0.015). Almost all of the officers (96%) had a positive attitude toward providing post-crash first aid to RTI victims.

Conclusions: Improved training of Tanzania traffic police officers, by means of an updated post-crash first aid curriculum and updated resources is recommended. Also, user-friendly post-crash first aid leaflets should be provided to traffic police for their reference.

Firefighters are exposed to traumatic and stressful psychosocial and physical strain in their work, and thus they are considered to be a group at high risk of burnout. The aim of this study was to investigate burnout (emotional exhaustion (EE) and depersonalization (DP) among Swedish female and male firefighters and to examine the gender-stratified relationship between psychosocial work environment and burnout when considering the moderating effect of coping strategies among Swedish firefighters. The overall mean values of both EE and DP were notably low in comparison with the general population in Sweden. We found that psychosocial work environment factors increase the risk of burnout among male firefighters. Among men, EE was associated with high demands and lack of social support in work. The association was also confirmed with DP as the outcome and lack of good leadership as the exposure among men. However, among female firefighters the association between psychosocial work environment factors and burnout failed to appear. Among women, EE and DP were only associated with the coping strategy Psychological distancing (PDi). A negative association with DP and the coping strategy Positive Reappraisal (PRe) was also found among women. Regardless of the result from the regression analyses, we must consider that the majority of the female and male firefighters in our study had low scores on the outcome variables EE and DP. Future studies should explore female and male firefighters' context and possible health-protecting environment.

Police personnel work under different circumstances in various environments involving stressful situations which can increase the risk of burnout. Aim of this study was to investigate the association between burnout (emotional exhaustion, EE vs. depersonalization, DP) and psychosocial work environment, stress of conscience as well as coping strategies among patrolling police officers in Sweden. Most of the independent variables; psychological demand, decision latitude, social support, and coping scales were correlated with EE and DP. A hierarchical multiple regression was performed to investigate the predictive impact of; psychological demand, decision latitude, social support, coping strategies and stress of conscience. Findings revealed that risk of EE increased with a troubled conscience for both women and men when coping strategies were added to the model. For men risk of DP increased with troubled conscience. Only low decision latitude was associated with risk of DP for women when coping strategies were added to the model. Results from this study indicate that stress of conscience has to be taken into consideration and also levels of social support and decision latitude when studying the influence of the psychosocial work environment on burnout.

Background: A critical incident is defined as an event stressful enough to overwhelm the usually effective coping skills of an individual. Firefighters are frequently exposed to critical incidents that might have consequences for individuals and their performance in organization. Aim: The aim of this study was to describe experiences of critical incidents among female and male Swedish firefighters. Method: In all 180 participants (16 women, 164 men) who had been involved in up to 25 critical incidents during the last year responded to a survey describing critical incidents experienced in the past year. A qualitative content analysis identified several areas for improvement in firefighters' working conditions. Results: Female firefighters were terse in describing their experiences, while the men described their experiences of critical events more vividly. The critical incidents described by the firefighters concerned such overwhelming situations as traffic accidents, huge fires, and other fatal incidents such as drownings and suicides. Risk of delay due to lack of equipment training and lack of medical education was mentioned. Lack of resources and organizational problems was mentioned as causing risks of failure. Several firefighters expressed frustration over being assaulted and threatened, or exposed to other kinds of violence. Not knowing how close, physically or mentally, one can get to people during ongoing rescue can lead to unsuccessful operations. Conclusions: Gender patterns should always be taken into account, making it possible for all firefighters to express and reflect on existentially tough experiences. Education needs to focus more on medical and mental health issues. Firefighters were sometimes exposed to the difficult challenge of violence and assault during rescue operations. The complexity of this problem needs to be highlighted, not only in firefighter organizations, but also in society in general.