Understanding the Role of Empathy and Gender on EMS Clinician Occupational Stress and Mental Health Outcomes

References

• Stassen W, Van Nugteren B, Stein C. Burnout among advanced life support paramedics in Johannesburg, South Africa. Emerg Med J. 2013;30(4):331–4. doi:10.1136/emermed-2011-200920.
   PubMed Web of Science ®Google Scholar
• Vettor SM, Kosinski Jr FA. Work‐stress burnout in emergency medical technicians and the use of early recollections. Journal of Employment Couns. 2000;37(4):216–28. doi:10.1002/j.2161-1920.2000.tb01028.x.
   Web of Science ®Google Scholar
• Haugen PT, Evces M, Weiss DS. Treating posttraumatic stress disorder in first responders: a systematic review. Clin Psychol Rev. 2012;32(5):370–80. doi:10.1016/j.cpr.2012.04.001.
   PubMed Web of Science ®Google Scholar
• Abbasi M, Zakerian A, Akbarzade A, Dinarvand N, Ghaljahi M, Poursadeghiyan M, Ebrahimi MH. Investigation of the relationship between work ability and work-related quality of life in nurses. Iran J Public Health. 2017;46(10):1404–12.
   PubMed Web of Science ®Google Scholar
• Feldman TR, Carlson CL, Rice LK, Kruse MI, Beevers CG, Telch MJ, Josephs RA. Factors predicting the development of psychopathology among first responders: a prospective, longitudinal study. Psychol Trauma. 2021;13(1):75–83. doi:10.1037/tra0000957.
   PubMed Web of Science ®Google Scholar
• Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103–11. doi:10.1002/wps.20311.
   PubMed Web of Science ®Google Scholar
• Hruska B, Barduhn MS. Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel. J Affect Disord. 2021;282:9–17. doi:10.1016/j.jad.2020.12.130.
   PubMed Web of Science ®Google Scholar
• Berger W, Coutinho ES, Figueira I, Marques-Portella C, Luz MP, Neylan TC, Marmar CR, Mendlowicz MV. Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):1001–11. doi:10.1007/s00127-011-0408-2.
   PubMed Web of Science ®Google Scholar
• Petrie K, Milligan-Saville J, Gayed A, Deady M, Phelps A, Dell L, Forbes D, Bryant RA, Calvo RA, Glozier N, et al. Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2018;53(9):897–909. doi:10.1007/s00127-018-1539-5.
   PubMed Web of Science ®Google Scholar
• Haugen PT, Splaun AK, Evces MR, Weiss DS. Integrative approach for the treatment of posttraumatic stress disorder in 9/11 first responders: three core techniques. Psychotherapy (Chic). 2013;50(3):336–40. doi:10.1037/a0032526.
   PubMed Web of Science ®Google Scholar
• Flannery RB. Treating psychological trauma in first responders: a multi-modal paradigm. Psychiatr Q. 2015;86(2):261–7. doi:10.1007/s11126-014-9329-z.
   PubMed Web of Science ®Google Scholar
• Kleim B, Westphal M. Mental health in first responders: a review and recommendation for prevention and intervention strategies. Traumatology. 2011;17(4):17–24. doi:10.1177/1534765611429079.
   Google Scholar
• Jones S, Nagel C, McSweeney J, Curran G. Prevalence and correlates of psychiatric symptoms among first responders in a Southern State. Arch Psychiatr Nurs. 2018;32(6):828–35. doi:10.1016/j.apnu.2018.06.007.
   PubMed Web of Science ®Google Scholar
• Fjeldheim CB, Nöthling J, Pretorius K, Basson M, Ganasen K, Heneke R, Cloete KJ, Seedat S. Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emerg Med. 2014;14(1):11. doi:10.1186/1471-227X-14-11.
   PubMedGoogle Scholar
• Crowe RP, Fernandez AR, Pepe PE, Cash RE, Rivard MK, Wronski R, Anderson SE, Hogan TH, Andridge RR, Panchal AR, et al. The association of job demands and resources with burnout among emergency medical services professionals. J Am Coll Emerg Physicians Open. 2020;1(1):6–16. doi:10.1002/emp2.12014.
   PubMedGoogle Scholar
• Grigsby DW, Knew MA. Work-stress burnout among paramedics. Psychol Rep. 1988;63(1):55–64. doi:10.2466/pr0.1988.63.1.55.
   PubMed Web of Science ®Google Scholar
• Reardon M, Abrahams R, Thyer L, Simpson P. Prevalence of burnout in paramedics: a systematic review of prevalence studies. Emerg Med Australas. 2020;32(2):182–9. doi:10.1111/1742-6723.13478.
   PubMed Web of Science ®Google Scholar
• Thyer L, Simpson P, Nugteren BV. Burnout in Australian paramedics. International Paramedic Practice. 2018;8(3):48–55. doi:10.12968/ippr.2018.8.3.48.
   Google Scholar
• Zolnikov TR, Furio F. Stigma on first responders during COVID-19. Stigma and Health. 2020;5(4):375–9. doi:10.1037/sah0000270.
   Google Scholar
• Cuff BM, Brown SJ, Taylor L, Howat DJ. Empathy: a review of the concept. Emotion Review. 2016;8(2):144–53. doi:10.1177/1754073914558466.
   Web of Science ®Google Scholar
• Decety J. Empathy in medicine: what it is, and how much we really need it. Am J Med. 2020;133(5):561–6. doi:10.1016/j.amjmed.2019.12.012.
   PubMed Web of Science ®Google Scholar
• Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18(8):670–4. doi:10.1046/j.1525-1497.2003.21017.x.
   PubMed Web of Science ®Google Scholar
• Petrucci C, La Cerra C, Aloisio F, Montanari P, Lancia L. Empathy in health professional students: a comparative cross-sectional study. Nurse Educ Today. 2016;41:1–5. doi:10.1016/j.nedt.2016.03.022.
   PubMed Web of Science ®Google Scholar
• Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87(9):1243–9. doi:10.1097/ACM.0b013e3182628fbf.
   PubMed Web of Science ®Google Scholar
• Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, Magee M. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934–41. doi:10.1111/j.1365-2929.2004.01911.x.
   PubMed Web of Science ®Google Scholar
• Reynolds W. The measurement and development of empathy in nursing. London: Routledge; 2017.
   Google Scholar
• Burks DJ, Kobus AM. The legacy of altruism in health care: the promotion of empathy, prosociality and humanism. Med Educ. 2012;46(3):317–25. doi:10.1111/j.1365-2923.2011.04159.x.
   PubMed Web of Science ®Google Scholar
• Mirhaghi A, Mirhaghi M, Oshio A, Sarabian S. Systematic review of the personality profile of paramedics: bringing evidence into emergency medical personnel recruitment policy. EAJEM. 2016;15(3):144–9. doi:10.5152/eajem.2016.80299.
   Google Scholar
• Pajonk FG, Andresen B, Schneider-Axmann T, Teichmann A, Gärtner U, Lubda J, Moecke H, von Knobelsdorff G. Personality traits of emergency physicians and paramedics. Emerg Med J. 2011;28(2):141–6. doi:10.1136/emj.2009.083311.
   PubMed Web of Science ®Google Scholar
• Grevin F. Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics. Psychol Rep. 1996;79(2):483–95. doi:10.2466/pr0.1996.79.2.483.
   PubMed Web of Science ®Google Scholar
• Williams B, Boyle M, Brightwell R, Devenish S, Hartley P, McCall M, McMullen P, Munro G, O’Meara P, Webb V, et al. An assessment of undergraduate paramedic students’ empathy levels. Int J Med Educ. 2012;3:98–102. doi:10.5116/ijme.4fba.9190.
   Google Scholar
• Williams B, Boyle M, Brightwell R, Devenish S, Hartley P, McCall M, McMullen P, Munro G, O'Meara P, Webb V. Paramedic empathy levels: results from seven Australian universities. International Journal of Emergency Services. 2012;1(2):111–21. doi:10.1108/20470891211275902.
   Google Scholar
• Williams B, Boyle M, Fielder C. Empathetic attitudes of undergraduate paramedic and nursing students towards four medical conditions: a three-year longitudinal study. Nurse Educ Today. 2015;35(2):e14-8–e18. doi:10.1016/j.nedt.2014.12.007.
   PubMed Web of Science ®Google Scholar
• Williams B, Boyle M, Tozer-Jones J, Devenish S, Hartley P, McCall M, McMullen P, Munro G, O’Meara P. Undergraduate paramedic students’ empathy levels: a two-year longitudinal study. JNEP. 2015;5(1):58–64. doi:10.5430/jnep.v5n1p58.
   Google Scholar
• Kilner T. Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: findings from a Delphi study. Emerg Med J. 2004;21(3):374–8. doi:10.1136/emj.2003.008243.
   PubMed Web of Science ®Google Scholar
• Raab K. Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature. J Health Care Chaplain. 2014;20(3):95–108. doi:10.1080/08854726.2014.913876.
   PubMedGoogle Scholar
• Michael G, Anastasios S, Helen K, Catherine K, Christine K. Gender differences in experiencing occupational stress: the role of age, education and marital status. Stress and Health: journal of the International Society for the Investigation of Stress. 2009;25(5):397–404. doi:10.1002/smi.1248.
   Web of Science ®Google Scholar
• Faravelli C, Scarpato MA, Castellini G, Sauro CL. Gender differences in depression and anxiety: the role of age. Psychiatry Res. 2013;210(3):1301–3. doi:10.1016/j.psychres.2013.09.027.
   PubMed Web of Science ®Google Scholar
• Whiteman K, Ruggiano N, Thomlison B. Transforming mental health services to address gender disparities in depression risk factors. J Women Aging. 2016;28(6):521–9. doi:10.1080/08952841.2015.1072027.
   PubMed Web of Science ®Google Scholar
• Zender R, Olshansky E. Women’s mental health: depression and anxiety. Nurs Clin North Am. 2009;44(3):355–64. doi:10.1016/j.cnur.2009.06.002.
   PubMed Web of Science ®Google Scholar
• Gradus J, Epidemiology of PTSD. National Center for Post-Traumatic Stress Disorder, Department of Veteran Affairs. 2013. [Accessed 2021 Aug 20]. Available from: https://www.mentalhealth.va.gov/coe/cih-visn2/Documents/Provider_Education_Handouts/Epidemiology_of_PTSD_Version_3.pdf.
   Google Scholar
• Bergen-Cico D, Lane S, Thompson M, Wozny S, Zajdel M, Barduhn M, Noce J. The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain. International Paramedic Practice. 2015;5(3):78–87. doi:10.12968/ippr.2015.5.3.78.
   Google Scholar
• Frazer H, Hansen C, Searle A, Lawrence-Wood E, Van Hooff M. Exploration of potential indicators of burnout, psychological distress and post-traumatic stress disorder, among Australian female first responders. Psychiatry Res. 2022;316:114771. doi:10.1016/j.psychres.2022.114771.
   Google Scholar
• Yoo J, Kim JH, Yoon J, Kim SS. Sexual harassment and its relationship with depressive symptoms: a nationwide study of Korean EMS providers. Am J Ind Med. 2019;62(1):74–9. doi:10.1002/ajim.22924.
   PubMed Web of Science ®Google Scholar
• Christov-Moore L, Simpson EA, Coudé G, Grigaityte K, Iacoboni M, Ferrari PF. Empathy: gender effects in brain and behavior. Neurosci Biobehav Rev. 2014;46(Pt 4):604–27. doi:10.1016/j.neubiorev.2014.09.001.
   PubMedGoogle Scholar
• Kimbrel NA, Steffen LE, Meyer EC, Kruse MI, Knight JA, Zimering RT, Gulliver SB. A revised measure of occupational stress for firefighters: psychometric properties and relationship to posttraumatic stress disorder, depression, and substance abuse. Psychological Services. 2011;8(4):294–306. doi:10.1037/a0025845.
   Web of Science ®Google Scholar
• Jitnarin N, Jahnke SA, Poston WS, Haddock CK, Kaipust CM. Posttraumatic stress disorder (PTSD) and mental health comorbidity in firefighters. Journal of Workplace Behavioral Health. 2022;37(3):147–68. doi:10.1080/15555240.2022.2081172.
   Web of Science ®Google Scholar
• Kimbrel NA, Flynn EJ, Carpenter GS, Cammarata CM, Leto F, Ostiguy WJ, Kamholz BW, Zimering RT, Gulliver SB. Internal consistency, test-retest reliability, and predictive validity for a Likert-based version of the Sources of Occupational Stress-14 (SOOS-14) scale. Psychiatry Res. 2015;228(3):961–2. doi:10.1016/j.psychres.2015.05.031.
   PubMed Web of Science ®Google Scholar
• Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, Brähler E. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1-2):86–95. doi:10.1016/j.jad.2009.06.019.
   PubMed Web of Science ®Google Scholar
• Linzer M. Mini Z burnout survey. Stepsforward. American Medical Association. 2019.
   Google Scholar
• Rohland BM, Kruse GR, Rohrer JE. Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians. Stress and Health: journal of the International Society for the Investigation of Stress. 2004;20(2):75–9. doi:10.1002/smi.1002.
   Web of Science ®Google Scholar
• Spreng RN, McKinnon MC, Mar RA, Levine B. The Toronto Empathy Questionnaire: scale development and initial validation of a factor-analytic solution to multiple empathy measures. J Pers Assess. 2009;91(1):62–71. doi:10.1080/00223890802484381.
   PubMed Web of Science ®Google Scholar
• Lock S, Rees CS, Heritage B. Development and validation of a brief measure of psychological resilience: the state–trait assessment of resilience scale. Australian Psychologist. 2020;55(1):10–25. doi:10.1111/ap.12434.
   Web of Science ®Google Scholar
• Memon MA, Cheah JH, Ramayah T, Ting H, Chuah F, Cham TH. Moderation analysis: issues and guidelines. JASEM. 2019;3(1):i–xi. doi:10.47263/JASEM.3(1)01.
   Google Scholar
• Huang G, Chu H, Chen R, Liu D, Banda KJ, O'Brien AP, Jen H-J, Chiang K-J, Chiou J-F, Chou K-R. Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: a meta-analysis. J Glob Health. 2022;12:05028. doi:10.7189/jogh.12.05028.
   PubMed Web of Science ®Google Scholar
• Hendrickson RC, Slevin RA, Hoerster KD, Chang BP, Sano E, McCall CA, Monty GR, Thomas RG, Raskind MA. The impact of the COVID-19 pandemic on mental health, occupational functioning, and professional retention among health care workers and first responders. J Gen Intern Med. 2022;37(2):397–408. doi:10.1007/s11606-021-07252-z.
   PubMed Web of Science ®Google Scholar
• Petrie K, Smallwood N, Pascoe A, Willis K. Mental health symptoms and workplace challenges among Australian paramedics during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(2):1004. doi:10.3390/ijerph19021004.
   PubMed Web of Science ®Google Scholar
• Wright HM, Griffin BJ, Shoji K, Love TM, Langenecker SA, Benight CC, Smith AJ. Pandemic-related mental health risk among front line personnel. J Psychiatr Res. 2021;137:673–80. doi:10.1016/j.jpsychires.2020.10.045.
   PubMed Web of Science ®Google Scholar
• Schwartz RM, McCann-Pineo M, Bellehsen M, Singh V, Malhotra P, Rasul R, Corley SS, Jan S, Parashar N, George S, et al. The impact of physicians’ COVID-19 pandemic occupational experiences on mental health. J Occup Environ Med. 2022;64(2):151–7. doi:10.1097/JOM.0000000000002380.
   PubMed Web of Science ®Google Scholar
• Petrino R, Riesgo LG, Yilmaz B. Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system? Eur J Emerg Med. 2022;29(4):279–84. doi:10.1097/MEJ.0000000000000952.
   PubMed Web of Science ®Google Scholar
• Blanchard J, Li Y, Bentley SK, Lall MD, Messman AM, Liu YT, Diercks DB, Merritt-Recchia R, Sorge R, Warchol JM, et al. The perceived work environment and well‐being: a survey of emergency health care workers during the COVID‐19 pandemic. Acad Emerg Med. 2022;29(7):851–61. doi:10.1111/acem.14519.
   PubMed Web of Science ®Google Scholar
• National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine ; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Taking Action against Clinician Burnout: a Systems Approach to Professional Well-Being. Washington, DC: national Academies Press, 2019.
   Google Scholar
• Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–46. doi:10.1016/j.mayocp.2016.10.004.
   PubMed Web of Science ®Google Scholar
• Karasek R, Theorell T. Healthy work: stress, productivity and the reconstruction of the working life. New York: basic Books 1990.
   Google Scholar
• Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly. 1979;24(2):285–308. doi:10.2307/2392498.
   Web of Science ®Google Scholar
• Ahola K, Hakanen J. Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord. 2007;104(1-3):103–10. doi:10.1016/j.jad.2007.03.004.
   PubMed Web of Science ®Google Scholar
• Nakao M. Work-related stress and psychosomatic medicine. Biopsychosoc Med. 2010;4(1):4. doi:10.1186/1751-0759-4-4.
   PubMedGoogle Scholar
• Stahl SM, Hauger RL. Stress: an overview of the literature with emphasis on job-related strain and intervention. Adv Ther. 1994;11(3):110–9.
   PubMed Web of Science ®Google Scholar
• Rodrigues Sampaio L, Coelho de Oliveira L, França Dourado Neto Pires M. Empathy, depression, anxiety and stress in Brazilian Health Professionals. Ciências Psicológicas. 2020;14(2):49–64.
   Google Scholar
• Yan Z, Zeng X, Su J, Zhang X. The dark side of empathy: meta‐analysis evidence of the relationship between empathy and depression. Psych J. 2021;10(5):794–804. doi:10.1002/pchj.482.
   PubMed Web of Science ®Google Scholar
• Wilkinson H, Whittington R, Perry L, Eames C. Examining the relationship between burnout and empathy in healthcare professionals: a systematic review. Burn Res. 2017;6:18–29. doi:10.1016/j.burn.2017.06.003.
   PubMedGoogle Scholar
• Kellner ME. Emergency medical professionals experiencing healthcare re-structure: Coping, empathy, and spirituality in relation to work-stress California School of Professional Psychology-Berkeley/Alameda; 2000.
   Google Scholar
• Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007;22(2):177–83. doi:10.1007/s11606-006-0039-6.
   PubMed Web of Science ®Google Scholar
• Lee H, Song R, Cho YS, Lee GZ, Daly B. A comprehensive model for predicting burnout in Korean nurses. J Adv Nurs. 2003;44(5):534–45. doi:10.1046/j.0309-2402.2003.02837.x.
   PubMed Web of Science ®Google Scholar
• Walocha E, Tomaszewski KA, Wilczek-Ruzyczka E, Walocha J. Empathy and burnout among physicians of different specialities. Folia Med Cracov. 2013;53(2):35–42.
   PubMedGoogle Scholar
• Yuguero O, Ramon Marsal J, Esquerda M, Vivanco L, Soler-González J. Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain. Eur J Gen Pract. 2017;23(1):4–10. doi:10.1080/13814788.2016.1233173.
   PubMed Web of Science ®Google Scholar
• Cansel N, Varol Fİ. Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center. Pediatr Transplant. 2023;27(2):e14430. doi:10.1111/petr.14430.
   PubMed Web of Science ®Google Scholar
• Maximiano-Barreto MA, Fabrício DD, Luchesi BM, Chagas MH. Factors associated with levels of empathy among students and professionals in the health field: a systematic review. Trends Psychiatry Psychother. 2020;42(2):207–15. doi:10.1590/2237-6089-2019-0035.
   PubMedGoogle Scholar
• McCann CM, Beddoe E, McCormick K, Huggard P, Kedge S, Adamson C, Huggard J. Resilience in the health professions: a review of recent literature. Intnl J Wellbeing. 2013;3(1):60–81. doi:10.5502/ijw.v3i1.4.
   Google Scholar
• Baskin RG, Bartlett R. Healthcare worker resilience during the COVID‐19 pandemic: an integrative review. J Nurs Manag. 2021;29(8):2329–42. doi:10.1111/jonm.13395.
   PubMed Web of Science ®Google Scholar
• McCain RS, McKinley N, Dempster M, Campbell WJ, Kirk SJ. A study of the relationship between resilience, burnout and coping strategies in doctors. Postgrad Med J. 2018;94(1107):43–7. doi:10.1136/postgradmedj-2016-134683.
   Web of Science ®Google Scholar
• Eaves JL, Payne N. Resilience, stress and burnout in student midwives. Nurse Educ Today. 2019;79:188–93. doi:10.1016/j.nedt.2019.05.012.
   PubMed Web of Science ®Google Scholar
• García‐Izquierdo M, Meseguer de Pedro M, Ríos‐Risquez MI, Sánchez MI. Resilience as a moderator of psychological health in situations of chronic stress (burnout) in a sample of hospital nurses. J Nurs Scholarsh. 2018;50(2):228–36. doi:10.1111/jnu.12367.
   PubMed Web of Science ®Google Scholar
• Hao S, Hong W, Xu H, Zhou L, Xie Z. Relationship between resilience, stress and burnout among civil servants in Beijing, China: mediating and moderating effect analysis. Personality and Individual Differences. 2015;83:65–71. doi:10.1016/j.paid.2015.03.048.
   Web of Science ®Google Scholar
• Havnen A, Anyan F, Hjemdal O, Solem S, Gurigard Riksfjord M, Hagen K. Resilience moderates negative outcome from stress during the COVID-19 pandemic: a moderated-mediation approach. Int J Environ Res Public Health. 2020;17(18):6461. doi:10.3390/ijerph17186461.
   PubMed Web of Science ®Google Scholar
• Kashyap SP, Kumar S, Krishna A. Role of resilience as a moderator between the relationship of occupational stress and psychological health. Indian Journal of Health & Wellbeing. 2014;5(9):1023.
   Google Scholar
• Mealer M, Jones J, Moss M. A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses. Intensive Care Med. 2012;38(9):1445–51. doi:10.1007/s00134-012-2600-6.
   PubMed Web of Science ®Google Scholar
• Arrogante O, Aparicio-Zaldivar E. Burnout and health among critical care professionals: the mediational role of resilience. Intensive Crit Care Nurs. 2017;42:110–5. doi:10.1016/j.iccn.2017.04.010.
   PubMed Web of Science ®Google Scholar
• Gayton SD, Lovell GP. Resilience in ambulance service paramedics and its relationships with well-being and general health. Traumatology. 2012;18(1):58–64. doi:10.1177/1534765610396727.
   Google Scholar
• Austin CL, Pathak M, Thompson S. Secondary traumatic stress and resilience among EMS. Journal of Paramedic Practice. 2018;10(6):240–7. doi:10.12968/jpar.2018.10.6.240.
   Google Scholar
• Watson P, Westphal R. Stress first aid for health care workers. National Center for PTSD. 2020. https://www.ptsd.va.gov/professional/treat/type/stress_first_aid.asp
   Google Scholar
• Mahaffey BL, Mackin DM, Rosen J, Schwartz RM, Taioli E, Gonzalez A. The disaster worker resiliency training program: a randomized clinical trial. Int Arch Occup Environ Health. 2021;94(1):9–21. doi:10.1007/s00420-020-01552-3.
   PubMed Web of Science ®Google Scholar
• Gunderson J, Grill M. Evidence-based program improves & sustains first-responder behavioral health. JEMS. 2014;39(3):57–61.
   PubMedGoogle Scholar
• Mistretta EG, Davis MC, Temkit MH, Lorenz C, Darby B, Stonnington CM. Resilience training for work-related stress among health care workers: results of a randomized clinical trial comparing in-person and smartphone-delivered interventions. J Occup Environ Med. 2018;60(6):559–68. doi:10.1097/JOM.0000000000001285.
   PubMed Web of Science ®Google Scholar