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Early Intervention for PTSD prevention in First Responders and Veterans EBP Model Selection Questions 1. Ask :  Does early psychosocial intervention prevent the development of secondary effects (traumatic stress/compassion fatigue/ burnout PTSD/suicide) after traumatic event exposure in first responder and veteran populations? 2. Acquire :  Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies. BMC Emergency Medicine , 21 (1). Loef et al, 2021. • The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis. PLOS ONE , 17 (8), Alshahrani et al, 2022. • Va/dod clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder: Clinician summary. (2018). FOCUS , 16 (4), • Schrader, C., & Ross, A. (2021). A review of PTSD and current treatment strategies. Missouri medicine , 118 (6) 3. Appraise :  Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies. BMC Emergency Medicine , 21 (1). Loef et al, 2021. o Rating: Level III, High Quailty  Inductive thematic analysis and pattern recognition from completely transcribed interviews were used in this article to show how data was analyzed into themes in a transparent manner. Through member checks, triangulation, and peer reviews, the authors verified the results and checked and confirmed the data. Since there were no pre-structured questions or subjects for debate, the participants were free to express their own opinions. The recurring themes led to new understanding and provided a fresh insight on the symptom reduction of PTSD  High quality due to transparency, diligence, verification, participant-driven inquiry and insightful interpretation. • The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis. PLOS ONE , 17 (8), Alshahrani et al, 2022. • Rating: Level 1, Good Quality • The main finding of this meta-analytic review is in line with most previous systematic reviews that psychological interventions are effective for reducing PTSD symptoms among first responders. The large majortiy of reviews favored postivie impact in reducing PTSD in first responder populations. Graphs showed positive results for treatments vs controls.

• Not considered high rating due to inadequate control, and failry definitive conclusions. • Va/dod clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder: Clinician summary. (2018). FOCUS , 16 (4), • Rating: High Quality • Study findings that help answer the EBP question: Charts utilized to illustrate the quality of evidence. Systematic reviews of RCT, comprehensive meta-analysis studies. Multiple References used to develop guidelines. Clearly defined diagnostic criteria. Pharmacological and Non- Pharmacological interventions were measured and compared. • High Quality due to documented systemic literature search, consistent results and sufficient numbers to support results, definitive conclusions and evident national expertise. 4. Apply :  Ethical considerations: o The profession is already regarded as vulnerable and the period immediately following a critical incident is particularly vulnerable.  Solution: Establish peer support teams to be “first in” and build rapport, normalize the feelings behind the critical incident. Lay groundwork for clinicians. o once participants are made aware of their role in the study, behaviors, and coping mechanisms may be changed, interviews may be fabricated, and results would therefore be inaccurate  Solution: Emphasize the importance of transparency in order to further assist peers who may experience the same symptoms of trauma. Educate the participants that their contribution will help mitigate PTSD diagnosis and help the professional group. o Lack of willingness to participate due to stigma surrounding PTSD/Mental Health  Solution: Early education of the physiological impact that is often involuntary post-critical incident. Normalize the aftermath of these events, and produce data that shows participants are not alone. o Privacy and confidentiality concerns with impacting career  Solution: Confidentiality/HIPPA agreement signatures, educate the boundaries and exceptions behind disclosure ie; harm to self/others. Involve family only if consented by the patient. 5. Assess :  Assess the success of treatment with monthly benchmarks. Ie; written questionnaires assessing the quality of mental health, and surveys regarding work/life balance and possible improvement. Ask family/coworkers who have been consented by patients to participate in what their observations have been regarding personality and coping mechanisms. Encourage weekly therapy sessions and “homework” to process emotions. .

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