Research Article Downtime after Critical Incidents in Emergency Medical Technicians/Paramedics Janice Halpern, 1 Robert G. Maunder, 1 Brian Schwartz, 2,3 and Maria Gurevich 4 1 Department of Pychiatry, Mt. Sinai Hospital and the University of Toronto, Toronto, Canada M5G 1X5 2 Public Health Ontario and Departments of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada M5G 1V2 3 Sunnybrook Osler Centre for Prehospital Care, Toronto, Canada M4N 3M5 4 Department of Psychology, Ryerson University, Toronto, Canada M5B 1X5 Correspondence should be addressed to Janice Halpern; janice.halpern@utoronto.ca Received 26 January 2014; Accepted 10 April 2014; Published 4 May 2014 Academic Editor: Patrick Schober Copyright © 2014 Janice Halpern et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Efective workplace-based interventions ater critical incidents (CIs) are needed for emergency medical technicians (EMT)/paramedics. he evidence for a period out of service post-CI (downtime) is sparse; however it may prevent posttraumatic stress disorder (PTSD) and burnout symptoms. We examined the hypothesis that downtime post-CI is associated with fewer symptoms of four long-term emotional sequelae in EMT/paramedics: depression, PTSD, burnout, and stress-related emotional symptoms (accepted cut-ofs deined high scores). Two hundred and one paramedics completed questionnaires concerning an index CI including downtime experience, acute distress, and current emotional symptoms. Nearly 75% received downtime; 59% found it helpful; 84% spent it with peers. Downtime was associated only with lower depression symptoms, not with other outcomes. he optimal period for downtime was between <30 minutes and end of shit, with >1 day being less efective. Planned testing of mediation of the association between downtime and depression by either calming acute post-CI distress or feeling helped by others was not performed because post-CI distress was not associated with downtime and perceived helpfulness was not associated with depression. hese results suggest that outcomes of CIs follow diferent pathways and may require diferent interventions. A brief downtime is a relatively simple and efective strategy in preventing later depression symptoms. 1. Introduction Emergency medical technicians (EMT)/paramedics expe- rience considerable workplace stress. his is relected in various recent comparisons of physical and emotional health measures. For instance, in a comparison with 25 other occupations, EMT/paramedics scored highest in physical symptoms, second highest in job dissatisfaction, and fourth highest in psychological diiculties [1]. he burden of stress for this occupational group is thought to be related to critical incidents, events that arouse intense distress which may interfere immediately with functioning or result in later emotional sequelae [2]. Critical incidents oten involve patient death [3] or a feeling of inability to help on the part of the EMT/paramedic [4]. It is not surprising, then, that the UK National Health Service annual sickness-absence rates are repeatedly the highest in ambulance workers [5]. EMS organizations have a responsibility to prepare their employees for critical incidents and to provide postincident strategies to mitigate their efects [6]. Over the past two decades, the eicacy of critical incident stress debrieing (CISD), the most relied-upon postincident mitigating strategy, has come increasingly into question [7, 8]. CISD is usually conducted in groups within a few days of the incident. It includes sharing of thoughts and feelings about the incident, as well as psychoeducation. Recent randomized control trials have failed to show a unique efect of CISD on posttraumatic symptoms, anxiety, or depression [9, 10] in high-risk occupa- tions. his leaves EMS organizations without evidence-based postcritical incident interventions to ofer their employees. he efectiveness of other potential strategies needs to be studied. Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 483140, 7 pages http://dx.doi.org/10.1155/2014/483140