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Open Access Research article

The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics

Janice Halpern1*, Robert G Maunder2, Brian Schwartz34 and Maria Gurevich5

Author Affiliations

1 Department of Psychiatry, Mt. Sinai Hospital and University of Toronto, 244 Dupont Street, Toronto, ON M5R 1V7, Canada

2 Department of Psychiatry, Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada

3 Public Health Ontario, and Department of Family and Community Medicine, University of Toronto, 1075 Bay St., 11th floor, Toronto, ON Canada

4 Previous Affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada

5 Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada

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BMC Emergency Medicine 2012, 12:10  doi:10.1186/1471-227X-12-10

Published: 3 August 2012



Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms.


EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed.


Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory.


Emotional sequelae are associated most strongly with EMT/paramedics’ personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.