13 Dec NO-FEAR Oslo Workshop Presentations Highlights
NO-FEAR hosted a three-day workshop in Oslo & online on the topic of Health Care Work during Covid-19: Looking back and Ethical, Legal and Social Issues of Security Critical Incidents.
The aim of the workshop was to share experiences and discuss psychological, ethical, social, legal aspects of emergency medical response during security critical incidents. Especially in light of the increased pressure healthcare workers have experienced during the Covid-19 pandemic and on how to prevent and reduce the extent of potential harm from threats and violence against EMS.
We believe we had a productive three days, leading the discourses in emergency medical care & health care curing Covid-19. See the agenda for a more comprehensive guide to the presentations included in the workshop. If you wish to learn more about each presentation, please see below the detailed descriptions.
If you are interested in seeing the results of our three-day workshop, our blog highlighting the central results to each panel will be published soon.
Austrian Red Cross – what we do in COVID-19 – Monika Stickler
Starting off the workshop Monika Stickler was giving input on tasks and challenges of the Austrian Red Cross during the COVID-19 pandemic. Austria is a federal republic with 8.9 Mio inhabitants in 9 branches. The Austrian Red Cross has more than 72.000 volunteers, 10.000 staff and 4.200 civilian service. As the largest humanitarian organization there are 460 Red Cross stations all over Austria. With our services we reach approx. 2.9 Mio people per year. AutRC is the largest provider of EMS in Austria and therefore is involved in different topics during the COVID-19 pandemic.
EMS and ambulance services keep running and do infection transports – both under special restrictions (PPE). AutRC us running and supporting the testing, within test stations and with mobile teams. Also, support at vaccination centers and at the health hotline is provided. All COVID related tasks are conducted additionally to every day’s work. Psychosocial support is given to staff, volunteers, and the public, also under special safety measures. AUtRCs expertise is involved on national and international level in different groups and supports the authorities.
The challenges of AutRC is multifaceted: it is a challenge to find and to educate new EMT or paramedics. The pressure to all staff and volunteers is massive to give more and more support. At the hospitals the entering regimes differs from house to house and often changes. Personnel is tired and frustrated. After downsizing all the support during the summer AutRC is now in a reconnection.
Crisis Communication and Health Care Work during Covid-19 by Ruth Kutalek
In her talk, Ruth Kutalek gave us insights on crisis communication and is drawing on results of a project on the occupational situation of HCWs during the pandemic. Difficulties of communicating in extreme situations includes communicating under challenging working conditions, physical barriers e.g. PPE & FFP3 masks, limited contact, Patients and relatives in distress (unknown course, loneliness, restriction to visit loved ones), Communicating medical uncertainties, unknown disease, Crisis communication with the public and communities (advocacy), language barriers (more prevalent in emergencies, less time and contact, no relatives allowed, less staff, stress and anxiety).
Stress experience and wellbeing of Health Care Workers during the COVID-pandemic by Alexander Kreh and Barbara Juen
In his talk, Alexander Kreh was talking about the impact of working in a pandemic affected environment on stress experience and wellbeing of health care workers. There is lots of evidence for high risks to mental health of health care workers in the short and long-term after disease outbreaks, as studies from previous outbreaks (SARS-COV-1, Ebola, H1N1) and the current COVID-19 pandemic suggest. In several studies risk factors such as high exposition to patients, inadequate training, pre-existing health conditions and sociodemographic factors (female gender, young age, nursing staff) were identified.
In UIBKs own mixed methods study interviews and focus group discussions with health care workers are conducted accompanied by a longitudinal survey study with health care workers in German speaking regions. Qualitative analysis of interviews and focus groups in the first wave of the pandemic shows that moral distress and moral injury is a common and central outcome of this crisis in many healthcare workers. Furthermore, organizational justice as well as a flexible decentralized approach to leadership lead to more collective and organizational resilience during the pandemic. In the survey study results show significantly increased risk for depression as well as higher stress levels in health care workers over the course of the pandemic.
Despite better circumstances in spring 2021 (availability of vaccination, better knowledge and routine in patient care), stress levels remain high as compared to late 2020. Data suggests that the feeling of powerlessness with regard to the pandemic is decreasing while anger in increasing. Efficient interventions to support staff and volunteers need to be implemented many levels and works best if given by trusted mental health professionals or peers in a very basic manner integrated into the overall support by the management (trainings, information, frameworks provided).
Aggression, polarization and stigma against HCWs during COVID-19 by Barabara Juen, Alexander Kreh, Monika Stickler, and Michael Lindenthal
Barbara Juen gave input on the sensible topic of aggression, polarization and stigma against HCWs during the COVID-19 pandemic, During past disease outbreaks, healthcare workers (HCWs) have been stigmatized by members in their community, for fear that they are sources of infection.
In the Covid 19 Pandemic, due to the global impact and long durance other forms of aggression as well as polarization between HCWs and the public developed. Now in autumn 2021 we have a situation in Europe where in many European Countries (especially those with low vaccination rates) HCWs have to fight for their right to be heard. Studies suggest that HCWs are significantly more likely to experience COVID-19-related stigma and bullying, often in the intersectional context of racism, violence and police involvement in community settings.
Different views on Non-pharmaceutical measures have been prominent during the whole pandemic but especially vaccination has divided societies into different groups. In Austria in October 2021 around 65 % of the population were vaccinated with a big group of people needing the third dose. Since the beginning in September 21 infection rates have increased toward very high levels and the healthcare system is seriously endangered. Polarization grows. Patients come into hospital not vaccinated, additionally they start discussions with HCW about Covid not existing, this being just a normal lung infection etc. Lockdowns for non-vaccinated groups have been tried as a measure to „force“ people into vaccination. Obligatory vaccination for HCW will be decided. In some HCW this results in the view that they are not really taken seriously and that they are punished whereas the population can „afford“ to not being vaccinated and come into their care anyway.
Measures to face polarization need to be implemented on political level (Being heard, one voice, transparency, strong measures taken against the virus, „we“ messages, investment in training and resources, laws against violence in HCWs), organisational level (strong leadership and support for HCWs (organisational justice, relational and decisional justice), protective measures, de-escalation teams and –trainings) and team levels (Peer support, on scene support and training for heads of wards and personnel, protective measures).
“Remote Multiplayer VR Security Player”, Antoon Vandenhove, Security Coordinator at the Norwegian Red Cross,
presented a collaborative project between the ICRC and the Norwegian Red Cross on remote training on secure behaviour in the field.
One of the main elements that hinder the delivery of humanitarian assistance to people in need is insecurity. The most recent figures from the Aid Workers Security Report reveal that in 2020, 108 aid workers were killed during humanitarian operations. Training aid workers in order to enable them to prevent security incidents, or to know what the best possible action might be if faced by a security incident, remains therefore a must for every humanitarian organisation.
Organising in-person security training requires quite some logistics and is time and cost intensive. The Covid pandemic led moreover to the cancellation of most in-person courses as travelling between countries and continents became impossible or too troublesome. The ICRC and the Norwegian Red Cross embarked therefore early 2020 on a project to create a virtual reality (VR) security training, that can be played by up to five people simultaneously.
The VR simulation is an open ended story of people who gather to prepare for a fieldtrip, hit the road and encounter a checkpoint where they are stopped by a group of armed men. Here they must try to negotiate their safe passage. The VR simulation allows for up to five people and one facilitator to participate. The requirement is to have six VR headsets and suitable laptops with the necessary software. The people participating in the simulation can be anywhere in the world, provided that there is a good internet connection.
“’Damned if you do, damned if you don’t.’” by Nils Ellebrecht
In his presentation, Nils Ellebrecht (Centre for Security and Society, Albert-Ludwigs-University Freiburg, Germany) presented results from an international survey on security critical incidents. On the basis of different statistical analyses, he examined and outlined the normative forces behind the decision to help in these situations. The second part of his talk was centred on the study participants’ opinions whether or not bystanders are willing to help in security critical incidents and what help they would expect or demand from them. The subsequent discussion focused on the results on “bystander’s willingness”, which show strong differences between the participating countries.
Bertrand Liard & Alex Salehi (White & Case LLP, Paris): First Aider Liability: Surveying the Legislations Regarding Liability of First Aid Providers around the World
The first minutes of an emergency situation are critical. It is therefore important that any bystander able to help be not hindered from providing assistance for legal reasons. This is why law firm White & Case has, on request of the French Red Cross, prepared and drafted a report to survey the applicable legislation regarding liability of the first aider in jurisdictions around the world.
Our report shows that in a majority of the surveyed jurisdictions, the legal framework is lacking the certainty needed to prevent any legal risks for the first aider. We have noted that in most jurisdictions, despite some exceptions, there is no clear definition or standards regarding the definition of first aid notions, an uneven application of the duty to rescue, and a flawed liability regime applied to first aider. We have made some recommendations to allow stakeholders to advocate for more legal certainty and a more protective regime for first aider, to avoid any hesitation based on legal risk and encourage any bystanders to provide assistance in an emergency situation.
Further information can be found here: https://www.globalfirstaidcentre.org/resource/report-first-aider-liability-2020/
Jelle Groenendaal (Research Director, Hague University of Applied Sciences) presented the results from his study “Putting It All Together: Integrating Ordinary People into Emergency Response”.
“Ordinary citizens may play an important role in the response to large or even small-scale emergencies. This however is often not recognized in the emergency plans and procedures developed by emergency services. As a consequence, the help of ordinary citizens is often underutilized or even rejected by professional responders.
This article documents different ways in which ordinary people in industrial societies have taken part in emergency response to highlight the potential they bring to disaster response. It then suggests practical ways planners and professional responders can anticipate the assistance of ordinary people in the emergency response. These suggestions are partly inspired by the plans and procedures of the Amsterdam-Amstelland Safety Region, which are aimed at making better use of the competences of ordinary people during and after emergencies.”
Abstract taken from article: Joseph Scanlon, Ira Helsloot, Jelle Groenendaal (2014): Putting It All Together: Integrating Ordinary People into Emergency Response, in: International Journal of Mass Emergencies and Disasters 32/1, 43–63 http://www.ijmed.org/articles/649/download/
Inclusion and Exclusion of Volunteers at Disaster Response Operations by Roine Johansson (Risk and Crisis Research Centre, Mid Sweden University)
Roine Johansson presented results from an analyses published together with Erna Danielsson, Linda Kvarnlöf, Kerstin Eriksson and Robin Karlsson (2018): At the external boundary of a disaster response operation: The dynamics of volunteer inclusion, in: Journal of Contingencies and Crisis Management 26/4, 519-529. https://doi.org/10.1111/1468-5973.12228
Abstract: “In the present article, practices of inclusion of different types of volunteers in the response to a large-scale forest fire in Sweden are studied. Semi-structured interviews were conducted with three types of voluntary actors. The volunteers were organized to different degrees, from members of organizations and participants in emergent groups to organizationally unaffiliated individuals. Organized volunteers were the most easily included, particularly if they were members of voluntary emergency organizations. It was difficult for volunteers lacking relevant organizational affiliation to be included. Disaster response operations are dynamic, conditions change over time, and tensions between different modes, degrees, and levels of inclusion may arise. However, irrespective of changing conditions, practices of inclusion of highly organized volunteers work best.”
Caring for ELSA – Lessons learned throughout the RESIBES project by Linda Madsen (Centre for Care Research, University of South-Eastern Norway)
Integrating unaffiliated volunteers in relief organisations’ disaster response requires several ethical, legal and social aspects to be taken care of in order to mitigate the risks of what Ulrich Beck characterised as reflexive modernization: How do we prevent risky solutions when aiming for resilience and security? How do we make sure technical systems for integrating spontaneous volunteers are not vulnerable for infrastructure breakdown? How do we secure the pool of trained and loyal human resources of the formal organisations – “the backbone” of civil security – when possibilities for spontaneous engagement increase? How do we motivate people to contribute to future disaster response without creating fear? What position does prevention have in the current era of resilience?
Bystander Helping in Emergencies: Evidence from Public Assaults and Beyond by Lasse Suonperä Liebst (Department of Sociology, University of Copenhagen)
By analysing CCTV footage from different countries, Lasse Suonperä Liebst and colleagues have challenged the social-psychological paradigm that bystanders are unlikely to help another person in need. Lasse summarized their findings published in several recent articles and presented them during the workshop.
“Half a century of research on bystander behavior concludes that individuals are less likely to intervene during an emergency when in the presence of others than when alone. By contrast, little is known regarding the aggregated likelihood that at least someone present at an emergency will do something to help. The importance of establishing this aggregated intervention baseline is not only of scholarly interest but is also the most pressing question for actual public victims—will I receive help if needed? The current article describes the largest systematic study of real-life bystander intervention in actual public conflicts captured by surveillance cameras. Using a unique cross-national video dataset from the United Kingdom, the Netherlands, and South Africa (N = 219), we show that in 9 of 10 public conflicts, at least 1 bystander, but typically several, will do something to help. We record similar likelihoods of intervention across the 3 national contexts, which differ greatly in levels of perceived public safety. Finally, we find that increased bystander presence is related to a greater likelihood that someone will intervene. Taken together these findings allay the widespread fear that bystanders rarely intervene to help. We argue that it is time for psychology to change the narrative away from an absence of help and toward a new understanding of what makes intervention successful or unsuccessful.”
Abstract from: Philpot, R., Liebst, L. S., Levine, M., Bernasco, W., & Lindegaard, M. R. (2020). Would I be helped? Cross-national CCTV footage shows that intervention is the norm in public conflicts. American Psychologist, 75(1), 66–75. https://doi.org/10.1037/amp0000469
“Reducing Risk of Violence against Healthcare Workers” by Michael Bradfield
In the presentation, Michael Bradfield, a UK qualified paramedic with a background in prehospital trauma and resuscitation, now at the University of Southampton, addressed the issue of violence against healthcare workers, noting that reports have increased during the COVID-19 period, but this is certainly not a new issue. It exists in conflict and non-conflict settings, and the published literature focuses on thematic areas which include vulnerabilities to attack (healthcare visibility and emblems), efforts at mitigating attacks or effects and attempts to study the consequences of attacks. There is not a consensus as to whether conflict and non-conflict settings are broadly similar in causes or prevention strategies, which is an ongoing area of research.
Risk assessment, mitigation and a focus on prevention is something that all EMS can seek to achieve, and examples were discussed as to how pre-hospital services may utilise legal protection, public awareness, campaigns, personal protective equipment and body warn cameras. The work of the Norwegian Red Cross in creating a training manual to help services reduce risk was introduced, the Trainning Manual for Ambulance and Pre-Hospital Response in risk situations, with examples of how case studies can help illustration a risk assessment and management approach for providers and leadership teams.
“Health Care in Danger – Red Cross and Red Crescent: Experiences from Conflict and Crises”
The Norwegian Red Cross, represented by Kaja Sannerud Andersen, Senior Adviser Protection and Policy and Merit Asaad, Regional Health Care in Danger Delegate, Iraq, presented on the Health Care in Danger initiative, which is reaching its 10th year anniversary. The initiative, created to address growing humanitarian concerns around threats and attacks on health care, is a priority area of collaboration between the ICRC and the Norwegian Red Cross.
Attacks on health care are prohibited under international humanitarian law (IHL), but unfortunately happen too often both in conflict and crises, and in times of peace. When health facilities and personnel are attacked, whether targeted or indirectly, it has severe and often long-term consequences for the population they seek to assist. In situations of armed conflict, health systems may already be fragile, and violence and threats against health care may further deteriorate the ability to provide safe and quality services.
In addition to Red Cross Red Crescent Movement partners, the HCiD initiative includes a broader Community of Concern of health institutions, organizations, academia etc. around the world. Over the past decade, the initiative has developed a range of tools, recommendations and good practices through consultations, research and advocacy at local, national, regional and global levels. In the past few years, emphasis is placed on the implementation of practical measures to prevent and mitigate the impact of attacks. The presentation underlined the need for solid problem analyses to arrive at suitable measures, and acknowledged that global data and statistics are still weak.
As an example of such a practical measure, Ms. Merit Asaad presented experiences from Iraq, where the Norwegian Red Cross is supporting the implementation of a training manual on the de-escalation of violence, targeting hospital staff.