Q and A with Author Andrea Furgani

Q1. What drew you into research involving stress?
The inspiration for this research stemmed from a question that an EMD, one of the authors of the study, asked me. As she finished her shift, she asked, “Have you ever wonder if we make more mistakes in evaluating emergency calls when we work for longer hours? Because in my opinion…” Starting with that question, we planned and developed the study, involving all the Telecommunication Centers in our region [Liguria].

Q2. Your recommendations for decreasing stress as related to work hours. In other words, are your results suggesting shifts that do not exceed a designated number of work hours and/or mandatory breaks during the work shift?
It would be nice to have an answer to this question! Research suggests that EMDs perform better in the first three hours of their work shift and that there is a gradual and progressive deterioration in the following hours. In our center, the dispatchers don’t have fixed breaks during their shift. Therefore, it was not possible to test whether planned breaks would actually benefit them. I think it could be a topic for future research. It would be very nice to create an international multicenter study, perhaps coordinated by the Academy.

Q3. Interesting conclusion reached in the Montassier study regarding the increased duration of emergency calls coinciding with the length of the work shift. Does that suggest that EMDs are staying on the line longer, and why would that occur?
The duration of the call was not the subject of our study, but we are in possession of preliminary data that confirm this trend highlighted by Montassier. I believe that the intense use of technological systems and very tight work rhythms, typical of the emergency field, can explain, at least partially, this phenomenon in terms of accumulation of “fatigue” by the EMD.

Q4. The study was conducted pre-pandemic. Do you think the pandemic has resulted in a greater stress impact on EMDs?
I believe that the COVID-19 pandemic has had an incredible impact on all of us, both on our professional and personal lives. At work we have been overwhelmed by unexpected, and sometimes unsustainable, volumes of calls; in a very short time we have had to find new ways to handle the calls and radically change the way we operate. On a personal level, many of us have had to do without the love and support of our loved ones. To protect them from the possibility of infection, many health workers chose to stay away from their spouses, significant others, and children. I believe that all this has had, and will have, an enormous impact on us as health professionals and as human beings.

Q5. Are there factors that could mitigate the impact of stress on an emergency dispatcher, such as length of service?
This could also be an interesting area to explore in future research. In my experience, I don’t expect seniority to reduce stress; quite honestly, I expect the opposite. I firmly believe that only structured support from psychologists can provide effective help. We must move beyond the vision of “heroic” emergency services personnel and take into consideration the “human” one. This is the only way that performances and the well-being of the health workers can improve significantly and in a solid and continuous way.

Q6. Does the organization, as a whole, offer programs to help EMDs achieve a work/life balance?
The Clinical Psychology and Psychotherapy Service of our hospital (Policlinico San Martino Hospital in Genoa) provides support for the hospital workers. Since the beginning of the COVID-19 pandemic, this service has been strengthened through the implementation of group activities and telephone sessions. I believe it is an extremely important and valuable service. Once the pandemic is over, I think it will be essential to offer a structured and stable support service within the Emergency Services.

Q7. Your research is a shift from how stress affects the EMD personally to how stress affects their work performance. What prompted this fairly novel approach to stress studies?
We could summarize it with the idea, certainly not new, that organizations are made up of men and women. We could refer to Shopenhauer’s famous parable of the hedgehogs to understand how we should work to find “a moderate reciprocal distance” between the human element and the performance element typical of organizations. Many excellent studies have focused on the human side; we felt we had enough data and experience to explore the organizational/performance side.

Q8. Are the results something you anticipated, or were you surprised by what you found?
Of course, we wondered about the expected results. Personally, I expected a significant prevalence of undertriage as the hours of work went by, but I was proven wrong by the results of the study! But isn’t the beauty of research finding what you don’t expect?

Q9. Your suggestions for further research into this topic.
As I mentioned earlier in this interview, some future studies could focus on seniority or increased call duration. Personally, I would find it particularly exciting and interesting to study the effectiveness of any organizational steps or measures to reduce stress and improve performance. I believe that the EMDs could already provide solutions to this problem. Therefore, it is essential that they are directly and heavily involved in this process.

Q10. Your advice to help increase the research pool in topic of emergency dispatch.
Be curious, be enthusiastic, and always be willing to question our own certainties!
(In Italian) Essere curiosi, essere entusiasti ed essere sempre disposti a dubitare delle nostre certezze!

Andrea Furgani, EMS Physician and Responder

Andrea Furgani, MD, has been working as an EMS physician and responder at Genoa Emergency Medical Services, University Hospital of San Martino (Azienda Ospedaliera Universitaria “San Martino” U.O.C. “118 Genova Soccorso,”) since 2008. He is a member of the International Academies of Emergency Dispatch (IAED) Council of Research, as well as a certified Emergency Medical Dispatcher (EMD) and an Emergency Medical Dispatch Quality Specialist (EMD-Q). He is an accomplished speaker, instructor, public health consultant, researcher, and a regular peer-reviewer for AEDR. He lives with his wife and child in Genoa, on the Italian Riviera in the Liguria region of Italy.

Find Out More

For more information, read the entire paper:

Is There any Correlation between Over/Under Triage and Number of Consecutive Working Hours in the Emergency Medical Communication Center?
Andrea Furgani, MD; Giuseppina Contiero, EMD; Christopher Olola, PhD; Salvatore Esposito, MD;
Stefano Ferlito, MD; Fabio Ferrari, MD; Roberto Sanna, MD; Francesco Bermano, MD.

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