The application of cross-cultural research in emergency service work-trauma

Abstract

Work-trauma, conceptually related to post-traumatic stress disorder (PTSD), can impact general pathology as well as traumatic reactivity. Whilst usually associated with the emergency services, work-trauma occurs in all personnel repetitively exposed, as part of their job, to actual or potential traumatic incidents (such as fatalities, serious injuries, fires, riots, harassment, shooting incidents, rape incidents etc.). The (limited) understanding of work-trauma is essentially predicated on mono-cultural (North American) data and approaches. Although a useful start, this does not accommodate underlying cultural differences. It is argued these differences fundamentally impact reliability. Two approaches are used here to begin the application of cross-cultural factors to work-trauma: 1. Using sources based on Hofstede's cultural differences in individualism/collectivism, masculinity/feminism, power distance, and uncertainty avoidance, a link is established with certain stages of the eco-systemic model of traumatic reaction (Peterson et al, 1991). 2. A detailed review of the emergency service environment including examination stressors, call-out rates, and general pressure to perform as well as broader social differences in economic conditions, working hours, quality of life and several other factors quantifies the extensive differences researchers need to acknowledge. Using unique data from three cultural settings (Japan, Hong Kong and the UK), preliminary analysis suggests nine variables consistently associate with work-trauma symptomatology: age, child-bearing status, usual alcohol consumption, change in alcohol consumption, exercise frequency, social support from a partner, social support from a close friend, contemplation of counselling, and action on counselling. When applied to a model, however, cultural variations in were large. This begins to suggest diverse cultural experiences are impacting work-trauma. Although phenomena such as resistance to counselling, the 'macho ethic' and alcohol habits within the emergency services are - as expected - culturally consistent, this is in itself inadequate for understanding work-trauma. At a theoretical level, researchers need to further explore the documented aspects of the emergency service and social environments with a view to developing instruments which measure cultural diversity. At a practical level, given the culturally consistent alcohol habits in emergency services, future researchers should consider the use of emergency service personnel as front-line diagnosticians of work-trauma. Counselling needs are assessed in this light.