SCC-CIVIC-FA Track B: Participatory Action Research to Enhance Equity and Prevent Moral Injury in Community Paramedicine

社区辅助医疗(CP)已成为紧急医疗服务的重要组成部分，为精神健康危机提供非警察响应。社区护理人员暴露在具有挑战性的环境中，这可能会导致精神痛苦和伤害。这一工作范围需要注重公平的做法，以改善向无家可归、精神健康危机和成瘾的弱势社区成员提供关键服务的情况。该项目采用参与性行动研究方法，以防止国家方案第一反应人员的精神伤害，并改善他们在与弱势群体合作方面基于公平的理解和做法。这一合作努力由民间合作伙伴旧金山消防局、圣何塞州立大学和退伍军人健康管理局的研究合作伙伴领导，并与里士满地区多服务公司合作，旨在提高CP急救人员的福祉，同时改善对弱势社区成员的关键服务的公平提供。该项目的总体目标是加强CP工作，以改善旧金山居民的福祉，最终创造可持续的成果，可在美国范围内推广。这项研究旨在解决研究和创新中的两个相互关联的差距：道德伤害和公平。虽然每一个都是独立重要的，但我们的理论是，它们在一个自我放大的反馈循环中运作，由此目睹不平等会导致精神痛苦，并为精神伤害埋下伏笔。反过来，由于精神伤害和倦怠而导致情绪麻木和脱节的CP成员更有可能从事一些做法，这些做法虽然可能是无意的，但却通过对客户造成伤害来加剧不平等，而不是通过干预来减少差距。虽然关于退伍军人精神创伤和护士精神创伤的评估和治疗已有广泛的研究，但还没有关于评估、预防或治疗急救医务人员或护理人员的精神创伤或伤害的研究。也没有先前的研究来检验急救人员或护理人员公平培训的有效性。这项干预研究通过使用经过验证的量表评估精神痛苦和伤害，并为急救人员确定对客户和机构有意义的工作场所功能指标，填补了一个关键空白。有针对性的干预措施包括公平和道德对话、个人技能培训和公共教育运动，以在SFFD CP司内创造一个支持性和了解创伤的环境，并加强公平能力。我们将试行一种新的数据集成策略，以提高CP数据的完整性和准确性，以评估CP关键绩效指标中的差异。公民创新挑战是与能源部、国土安全部和国家科学基金会的合作。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

Community paramedicine (CP) has emerged as a vital component of emergency medical services, providing non-police responses to mental health crises. Community paramedics are exposed to challenging circumstances, which may lead to moral distress and injury. This scope of work requires equity-oriented practices to improve the delivery of critical services to vulnerable community members experiencing homelessness, mental health crises, and addiction. This project uses a participatory action research approach to prevent moral injury among CP first responders and improve their equity-based understanding and practices in working with vulnerable populations. This collaborative effort led by civic partner San Francisco Fire Department, research partners from San José State University and the Veterans Health Administration, and with collaboration from Richmond Area Multi-Services Inc., seeks to enhance the well-being of CP first responders while improving the equitable delivery of critical services to vulnerable community members. The project’s overarching goal is to strengthen CP work to improve the wellbeing of residents of San Francisco, ultimately creating sustainable outcomes scalable across the U.S. This study aims to address two interrelated gaps in research and innovation: moral injury and equity. While each is independently important, we theorize that they operate in a self-amplifying feedback loop, whereby witnessing inequities causes moral distress and sets the stage for moral injury. In turn, CP members who are emotionally numb and disengaged as a result of moral injury and burnout are more likely to engage in practices that, while likely unintentional, reinforce inequities by causing harm to clients, rather than intervening to reduce disparities. Although extensive research exists on the evaluation and treatment of moral injury in military veterans and moral distress among nurses, there has been no prior research evaluating, preventing or treating moral distress or injury among Emergency Medical Technicians (EMTs) or paramedics. There is also no prior research examining the effectiveness of training for EMTs or paramedics on equity. This intervention study fills a critical gap by evaluating moral distress and injury using validated scales and identifying indicators of workplace functioning for first responders that are meaningful to clients and agencies. The targeted interventions include equity and ethics conversations, individual skills training, and public education campaigns to create a supportive and trauma-informed environment within the SFFD CP Division and strengthen equity capacity. We will pilot a novel data integration strategy to improve completeness and accuracy of CP data to evaluate disparities in CP key performance indicators.The CIVIC Innovation Challenge is a collaboration with Department of Energy, Department of Homeland Security, and the National Science FoundationThis award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.