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

社区护理（CP）已成为紧急医疗服务的重要组成部分，为心理健康危机提供非警察反应。社区护理人员暴露在具有挑战性的环境中，这可能导致道德困扰和伤害。这一范围的工作需要以公平为导向的做法，以改善向面临无家可归、心理健康危机和吸毒成瘾的弱势社区成员提供的关键服务。该项目采用参与式行动研究方法，以防止CP第一反应者之间的精神伤害，并改善他们在与弱势群体合作时基于公平的理解和做法。这项合作由公民合作伙伴旧金山弗朗西斯科消防局、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第一响应者的福祉，同时改善向弱势社区成员公平提供关键服务的情况。该项目的总体目标是加强CP工作，以改善旧金山弗朗西斯科居民的福祉，最终创造可持续的成果可扩展到整个美国本研究旨在解决两个相互关联的研究和创新的差距：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回路中运作，目睹不平等会导致道德痛苦，并为道德伤害奠定基础。反过来，由于道德伤害和职业倦怠而导致情感麻木和脱离的CP成员更有可能从事这样的做法，即可能是无意的，通过对客户造成伤害来加强不平等，而不是进行干预以减少差异。虽然存在广泛的研究评价和治疗的道德伤害退伍军人和道德困扰的护士，有没有以前的研究评价，预防或治疗道德困扰或伤害的紧急医疗技术人员（EMT）或护理人员。也没有先前的研究检查EMT或护理人员公平培训的有效性。这项干预研究填补了一个关键的空白，通过使用有效的量表评估道德困扰和伤害，并确定对客户和机构有意义的第一反应者的工作场所功能指标。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活动，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，以提高清洁生产数据的完整性和准确性，以评估清洁生产关键绩效指标的差异。该奖项反映了NSF的法定使命，并通过使用基金会的知识价值和更广泛的影响审查进行评估，被认为值得支持的搜索.

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.