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，这可能导致道德上的痛苦和伤害。这一工作范围需要以公平为导向的做法，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的关键服务。本项目采用参与性行动研究方法，防止CP急救人员的道德伤害，并提高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伙伴领导，并与里士满地区多服务公司合作，旨在提高急救人员的福祉，同时改善向弱势社区成员提供关键服务的公平程度。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，最终创造可在全美推广的可持续成果。这项研究旨在解决研究和创新中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，但我们认为它们在一个自我放大的反馈循环中运作，即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，由于道德伤害和倦怠而在情感上麻木和脱离的CP成员更有可能参与一些可能是无意的做法，通过对客户造成伤害来加剧不公平，而不是干预以减少差距。虽然对退伍军人道德创伤和护士道德痛苦的评估和治疗有广泛的研究，但对急救医疗技术人员道德痛苦或道德伤害的评估、预防和治疗尚无研究。也没有先前的研究检查培训的有效性急救医生或护理人员的公平。这项干预研究通过使用有效的量表评估道德痛苦和伤害，并确定对客户和机构有意义的第一响应者的工作场所功能指标，填补了一个关键的空白。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整合策略，以提高CP数据的完整性和准确性，以评估CP关键绩效指标的差异。公民创新挑战赛是能源部、国土安全部和国家科学基金会的合作项目。该奖项反映了美国国家科学基金会的法定使命，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.