Table 1 Themes, descriptions, and example quotes 

Some events are inherently more stressful than others

There were certain features of events which led them to be more stressful:

  1) Events that were unexpected or involving obvious injuries. Both cultures have similar reactions to the same types of trauma. However, the type of event discussed varied between cultures:

    • In Saudi, participants seemed most impacted by car accidents

    • In the UK, participants frequently discussed the emotional impact of events including assault, violence, and family disputes

  2) Events threatening the safety of ambulance personnel. Both cultures discussed their concern over safety threats, but UK paramedics emphasized this theme more.

  3) Events involving vulnerable persons, such as children or the elderly. There were negative emotional impacts on child victims in both countries. Participants in Saudi Arabia reported being affected by events involving female victims

  • Traffic accidents are the worst effect on me, and the first accident I faced in my work was the worst one. (SA par 10)

  • I would say the family events are more stressful, and my worst one would be that a friend of my children got killed on a farm. (UK par 68)

  • The worst one was when my crewmate and I got attacked by a man with a baseball bat and my crewmate ended up with a fractured skull. (UK par 02)

  • The hardest event is car accidents, especially if the victims and injured are female because it is difficult to deal with them. They suffer from severe injuries, and at the same time, they do not want to be touch by a strange man. Therefore, I am compassioning with them. (SA par 11)

The pressure of organisational and interpersonal stressors

Organisational and interpersonal stress was described as significant, but the nature and type of this stress varied depending on the culture. Sources of stress in this theme included:

  • Pressure from colleagues such as bullying or unqualified/inexperienced partners

  • Organizational pressure such as lack of interest feeling to lose a job or being unprotected from infectious diseases

  • pressure such as unappreciation and disrespect from people

  • I find criticism by colleagues stressful because there is widespread bullying within ambulance services. (UK par 16)

  • The main management of the authority unfortunately, does not appreciate the work of the paramedic through some policies that apply to the paramedic. (SA par 44)

Convergence and divergence in cross-cultural coping strategies

This theme described the similarities and differences in coping strategies and distraction techniques across cultures

  (1) Cross-culturally used techniques:

    • Sport activities

    • Separating between work and private lives

    • Learning from other first responders

  (2)Culturally variable coping techniques:

    • Prayer and believing

    • Gambling

    • Drinking alcohol with family members or friends

  • I run quite a lot, so I find that's a really good way of sorting things out in my head. (UK par 02)

  • when I'm out of work, I close my phone and do not share my activities with colleagues to forget all the daily events I've been through. (SA par 05)

  • I knew this strategy from a colleague who works police officer, and as you know, he faces similar cases as I do, and told me that if you have any emotional problems at work do not keep that issue inside your mind, you must speak other about what you faced because you will psychologically suffer. (SA par 11)

  • Yes, the praying, I use it a lot because when I am uncomfortable with something wrong in my work, or in my life, I prepare to pray. I feel a wonderful comfort even if nothing happens in the subject matter that made me worry because I believe that my God, will guide me to solve this problem. (SA par 14)

  • I typically find gambling is a good distraction technique as well, so I would sometimes go and just put bets on and just relax for an hour or so. (UK par 14)

  • I find after the event I will typically try and distract myself. So, there's been times where I've asked family members to go for drinks out just to distract myself, get into a different environment other than the normal home that I come back to. (UK par 14)

Preferring formal and confidential support

This theme explains the preferences of paramedics regarding the support they would like to help them cope with potentially traumatic work events. Their preferences were for:’

  • Formal support or intervention

  • Individual support

  • The official intervention feels me that I am under the attention of Red Crescent as a staff member in all psychological and educational aspects. This thing gives me more motivation in my work performance and in everything around me. (SA par 05)

  • Probably individual treatment I would choose. I think I just feel more comfortable speaking to just one person who would probably understand. I think I'd be more open with him rather than in a big group. I think I'd struggle to speak freely in a big group. (UK par 56)