A pre-emptive resilience program called Finnish Sisu Training to improve prehospital work performance

INTERVENTION: The study enrolled 16 paramedics. Eight of them were signed to the intervention group and eight in the control group respectively. The randomization was done by the local EMS work shift co‐ordinator to two groups consisting of two teams each. The work shift coordinator otherwise took no part in the study, did not know the study design and had no Finnish Sisu Training nor iPREP training. The intervention group received 16 hours of Finnish Sisu Training, which included core components such as: 1. Education about the physiology of the stress response system, energy management, and fuelling for peak performance 2. Group instructions on how to use mental focus and visualization to enhance sensory perception and situational awareness in performance and non‐performance settings 3. Instruction and use of biofeedback to practice engaging in controlled breathing exercises that have been shown to enhance central nervous system control during stress 4. Education of cognitive biases affecting work performance 5. Education of cognitive biases during stress The control group had no prior training but instead kept with their normal daily routines. After the intervention group received Finnish Sisu Training all study participants took part in three full‐scale simulations in subsequent days. These simulations were designed to enhance stress. Physiological measures (maximum heartbeat, heart rate variability and respiratory rate), self‐evaluation and outside observers using structured evaluation forms were recorded. In each simulation four paramedics took part who were either in the intervention group or the control group. The study group were not mixed during simulation scenario interventions. The study results were then analysed and compared. The control group received the training CONDITION: Work performance of prehospital personnel ; Not Applicable PRIMARY OUTCOME: 1. Situational awareness measured using observer form. In the observer form there are five statements each worth 1 point, receiving a maximum of 5 points. Timepoints: From the start of each simulation scenario (team arriving on scene) until the simulation scenario ends.; 2. Decision‐making skills measured using observer form. In the observer form there are five statements each worth 1 point, receiving a maximum of 5 points. Timepoints: From the start of each simulation scenario (team arriving on scene) until the simulation scenario ends.; ; 1. & 2. Primary outcomes studied in combination receiving a maximum of 10 points. INCLUSION CRITERIA: 1. Aged 18 years or older 2. Paramedics with 3 years of work experience or prehospital physicians with at least 1 year of field experience SECONDARY OUTCOME: 1. Self‐evaluation using a Likert scale self‐evaluation form. Timepoints: Before the actual simulation scenario starts and immediately after the simulation scenario has finished, but before the defusing session starts.; 2. Recovery after each simulation scenario measured using the Firstbeat Life device, which recorded the participant's physiological parameters via two electrodes detached into the study participant’s torso: For recovery only heart rate variability (HRV) was compared. The physiological measurements are sent via Bluetooth connection into the participants' phone app and to the lead researcher's computer’s specified Firstbeat life webpage.Timepoint: Each defusing session starting after a simulation scenario has ended and self‐evaluation and respiratory rate counting has been done by the observer.; 3. Maximum heart rate during each simulation scenario measured using the Firstbeat Life device and the lead researcher’s computer.Timepoints: From the start of each simulation scenario (team arriving on scene) until the simulation scenario ends. ; 4. Respiratory rate measured using manual counting by the observer before and after each simulation scenario. Timepoints: Before the actual simulation scenario starts and immediately after the simulation scenario has finished, but before the defusing session starts.; 5. Heart rate variability (HRV) measured during each simulation scenario using the Firstbeat Life device and the lead researcher’s computer. Timepoints: From the start of each simulation scenario (team arriving on scene) until the defusing session ends.; ; Timepoints of when the simulation scenario started and ended with each study team as well as when defusing sessions started and ended were recorded and compared with Firstbeat life timeline results.; ; Primary and secondary outcomes were measured in all three simulation scenarios separately and compared with study groups; Simulation 1 comparison of intervention group vs control group outcome results; Simulation 2 comparison of intervention group vs control group outcome results; Simulation 3 comparison of intervention group vs control group outcome results