Running head: LONG-TERM RESPIRATORY DISORDERS Long-term respiratory disorders among World Trade Center Healthcare Providers 1 2 LONG-TERM RESPIRATORY DISORDERS Introduction to the problem Over time there has been tremendous growing concern regarding the health effects arising among survivors and healthcare providers from the 9/11 attacks in the United States Financial District of Lower Manhattan. It is recorded that within a matter of seconds after the collapse of the huge World Trade Center, many foreign objects, building materials, furniture and electronic equipment were pulverized and all spread to over the area. The healthcare providers of this famous New York City terrorist attack are said to be suffering from an increased long-term respiratory disorder. This includes asthma as well as other related lower respiratory diseases such as lung cancer almost two decades after the terrific attack. It is understood that when providing healthcare services, the healthcare providers were either exposed to unlimited dust cloud or acquired physical injuries in the course of the tragic attack on the World Trade Centre. According to Injury Epidemiology journal, these physical injuries and exposure to dust cloud may be the major cause of the increase long-term risk of contraction to respiratory diseases such as asthma, among other respiratory diseases. This study seeks to establish the long-term respiratory disorders suffered by the World Trade Center Healthcare providers. This group of disaster responders represents a highly exposed population since they were the first responders. This study will report findings from research interviews as well as from the available literature regarding the 9/11. Furthermore, this research will include data relating to persistence and severity of long-term respiratory disorder among the healthcare providers. Background 3 LONG-TERM RESPIRATORY DISORDERS The famous 9/11 terrorist attacks on the New York City-based World Trade Center, exposed thousands of healthcare provides alongside other rescue mission workers on the scene to dust. This has later be associated with causing a handful of respiratory disorders such as asthma, but not limited to significant declines in lung function in the first year, among most 9/11 healthcare providers. This highly tragic attack on US leading trade center immediately left 2751 people dead among whom included 343 workers that were the US and most specifically the Fire Department of New York City rescue team (Jordan, et al. 2015). Most deaths at the scene of the attack were caused by severe physical injuries caused by the falling debris of the building, fire and suffocation (Friedman, et al. 2016) Most the healthcare providers just like other rescue teams were exposed to a dense, persistent dust cloud that comprised of pulverized building materials as well as hazardous chemical by-products of pyrolysis and combustion. The healthcare providers were in the scene of the World Trade Center attack for nearly ten months which was sufficient enough to expose them to many health hazards during and after the mission. The attack consequences among the healthcare providers are known to include substantial loss in these physicians pulmonary function within the first year immediately after the World Trade Centre attack. This is a record score in relation to pulmonary fail or loss as it noted to be more than 12 times the yearly ageassociated pulmonary loss rate. In addition, the highest long-term respiratory disorders were observed among healthcare providers who got to the scene of the attack on the same morning. Furthermore, both the healthcare provider as well as many rescue mission workers and volunteers as well as residents of lower Manhattan that were exposed to dust cloud from the World Trade Center registered abnormal results on spirometry that persisted in the course of a three-year follow-up. Moreover, 4 LONG-TERM RESPIRATORY DISORDERS a research done at the New York City Department of Health and Mental Hygiene indicates that healthcare providers who were exposed to the pulverized dust cloud or suffered physical injuries or both in the course of the attack are witnessing a continued growth respiratory disorders nearly two decades later. The most common long-term respiratory disorders among the 9/11 healthcare providers are sarcoidosis, asthma, pneumonia and granuloma pneumonitis. Research questions This research will be guided by the following research questions: 1. What are the long-term respiratory disorders of the World Trade Center Healthcare providers? 2. What were the major causes of the long-term respiratory disorders among World Trade Center Healthcare Providers? 3. What measures have been put in place to control long-term respiratory disorders among World Healthcare providers? Research methodology Delimitations and limitations This research study is delimited to a World Trade Center Healthcare providers. The rescue mission at the World Trade Center comprised of more than 60,000 professionals from different teams. All these teams were equally exposed to same working condition thus concentrating on one team could give a generalized representation of the long-term respiratory disorders among the people involved in the 9/11 rescue mission. In addition, the long-term 5 LONG-TERM RESPIRATORY DISORDERS respiratory disorders are delimited to World Trade Center Healthcare providers. Furthermore, in this research, the research interview and healthcare condition will only be done on the available World Trade Center Healthcare providers. The significance of the study. This study will greatly contribute in adding to the knowledge about long-term respiratory disorders among people engaged in hazardous rescue missions. The study will add literature knowledge to the area or field of healthcare providers in rescue practices that had previously been overlooked. In addition, the study will check on the major long-term respiratory disorders research findings among World Trade Center Healthcare providers on other studies. The research study will as well determine the trends of long-term respiratory disorders over time among the World Trade Center Healthcare providers. Furthermore, the study provide the society with an incentive on how to best equip the healthcare providers in the future rescue mission to avoid repeating the same mistakes. The study will as well be critical to the healthcare education area as it will add to the existing literature and recommend a future area of study. Literature review Long-term Respiratory Disorders The long-term respiratory disorders on healthcare providers’ subsequent to the World Trade Center attack include Asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic, Bronchitis, Lung Cancer, Cystic Fibrosis/Bronchiectasis, and Pneumonia. Asthma is a chronic respiratory status which results in breathing challenges as a result of inflammation of the airways (Ferkol, & Schraufnagel, 2014). Among the World Trade Center Healthcare providers, Asthma 6 LONG-TERM RESPIRATORY DISORDERS can be described from the presence of the following symptoms: wheezing, dry cough, chest tightness and shortness of breath as indicated in the graph below. Source: Moline (2017). Asthma is associated with environmental allergies. The allergic reactions, infections as well as pollution can all be a major cause of an asthma attack. In addition, most of the healthcare providers at World Trade Center attack were found to have breathlessness respiration condition. This is a condition known as obstructive pulmonary disorder as a result of the patient failing to inability to exhale normally. Most of the World Trade Center health care providers exhibited this effects of this disease through symptoms that constitute shortness of breath as well as a cough up sputum especially in the morning. However, it was not easy to identify the people affected with this respiratory disease because its symptoms 7 LONG-TERM RESPIRATORY DISORDERS are largely mistaken for the normal person gradual aging process and body deterioration except for the very young health care providers. Pneumonia was also a common disease among the World Trade Center health care providers within the first year after the rescue mission. The disease is lung disease that results from an infection in the lungs air sacs. Typically, these infections are either bacterial, viral or fungal. For some healthcare providers, pneumonia was identified and treated with patients recovering within three weeks, however, there was a significant number of healthcare providers who extremely serious pneumonia condition that even threatened their life. Pneumonia is known to greatly affect the very young as well as old people. Its symptoms include high fever, cough, shaking chills as well as breathlessness which can either be mild or severe. Causes of long-term Respiratory Disorders The 9/11 rescue workers significantly worked under dense, persistent dust cloud that comprised of pulverized building materials as well as hazardous chemical by-products of pyrolysis and combustion. Dust and fumes from combustion as well as hazardous chemicals are known to pollute the air and cause breathing difficulties. Typically, congenital anomalies of along the respiratory tract are known to be rare but they do happened. They can be described as the major causes of respiratory disorders. This is because they are known to cause upper respiratory tract resulting in exudation of neutrophils, macrophages, and fluids), or erosion and ulceration of the nasal mucosa. The malfunction can be as a result of viral, bacterial, fungal, or parasitic agents, as well as hypersensitivity reactions. These may include localized allergies and anaphylaxis as in the case of asthma. During the 9/11 rescue mission, the air was highly polluted with dust particles 8 LONG-TERM RESPIRATORY DISORDERS that are largely associated with carrying allergies reactants that cause asthma. Dust and foreign particles in the air have as well-being a great contributor long-term respiratory disorders. For instance, Sarcoidosis a respiratory disease among the World Trade Center health care providers was as a result of Dust Exposure. The existing literature review elevates levels of sarcoidosis among firefighters in the attack and associates it with dust particles. Furthermore, there are other research findings that have reported sarcoidosis cases among rescue workers and they also relate it to Ground Zero dust exposure. In addition, York City health department also confirmed that dust exposure from the disaster contributed to a sarcoidosis death. Over the past 10 years, there has been an average of 32 sarcoidosis deaths annually from the World Trade Center rescue workers. Furthermore, there have also been an average of 362 and 439 sarcoidosis-related hospitalizations annually in New York City. Moreover, the cancer cases suffered by various 9/11 healthcare providers can be associated with inhalation of beryllium as well as other metal dust and fumes or pulverizing materials. Measures to Control Long-Term Respiratory Disorders Basically, the interventions measures of different respiratory disorders suffered by healthcare providers are usually costly and sometimes ineffective in reducing or avoiding premature deaths. As such, such these respiratory diseases can be can be best managed through preventive as well as therapeutic strategies which are associated with greater societal effect as opposed to the actual management of the respiratory disorders manifestations as they arise in people. Therefore, the best preventative measure for respiratory disorders is to rollout vaccination schemes so as to reduce the burden of respiratory diseases as opposed to individual management of community-acquired pneumonia as well as and respiratory chronic diseases (Frank et, al. 2010). In addition, the main prevention plans constitute of efforts by multiple 9 LONG-TERM RESPIRATORY DISORDERS government agencies as well as the society coming together to develop appropriate priorities for action. According to Royal File Saving (2018), nearly every year, approximately five people happen to lose their lives while attempting to rescue someone in trouble. This is usually not the aim of any rescue mission regardless of its magnitude. As such Loyal Life Saving (2018), note that despite the status of the current condition the rescuer personal safety should remain paramount in any rescue situation. As such, rescuers are advised to be aware of facts such as that people in difficulty are often in a state of panic and can very easily drag the rescuer underwater in their attempt to stay afloat. Furthermore, Loyal File Saving (2018), recommend that any rescuer should first assess the reason why the person is in trouble. This could help in developing a good strategy on how to get them out of danger without risking your life. This is, however, difficult in some scenarios such as the one for 9/11. Loyal Life Saving recommend that rescue teams need to be well informed, well equipped and thoroughly trained and united. In relation to terrorist attacks or any tragic happening, the bodies or agencies responsible for managing people that provides rescue missions should adhere to safety measure of their workers. To start with, the medical officers should be subjected to thorough safety training prior to any deployment to rescue missions. This would help the rescuers to care for their safety even as they seek to rescue others. In addition, to prevent inhalation of dust particles during rescue missions, some research study recommend that rescue team should be equipped with protective gears for hands, body, face, head, eyes, and nose. This has been found to be quite effective in people that work in hazardous areas such as mining, firefighting as well as in hospitals. 10 LONG-TERM RESPIRATORY DISORDERS References Ferkol, T., & Schraufnagel, D. (2014). The global burden of respiratory disease. Annals of the American Thoracic Society, 11(3), 404-406. Frank E. Speizer, Susan Horton, Jane Batt, and Arthur S. Slutsky. (2010). Disease Control Priorities in Developing Countries. 2nd edition. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11773/ Friedman, S. M., Farfel, M. R., Maslow, C., Jordan, H. T., Li, J., Alper, H., ... & Brackbill, R. M. (2016). Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster. Occup Environ Med, oemed-2015. Jacqueline Moline, (2017). Advances in the Screening and Treatment for WTC Responders and Survivors - WD2813 Jordan, H. T., Stellman, S. D., Reibman, J., Farfel, M. R., Brackbill, R. M., Friedman, S. M., … Cone, J. E. (2015). Factors associated with poor control of 9/11-related asthma 10–11 years after the 2001 World Trade Center terrorist attacks. The Journal of Asthma, 52(6), 630–637. http://doi.org/10.3109/02770903.2014.999083 Loyal File Saving (2018), Rescue Safety, Self-Preservation is the key in any rescue. Retrieved from https://www.royallifesaving.com.au/families/out-andabout/activitiesequipment/rescue-safety 11 LONG-TERM RESPIRATORY DISORDERS Running head: HELP-SEEKING TENDENCIES Help-seeking Tendencies of Medical Practitioners Facing Trauma Name Institution 1 HELP-SEEKING TENDENCIES 2 Contents Abstract ............................................................................................................................... 3 Background ......................................................................................................................... 4 Purpose of the Study ........................................................................................................... 5 Objectives ........................................................................................................................... 6 Hypotheses .......................................................................................................................... 6 Literature Review................................................................................................................ 7 Theoretical Approach.......................................................................................................... 8 Methodology ....................................................................................................................... 9 Data Collection ................................................................................................................ 9 Data Analysis ................................................................................................................ 12 Validity and Reliability ..................................................................................................... 13 Significance of the Study .................................................................................................. 14 Limitations and Delimitations........................................................................................... 14 Conclusion ........................................................................................................................ 15 Acronyms and meanings of words................................................................................. 15 References ......................................................................................................................... 16 Appendix A ....................................................................................................................... 18 HELP-SEEKING TENDENCIES 3 Abstract The occurrence of disasters in the country and around the world is common and it highly relies on the medical practitioners and rescue workers to respond effectively to such incidences. While the primary victims are given much emphasis, little effort is accorded in realizing the trauma and psychological distress that second victims that are the responders go through. This research proposal presents the guidance to the research regarding how those practitioners seek help and whether it helps them. It is based on the hypothesis that help-seeking tendencies are limited and most of the results produced are unsatisfactory. This research proposal presents a justification for carrying out mixed-methods research into the help-seeking tendencies of health providers and the effects they have on them. HELP-SEEKING TENDENCIES 4 Help-seeking Tendencies of Medical Practitioners Facing Trauma Healthcare providers, in the face of disaster, are arguably the most relied-on personnel alongside rescue workers. Whether the medical personnel attends to victims of isolated accidents or large-scale disasters such as hurricanes, they face an extremely difficult time, especially if the number of victims is high. Handling this pressure as well as the traumatizing experiences of people in critical conditions hurt the practitioners’ mental health and thus affects their well-being as well as their jobs. This concern has received much attention from researchers and thus has led to several research efforts that allowed them to understand the mental issues that medical practitioners face in the time of disaster. However, little research has been dedicated to the coping strategies of these practitioners and their effectiveness in relieving stress and psychological issues among them. It is, therefore, crucial, to understand the help-seeking trends and results of medical personnel who undergo traumatizing experiences attending to victims of disasters. Background The issue of mental distress in healthcare workers has been highlighted in many previous studies. Often, researchers review how health providers are affected by such events. For instance, Routsalainen et al. (2015) claim that every huge disaster such as the hurricanes has a distressing effect on the healthcare providers who are involved with the victims of the disaster. Furthermore, it is not only the catastrophes that cause such mental distress. The smaller disasters such as car accidents or manmade disasters such as mass shootings also cause mental distress on the healthcare providers. An example of such a disaster is the Las Vegas shooting which claimed the lives of around 50 people including the shooter. In such an incident, respondents face a crisis whereby they have to rescue many people at once and also attend to fatal wounds. Even worse, they witness some of the survivors die when in medical care. HELP-SEEKING TENDENCIES 5 Other than the recognition of the existence of such distress, it has also been established that the occurrence of such disasters is high around the globe. Therefore, it is highly likely for a healthcare provider to face such disasters in their workplace. For instance, Kahn (2005) claims that natural disasters kill more people in impoverished countries than in developed ones despite an insignificant difference in the number of disasters. These costs account for issues such as tornadoes and hurricanes and floods as well. These statistics are exclusive of human-made disasters such as shootings and accidents. Therefore, it is already established that disasters happen all the time and thus health care providers may be increasingly exposed to such in their responses. Although many researchers have delved into analyzing the cost of care and the effects that the psychological effects of traumatizing catastrophes have on the healthcare providers, little research has been done on the help-seeking tendencies of the providers in the care for the psychological and emotional problems that they may develop due to the exposure to these disasters. Therefore, there is a gap in research whereby the follow-up on the apparent aftermath of the psychological distress is missing. Therefore, researchers have failed to identify whether healthcare providers effectively seek treatment and help regarding the trauma and psychological problems they may encounter during the response to these disasters. This research proposal, therefore, aims to engage in research that will illuminate the aftermath of healthcare providers after enduring stress and psychological issues due to the exposure to the traumatic disasters and catastrophes. Purpose of the Study The study aims to establish the trend of medical practitioners seeking psychological support after attending to emergency patients in traumatizing conditions. Some of these patients are patients brought in after fatal accidents, fire incidents, and other patient-deforming incidences HELP-SEEKING TENDENCIES 6 that can cause trauma to the medical physicians. Furthermore, the research aims to find out the satisfaction rates of those practitioners who seek psychological support and help after the traumatic experiences. To accomplish this purpose of the research effort, the following questions will act as the guiding research questions: 1. What extent of the psychological effects befalls medical practitioners who tend to patients in traumatizing conditions? 2. Do healthcare providers seek professional help after facing a disaster? 3. Does providing psychological evaluations post-disaster response reduce stress levels in healthcare providers? Objectives The first objective of the study is to identify whether medical practitioners get stressed by and after treating patients who are in traumatizing shapes; for instance, survivors of fire incidents and car accident survivors. Secondly, the research will seek to understand whether medical practitioners who are affected by stress or mental disturbances due to such treatment instances seek professional help from psychotherapists. Also, the research will also seek to find out whether those practitioners who go into therapy get any help, and if so, if they believe that the help they get is satisfactory. By satisfactory, the implication is that the levels of stress are eliminated or considerably reduced in the physician’s lives after therapy. Hypotheses Very few medical practitioners seek help after tending to patients in traumatizing conditions. This is because they are caught up at work and they cannot get sufficient time out of duty for treatment and therapy. Also, most medical practitioners who go for therapy might find it helpful because they understand its value, but the situation is more likely to occur again because they will meet patients in such situations afterward. These hypotheses are considered at the HELP-SEEKING TENDENCIES 7 beginning of the research and the study will aim to credit or discredit them. Essentially, the research will allow researchers to understand the frequency and effects of help-seeking tendencies among healthcare providers who face difficult times with victims of disasters. Literature Review Papadatou, Anagnostopoulos, and Monos (1994) researched on mental health concerns in medical practitioners. They realized that medical practitioners who responded to fatal emergency patients, more especially in first aid, were more vulnerable to mental disorders. Moreover, other than the incidence of mental health concerns it is identified that children victims pose the greatest impact on medical practitioners. Crabbe, Bowley, Boffard, Alexander, and Klein (2004) researched on the stress exposure and coping with staff working in the emergency department. They were mainly interested in evaluating how medical practitioners who treat patients from car accidents and other fatal accidents react to stress caused by the conditions of the patients. Other medical physicians also mentioned fire victims, and sexual assault victims were also extremely traumatizing duties. Only 38% of staff who made the population for the study mentioned that they had not experienced any form of trauma. Female nurses were found to have the highest score in consideration of the level of trauma (Crabbe et al., 2004). However, this is insignificant because the study was completed in South Africa where being a nurse is almost equal to being a female. The rest had experienced at least one type of traumatizing case. In this case, practitioners sought help from their fellow health care providers through normal workplace sharing and socialization. In another study, 50% (536) of personnel in a healthcare center admitted having played a role in the rescue and treatment plans of the 300 injured victims, and the collection of 29 bodies of the victims who died in the bomb incidence. High PTSD levels were recorded for the participants who were involved in ambulatory services. None of them reported having gone to HELP-SEEKING TENDENCIES 8 seek any professional support after the traumatizing duty (Luce, Firth-Cozens, Midgley, and Burges, 2002). Furthermore, when researching the effectiveness and efficiency of psychotherapy, Ko, Ford, Kassam-Adams, Berkowitz, and Wilson (2008) present research into the effectiveness of psychotherapy on medics dealing with disaster victims. The research found out that emergency responders do not get exactly what they want during therapy, at least not 90% of them. Only 10% confessed that the models embraced by the psychotherapist work effectively on their stress (Ko et al., 2008). The research already performed on the topic guides that it is probable that most medical practitioners do not seek help or do not find the services they find very helpful to their situations. It is, therefore, necessary to carry out further research on the topic to compel the relevant authorities to take action regarding the response to the second victims in the face of disaster. Theoretical Approach Several theories relate to disaster response and recovery in the context of healthcare. This section of the proposal focuses on the theoretical background that this study will apply in researching the particular issues of attention. Therefore, the theory of stress and psychological well-being of healthcare providers after responding to disasters will be highlighted. The essence of knowing the theory that will apply is to acknowledge that the research will be based on preceding theories which are applicable in real life. That way, the research will have a solid foundation that it will be based on rather than utilizing speculations to carry out the research. The theory that inspires this research is the cognitive psychological theory. First, this theory focuses on determining the psychological processes that people engage in based on their thought processes, decision-making, and behavior. According to Neisser (2014), the translation of theoretical approaches to behavior can be effectively based on the cognitive effects on an individual’s behavior and efficiency in the workplace. Therefore, the research focuses on using HELP-SEEKING TENDENCIES 9 this theory to outline how the experiences of the respondents could have affected their thinking processes and their emotions thus leading to patterns of behavior. This connection between the thinking patterns and the behavior of the research population if efficient and corresponds to the cognitive psychological approach that inches on the need for a connection between thoughts and actions. Methodology This section of the research proposal focuses on the proposed methods that will be used in the research process to obtain answers from the research participants. It handles the data to be collected, the research design, data collection methods, and also the analysis of the data as well. The researcher intends to employ a mixed-methods approach to the study for a comprehensive understanding of the issues portrayed in this study. The mixed methods research, according to Creswell (2017), allows one to get an overview of the situation on the ground as well as the feelings and attitudes of those involved in it. Essentially, using this approach in this research will allow the researcher to understand the issue of dealing with traumatic experiences from a statistical as well as experiential point of view. It is thus deemed the best approach to this research since it will avail information in different dimensions to satisfy the purpose of the research. Data Collection As identified that mixed methods research will be applied, data collection will thus be based on the researcher’s ability to obtain both qualitative and quantitative data. First, the quantitative research approach will be applied. In this approach, a simple statistical approach will be used to obtain the data. Participants in the study will be obtained from five Level I and Level II centers in different cities that have been affected by catastrophes in the past. This site for the research is efficient in that it will allow the researcher to easily access research participants who HELP-SEEKING TENDENCIES 10 fit the criteria for research validity and reliability. According to Ejeta, Ardalan, and Paton (2015) health care facilities in the disaster areas where huge disasters have been experienced in the past are likely to have more professionals who are facing psychological distress or at least faced it at one point in their careers. Therefore, the undisclosed locations of research, having been hit by heavy natural and manmade disasters, form the best locations for data collection. The quantitative research approach to the study will precede the qualitative research mainly because of the need for the statistical count of the respondents who qualify for the qualitative research. In the quantitative research approach, the main aim will be to find out how many healthcare practitioners have sought care after a traumatizing experience with disaster victims. Osborne, Thomas, and Forbes (2010) claim that a considerably huge number of research participants in issues of disaster response are willing to share their experiences. Therefore, getting the number of participants who have sought help due to the trauma will set the stage for the second part of the research which is the qualitative research. In this study, the participants will be asked if they encountered traumatizing events due to disasters and whether they sought psychological help after they encountered those issues. Furthermore, the researchers will be asked to subjectively state whether they felt that any help they sought helped them. This research approach will allow the researchers to come up with a statistical figure that describes the fraction of participants which has encountered the disaster. The results of the quantitative research will be classified into several categories. First, a category of the number of healthcare practitioners which has faced traumatizing experiences due to disaster will be obtained from the research. The number will allow the researcher to understand the frequency of dealing with traumatizing events due to disaster. Secondly, the number of practitioners that sought psychological help among those who faced trauma will also HELP-SEEKING TENDENCIES 11 be obtained. This fraction will be a derivative of the first statistical result. On the third step of the research, the number of practitioners who subjectively state that their problem was solved by seeking help will also be obtained. From these three levels of research results, the statistical analysis will reveal trends in the healthcare sector. Beyond this preliminary quantitative research, the qualitative research study will be conducted. This research approach is the more crucial of the two mainly because it will evaluate the experiences and attitudes of research participants in the aftermath of traumatizing events. Scott et al. (2009) explain that healthcare practitioners become second victims when caring for trauma patients and thus they are either directly or indirectly affected by those events as well. The qualitative approach will provide a chance to the second victims to express themselves regarding how they sought care and if not why they did not. These qualitative narratives provide an opportunity to the researcher to understand underlying attitudes towards help-seeking behavior among healthcare providers as well as their attitudes, constraints, and effects due to the different courses of action. The qualitative research will inquire why and how medical personnel sought help with psychological issues that they faced after dealing with victims of a disaster. The typical research questionnaire will include two sets of research data including quantitative and qualitative research questionnaires. The second (qualitative) questionnaire will include open-ended questions which allow the respondent to elaborate their experiences and attitudes that will allow them to be heard regarding the issue of trauma and psychological distress that they faced. According to Scott (2011), qualitative approaches to the second victims allow them to access a forum that will listen to them and thus provides a system of psychological relief as well. That HELP-SEEKING TENDENCIES 12 way, other than the open-ended research questionnaires, follow-up interviews will be conducted and recorded with the respondents. The interviews will provide an opportunity for the researcher to increase the validity of data collected and also understand the emerging issues in a deeper perspective. These interviews will simply allow the respondents to explain their coping strategies following the traumatizing experiences with victims of disasters. The reason for following up on the interviews is mostly an emotional and clarity one. By interviewing the respondents, the researcher will understand their emotional stability and the effect of such disasters on their motivation. Furthermore, a one-onone encounter with respondents will allow for better observation of the research participants to better understand their responses. However, the two sets of questionnaires issued to the respondents will be used as the primary sources of data since they are easy to analyze and document. Data Analysis The data analysis process is crucial mainly because it allows the researcher to come up with justifiable evidence of the research results and conclusions made by the research process. The data analysis for both qualitative and quantitative data will be carried out in three main ways. First is the thematic approach to data analysis. Through this approach, the research, with the help of additional data analyst experts, will use data coding and reading-rereading to come up with themes that are identified in the respondent answers and interview transcripts. The use of this method will mostly be useful in qualitative data analysis because, according to Fereday and Muir-Cochrane (2006), the thematic approach allows the researcher to come up with observations which dig deep into themes presented by the experiences of respondents. In coding, the ATLAS.ti application will be used for qualitative data analysis. HELP-SEEKING TENDENCIES 13 Furthermore, a deductive approach to data analysis will be adopted as an analytical method. This approach will be deduced from the hypotheses formed at the beginning of the study to judge whether results from respondents agree with hypotheses or not. This approach will be inspired by the fact that themes and concepts are preconceived and thus testing them with the data will form the shortest channel of data analysis. Inspired by Creswell (2017), the approach will adopt the different themes and conclusions that are presented in the hypotheses and thus test them with a check from the data present. This approach to data analysis will directly answer the research questions and form a basis for further research in the future. Validity and Reliability Validity and reliability in research are crucial measures without which research results may be useless or even misleading. Validity is the assurance that the tools used measure what they claim to be measuring and also that the results can be generalized. On the other hand, reliability is the measure that ensures that the research is repeatable and that results may be repeated in another construction of the same research. Validity in the research is necessary but not sufficient for reliability to occur (Read, 2013). The research is aimed at studying mental conditions that arise in medical practitioners who respond to emergency situations whereby they deal with traumatic patients. Therefore, for starters, the research has to ensure that it deals with the relevant research participants. Furthermore, the study seeks to determine the trends followed by these medical practitioners in dealing with the trauma that arises from dealing with emergency cases. The research tool in Appendix A is aimed at ensuring the data collected is valid and accurate. It is to ensure that data collected by the various investigators are in harmony and that the criteria provided are in accordance with the aims of the research. Before determining if an individual will be useful to be incorporated in the study the investigators are required to assess him/her using the research tool above. For part 1 each yes HELP-SEEKING TENDENCIES 14 response is awarded 1(one) point and each no response gets 0(zero) points. However, for part 2 each yes response receives 0(zero) points while each no receives 1(one) point. The total of points from part 1 and 2 are calculated and this score will determine if an individual should be part of the sample data. First of all, it is a must an individual be a medical practitioner who is working in emergency response. Furthermore, the individual should have a score of more than 8 from the research tool to be incorporated into the study. Significance of the Study Medical practitioners work in one of the most unpredictable environments. They are faced with different types of tasks. One task that exerts mental pressure is treating patients who are brought in in heavily deformed shapes. This includes patients from car accidents, fires, among other fatalities. According to research, these fatalities cause trauma to medical practitioners. The groups that are affected most are the emergency medical responders (EMS), ambulatory service nurses, and nurses who offer first aid to patients arriving in emergency conditions. Research also shows that some patients cause more traumas than others; for instance, nurses confessed that treating children in such situations is more traumatizing than treating adults in such positions (Crabbe et al., 2004). Some of these medical PR actioners do not undergo any treatment, while others undergo treatment they are not satisfied with. EMS responders are in better positions of getting treatment, while nurses and other medical responders who are not part of the first responder’s category find any professional psychotherapy help. The research will help bring to light the issue of seeking help among medical practitioners and thus open the way to better practices that will allow the practitioners, as second victims, to acquire help as well. Limitations and Delimitations The main limitations of the study are the difficulty of finding medical practitioners who are ready to respond. The researcher will need to gather data from this population. Another HELP-SEEKING TENDENCIES 15 limitation is the amount of time and money needed to travel from one point to another, to look for hospitals and talk to responders. There are also delimitations. First, FEMA is open to scholarly researches, and will direct me to some of their EMS first responders. The second delimitation is that the data collection researcher lives close to a hospital where a relative works and can introduce them to some nurses who may be the first respondents to the research. Conclusion Understanding the help-seeking tendencies of medical personnel who experience traumatizing events when responding to disaster victims is crucial because it will allow more innovative responses to the trauma experienced by the practitioners as second victims. This research will focus on personnel who have had experiences that traumatized them due to their interaction with disaster victims. The funding and authorization of this research will allow a critical approach to medical employee satisfaction and will indeed create a platform for increasing their abilities to cope with such incidences. This research is bound to set up the path to changes in practice that will allow medical practitioners to deal with psychological issues emanating from trauma better. Acronyms and meanings of words FEMA- Federal Management Emergency Agency (USA) EMS- Emergency Medical Responders CBT- Cognitive behavioral therapy EMDR- Eye movement desensitization and reprocessing HELP-SEEKING TENDENCIES 16 References Crabbe, J. M., Bowley, D. M. G., Boffard, K. D., Alexander, D. A., & Klein, S. (2004). Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims. Emergency Medicine Journal, 21(5), 568-572. Creswell, J. W. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications. Ejeta, L. T., Ardalan, A., & Paton, D. (2015). Application of behavioral theories to disaster and emergency health preparedness: A systematic review. PLoS currents, 7. Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 80-92. Kahn, M. E. (2005). The death toll from natural disasters: the role of income, geography, and institutions. Review of economics and statistics, 87(2), 271-284. Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., . . . Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396404. Luce, A., Firth-Cozens, J., Midgley, S., & Burges, C. (2002). After the Omagh bomb: Posttraumatic stress disorder in health service staff. Journal of traumatic stress, 15(1), 2730. Neisser, U. (2014). Cognitive psychology: Classic edition. Psychology Press. HELP-SEEKING TENDENCIES 17 Osborne, R. B., Thomas, A. J., & Forbes, J. (2010, March). Teaching with robots: a servicelearning approach to mentor training. In Proceedings of the 41st ACM technical symposium on Computer science education (pp. 172-176). ACM. Papadatou, D., Anagnostopoulos, F., & Monos, D. (1994). Factors contributing to the development of burnout in oncology nursing. Psychology and Psychotherapy: Theory, Research and Practice, 67(2), 187-199. Raphael, B., & Wilson, J. (Eds.). (2000). Psychological debriefing: Theory, practice and evidence. Cambridge University Press. Read, J. (2013). Reliability and validity. Models of madness: Psychological, social and biological approaches to psychosis, 47. Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No. CD002892. DOI: 10.1002/14651858.CD002892.pub5. Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider “second victim” after adverse patient events. BMJ Quality & Safety, 18(5), 325-330. Scott, S. (2011). The Second Victim Phenomenon: A Harsh Reality of Health Care Professions. Patient Safety Network. Retrieved from https://psnet.ahrq.gov/perspectives/perspective/102 HELP-SEEKING TENDENCIES 18 Appendix A Research tool Part 1: Each yes response is 1 point while each no is 0 points Criteria Yes No 1. Is the individual a medical practitioner? 2. Does he/she work in emergency response? 3. Does he/she work with children in emergency situations? 4. Does the individual work with patients who are victims of fire or sexual abuse? 5. Has the individual encountered patient death from emergency situations? 6. Does the individual get stressed after attending to patients of trauma? 7. Has the individual ever gotten into depression due to dealing with traumatic patients? 8. Does the individual have any mental health problem? Part 2: Each no response is 1 point while each yes is 0 points Criteria Yes No 1. Does the individual have a good support system? HELP-SEEKING TENDENCIES 2. Does he/she seek professional help after dealing with traumatic cases? 3. If the answer to question 2 is yes, does it help? 4. Is the type of professional help given satisfactory? 5. Does getting psychological evaluation post response reduce stress levels? 19 
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