FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention

Figures & data

Table 1. The FIRECARE program.

All sessions start and end with an ‘internal weather’ check, and 5 min of cardiac coherence practice.
Workshop 1: “Awareness and automatic pilot”
To raise awareness that we all tend to be on automatic pilot most of the time.
To realize that paying attention to details can reveal things that have been forgotten or not noticed.
Realizing that mind-wandering is a normal phenomenon.
Workshop 2: “Living in your head”
Becoming aware of pleasant and unpleasant experiences without getting lost in ruminative thoughts.
Developing the principle of direct and experiential knowledge.
Our interpretation of events and subsequent reactions are at the very heart of what keeps ruminations going.
Workshop 3: “Recognizing aversion”
Recognizing aversion: the mind’s habitual reaction to unpleasant feelings and sensations.
Learning to stay present by giving ourselves another way of seeing things.
Discover that we have access to these events through different channels: the body, emotions, and thoughts.
Workshop 4: “Letting be and letting go”
Allowing things to ‘be’ (acceptance/permission) and letting go.
Developing an attitude of kindness toward the experience.
Deliberately bringing a gentle and caring awareness to the bodily manifestations of any painful experience.
Workshop 5: “Thoughts are not facts”
Becoming aware that the mind’s inferences or comments can cause or sustain emotional reactions.
Establishing a different relationship with thoughts.
Consider thoughts as events of the mind and not as personal truths.
Workshop 6: “How can I take better care of myself”
Using ‘action’ to the best of one’s ability to take care of oneself.
Responding more quickly and effectively to a deteriorating mood.
Increase resources and coping strategies.

Figure 1. Periods of interest during the program. P1 represents the first period in which the intervention group followed FIRECARE, and the control group was waitlisted, P2 represents the second period in which the waitlist control group followed FIRECARE. P3 is defined as three-month follow-up for the intervention group and the waitlist control group.

Figure 2. Progress through the phases of a two-group parallel non-randomized trial.

Table 2. Sociodemographic data for total sample, intervention group and waitlist control group.

Inclusion data	Total sample	Intervention group	Waitlist control group	p
	N = 66	N = 35	N = 31
Professions
Physicians Nurses Ambulance operators	44%	45.7%	42%	0.75
	35%	28.6%	42%	0.25
	21%	25.7%	16.1%	0.34
Sex				0.53
Male Female	65%	68.5%	61.3%
	35%	31.4%	38.7%
Age (median)	37.5 (23; 61)	37.7	36.1	0.41
Professional experience
<5 years 5–10 years 10–15 years >15 years	24%	17.1%	32.2%	0.15
	12%	14.3%	9.7%	0.5
	16%	20%	12.9%	0.44
	46%	48.5%	45.2%	0.78
Seniority in the PFB (median)	6 (1; 28)	8	8.5	0.84
Previous practice
Mindfulness Cardiac coherence	26%	21.2%	32.2%	0.31
	21%	17.1%	25.8%	0.39

A p-value of ≤0.05 was considered statistically significant.

Table 3. ProQOL-5 subscales and FMI score baseline data for intervention and control group.

Variables	M (SD)	M (SD)	p
	Intervention group	Control group
Age	38	36	0.41
Sex
Female	29% (n = 11)	33% (n = 12)	0.52
Profession
Physicians Nurses Ambulance operators	24.2%	19.7%	0.09
	15.2%	19.7%	0.25
	13.6%	7.6%	0.34
Seniority	8	8.4	0.83
Numbers of sessions (total six)	5.57	5.42	0.42
Professional experience
<5 years 5–10 years 10–15 years >15 years	9%	15.2%	0.15
	7.6%	4.6%	0.56
	10.6%	6.1%	0.44
	25.8%	21.2%	0.78
Previous practice
Meditation Cardiac coherence	11%	15.6%	0.31
	9%	12%	0.39
ProQOL subscales
Burnout low (≤22) moderate (23–41) high (>42) Secondary traumatic stress Compassion satisfaction	23.6 ± 3.8	22.7 ± 5.4
	26%	58%	0.43
	74%	42%	0.07
	0%	0%
	23.3	21.9 ± 5	0.29
	38.4	36.7 ± 5.8	0.19
Freiburg Mindfulness Inventory
FMI presence FMI acceptance Total	19.1 ± 3.9	18.7 ± 4.2	0.71
	14.9 ± 3.5	16.2 3.2	0.16
	34.1 ± 6.9	34.5 ± 6.5	0.78

A p-value of ≤0.05 was considered statistically significant.

Figure 3. Immediate impact of the FIRECARE program on the burnout score (ProQOL-5) (a) and the secondary traumatic stress (b) according to the burnout level at baseline vs. waitlist control group. Delta 1i represents the value of the score measured after vs. before during period 1 for the experimental group. Delta 1c represents the value of the score during period 1 for the waitlist control group. F (1, 62) = 0.75, p = 0.38 (a); F (1, 62) = 9.02, p = 0.0038 (b).

Figure 4. Three months follow-up impact of the FIRECARE program on burnout score (ProQOL-5) according to the period of the FIRECARE program. Delta 3 represents the value of the score measured after vs. at 3 months follow up of the training for intervention group and waitlist control group. F (1, 62) = 5.28, p = 0.024.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.