Generalisations should thus be made with caution. The sample was of appropriate size given the nature of the topic and, in particular, difficulty in recruiting participants due to high levels of workload and staff turnover. The decision to recruit mainly nurses was based on the fact that this professional group

represented the biggest user group of this system, which is also responsible for the coordination of activities in this Inhibitors,research,lifescience,medical clinical setting to meet the wait target. Also, our attempts to recruit medical staff that met our selection criteria were unsuccessful. We acknowledge that this may be a significant weakness of our sampling methodology. Conclusions Policy changes can have deep and unintended consequences Inhibitors,research,lifescience,medical for health care organisations. We have shown that the imposition of a wait-time target led to the development of a new, and very sophisticated, way of working in the ED studied. This consisted of a complex arrangement of people, process, technology and space, none of which was intended by those who originally framed the 4 hour wait target. There is wide agreement among clinicians

Inhibitors,research,lifescience,medical that this target raised the profile of the ED in the hospital and concentrated efforts to address patients’ dissatisfaction with waiting times. It forced them to self-examine their practices, and rethink about the way they use space and manage information and patient flows. At the same time, it has put added pressure on them which causes concern over the effect it might have on their interpersonal relationships with their patients and colleagues. Linking patient satisfaction with clinician satisfaction may be the way forward. Competing interests The authors declare that they have no competing Inhibitors,research,lifescience,medical interests. Authors’ contributions PV designed the study, collected, analysed and interpreted the data, and drafted the SCR7 nmr manuscript. ST conceived the study, participated in its design and coordination, and helped to draft the manuscript. All authors Inhibitors,research,lifescience,medical read and approved the final

manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/14/12/prepub Acknowledgements We are indebted to the clinical, administrative and managerial staff on the emergency department studied for their support. We also thank Parvulin the ICT team and the Estates Office on the same hospital.
Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology.