Introduction

The psychology of crises, emergencies and catastrophes is an area of recent development within the context of the scientific discipline of psychology. However, Spain has experienced rapid growth in this field since the late 1990s due to the demand for psychological intervention in crisis situations. The common symptoms experienced by victims and the need to provide psychological support in both everyday emergencies and major catastrophes have historically evolved. It is important to regulate this discipline to guarantee the training of professionals and the integration of this discipline into the public care system1.

In our national context, the 1996 Biescas flood and the provision of psychological assistance services near ground zero is usually considered the start of this contemporary field and the provision of psychological assistance in the face of a critical incident.

Subsequent events related to massive terrorist attacks (September 11, 2001, in the United States or March 11, 2004, in Spain) highlighted the need for the development of procedures and protocols not only for psychological assistance to direct and indirect victims but also for the management and organization of psychological assistance devices on a large scale in the face of massive critical incidents.

More recent events, such as the emergence of severe acute respiratory system coronavirus 2 (SARS-CoV-2), leading to the coronavirus disease 2019 (COVID-19) pandemic, declared as such by the World Health Organization on March 11, 2020, led to the urgent need for a new psychological intervention model to address the crisis and provide direct support to affected people.

While the occurrence of railway or aeronautical accidents led to the development of large-scale psychological assistance procedures in situ (i.e., close to ground zero) or in family care centres, it has not been until recent years that these needs have been included in the specific legislation regarding the responses that the airline or railway companies must provide in Spain. However, in Spain and throughout the world, large organizations have created good practice guidelines that must be followed for correct performance of psychological work, including "Ethical Principles of Psychologists and Codes of Conduct” by the American Psychological Association2, “Entry-to-Practice Competency Profile for Counselling Therapists” by the Federation of Associations of Counselling Therapists in British Columbia3 and the “Code of Ethics of the Psychologist” by the General Council of Psychology of Spain4.

A review of the literature has been conducted based on the symptoms that may arise in these types of situations, as well as the competencies that may be necessary for clinical psychologists to optimally address these contexts.

Starting with the described symptoms, the study of Cervellione5 aimed to evaluate the symptoms and reactions of the population to the event using data collected from the triage cards used by SIPEM SoS Emilia Romagna (Italy) with the goal of describing the clinical symptoms and defining the criteria of emergency psychology. A total of 40.9% of respondents requested psychological support for the management of anxiety symptoms, a need that was also reported by 55% of the respondents who reported previous psychological problems. At the same time, in 2022, Panzeni6 developed the Perceived Psychosocial Support Scale (PSSS) to assess perceived psychological and social support in clinical and emergency settings. The PSSS was administered to a clinical sample during the early period of the COVID-19 pandemic, and good psychometric properties were found. The results indicated that fewer sessions and more emotional symptoms were associated with lower scores on the PSSS, suggesting that this scale may be useful for individualizing treatments and allocating resources in clinical and emergency settings.

After Hurricane Katrina in 2005, the speed at which emergency devices were activated was key, and the authors recommended the implementation of a series of unified tools for the correct organization of responses to these situations7. For this reason, organizations such as the Pan American Health Organisation promoted the development and implementation of articles, manuals and guidelines on hospital triage systems8. This promotion was also supported by Ursano (2003), who pointed out the need to develop care strategies for mental health at both the individual level and the community level9. Importantly, Ursano also mentions in his book that it is important for emergency psychologists to consider that the most severe psychiatric consequences are those due to terrorist acts and torture.

The 20-item Self-Report Questionnaire (SRQ-20) was used to evaluate distress in Vietnamese adults before and after Typhoon Xangsane10. Variations in mental health symptoms were observed, and sex and age played important roles, as women and older people experienced greater distress. The association of factors such as evacuation, personal injury, and fear during the event differed with distress levels, which were associated with the age and sex of the participants.

However, individuals can also find themselves in micro situations, such as domestic violence. In 199511, the challenges faced by medical and mental health professionals in dealing with cases of family violence, especially in primary care settings, were highlighted. The characteristics of both physicians and patients that make the detection of domestic violence difficult were examined, and the role of psychologists in these settings in terms of facilitating the detection and treatment of violence was highlighted. It was concluded that efforts should include educating clinicians through collaboration and providing on-site resources for information and consultation.

The symptoms that the relatives of the victims of a crisis situation may present can vary depending on multiple factors, such as the age of the person, the type of crisis situation, the medical and psychological history of the person and the person’s existing psychosocial situation. The expected psychological symptoms are mainly anxious or depressive characteristics, although other types of psychological symptoms may appear. In this type of situation, it is essential that mental health professionals be able to identify the psychological, physiological, behavioural and community responses that these types of crisis situations, which are increasingly part of daily life, produce. A prior competence profile must be obtained, and emergency psychologists must have training in obtaining these profiles12. According to the scientific literature, when faced with a critical incident, people have a greater tendency to develop psychological symptoms than physical symptoms, which means that mental health resources may be overwhelmed; therefore, it is essential to train mental health professionals in interventions during crises, which will, in turn, lead to more effective use of emergency services13.

Continuing with the competencies that psychologists should have, in 2005, the results of an investigation on the evaluation of competencies necessary for professional practice in psychology were presented. The importance of evaluation to improve both the initial training and the continuous development of psychologists was highlighted14. Additionally, among the competencies that mental health professionals who act after critical incidents should have, it is worth highlighting the ability to assess the situation and the associated symptoms and the ability to prioritize, as it is essential to have good tools of triage that allow working with common criteria. It is also convenient to develop liaison psychiatric assistance with other postaccident health services15.

There are three competencies that stand out in the competency profiles of crisis and emergency workers. On the one hand, resilience can be defined as the ability to recover or successfully cope with adverse circumstances. Resilience promotes positive adaptation to adverse situations and is associated with good psychosocial adjustment and good mental health16. In health personnel, such as nurses, this concept is very relevant and is linked to other factors, such as the balance between personal and work life or the ability to cope17. Resilience not only affects self-care but also patient care and is especially relevant in contexts in which there is continuous exposure to human suffering and/or work conditions that can be considered stressful18.

Empathy can contribute to resilience by providing meaningful connections with others, emotional support, and a deeper understanding of shared experiences during difficult times, such as those that occur after critical incidents19.

Emotional intelligence can be defined as the ability to know one’s own emotions and be aware of other emotions20. Emotional intelligence allows an individual to rationalize their emotions and involves the processing of emotional information21. This competence is very relevant for crisis interventions since it allows correct processing of information and the ability to correctly identify, understand and manage one’s own emotions and those of third parties22. Emotional intelligence comprises three components23: emotional attention, i.e., the identification of emotions; emotional clarity, i.e., the understanding of emotions; and emotional repair, i.e., emotional recovery from critical events (e.g., focusing on positive aspects rather than negative ones). Emotional intelligence is related to psychological well-being, mental health, decreased anxiety-depression symptoms24 and good psychological adjustment25. Psychologists who are able to understand and control their own emotions can also understand and help manage their patients’ emotions (as long as it is done compassionately and not experimentally). Psychologists’ ability to manage their own feelings allows them to provide more effective and understanding support, thus creating a more beneficial therapeutic environment for their patients. This capacity allows the psychologist to carry out a positive restructuring of their emotions, reducing their level of discomfort26. Emotional intelligence could be related to health and disease processes and could be a protective factor. A positive relationship was also found between emotional intelligence and psychological well-being, empathy and self-esteem27. Strong emotional intelligence is closely linked to good mental health, while low emotional intelligence is related to mental health problems28.

The objective of this study was to develop the Crisis and Emergency Intervention Skills Scale (CEISS) and to analyse its psychometric properties and the relationship of the CEISS score with the most relevant job competencies for health work in emergencies. Based on the bibliographic review carried out, it is essential to have a standardized measuring instrument that allows evaluating whether the professional competencies possessed by a person are adequate to carry out this type of work. An instrument with these very specific characteristics has yet to be developed.

Following a review of the literature on psychological intervention in emergencies and disasters, the findings were cross-checked with the expert group from the World Association of Emergency Psychology and the Spanish Society of Psychology Applied to Catastrophes, Emergencies and Emergencies generated a set of relevant aspects to be evaluated, which were operationalized in 28 items. These 28 items were administered to an incidental sample of personnel involved in psychological intervention during emergencies in Spain and Latin America (N = 76). From a frequency analysis, the items with the highest percentages in the categories “Strongly agree” and “Agree” were selected. The 14 items chosen were then applied to an incidental pilot sample (N = 57). By successive reliability analyses using internal consistency and item analysis, items with low corrected Homogeneity Index values were eliminated if their elimination improved the Cronbach’s alpha internal consistency index. This process resulted in the retention of 10 items, with a Cronbach’s alpha coefficient of 0.075. During the Confirmatory Factor Analysis (CFA), one additional item was removed, resulting in a final version comprising 9 items.

Method

Participants

The sample consisted of 117 subjects (53% women and 47% men) aged between 24 and 76 years (M = 46.82, SD = 12.83). An incidental sample of professionals and volunteers involved in emergency response was selected, 37.6% of whom were psychology graduates. The inclusion criteria were being over 18 years of age and currently working or having experience in emergency intervention and assistance. The exclusion criterion was not meeting the stated inclusion criteria.

Measures

Sociodemographic and occupational questionnaire

The questionnaire is an ad hoc tool that consists of questions related to demographic and occupational data, with closed questions. The variables included were sex, age, type of professional (psychologist, nurse, physician, etc.) and years of experience in the profession.

Crisis and Emergency Intervention Skills Scale (CEISS)

The questionnaire was prepared ad hoc for this research. This CEISS assesses skills and behaviours in crisis and emergency assistance. The instrument consists of 9 items each with a 5-point Likert-type response (0 = totally disagree, 4 = totally disagree). The total score ranges from 0 to 36 points, with higher scores indicating a higher level of relevant competencies. These items were selected from an initial list of 28 skills and ways of acting that have been suggested by a group of expert emergency psychologists as being relevant to providing assistance and support to individuals affected by crisis and emergency situations. In the present sample, McDonald’s omega (ω) was 0.90.

12-Item version of the Trait Meta-Mood Scale 29

The 12-Item version of the Trait Meta-Mood Scale (TMMS-12) is a shortened version of the Trait Meta-Mood Scale (TMMS)30. It assesses emotional intelligence, which refers to the ability to know one’s own emotions and those of others, allowing the individual to process and rationalize their emotions. This ability is very relevant for crisis interventions, as it allows a correct processing of information and the ability to identify, understand and correctly manage one’s own emotions and those of others22.

The TMMS-12 was scored on a 6-point Likert-type scale (1 = strongly disagree to 6 = strongly agree), where higher scores on each dimension indicate higher levels of attention, clarity, and emotional repair. The results of the confirmatory factor analysis (CFA) corroborated the trifactorial structure of the original scale (attention, clarity and emotional repair). Furthermore, these dimensions showed adequate reliability and were correlated with measures of depression, rumination and life satisfaction. In the present sample, Cronbach’s alpha values for attention, clarity, and emotional repair were 0.91, 0.91, and 0.90, respectively.

10-item version of the Connor-Davidson Scale 31

The 10-item version of the Connor-Davidson Scale (CD-RISC 10) is based on the Connor-Davidson Resilience Scale32. This tool measures resilience, which refers to the individual’s capacity for positive adaptation to adverse situations, which is associated with adequate psychosocial adjustment, work-life balance, good coping skills and mental health. Among healthcare workers, such as nurses and physicians, this skill is crucial as it affects not only oneself but also patient care, since in this context it is common to be continuously exposed to human suffering and/or working conditions that can be considered stressful.

The CD-RISC 10 consists of 10 items (items 1, 4, 6, 7, 8, 11, 14, 16, 17, and 19) from the original scale. Using this scale, participants are asked to indicate to what extent they agree with each of the statements presented to them. Responses are given on a five-point Likert-type scale ranging from 0 (totally disagree) to 4 (totally agree), where higher scores indicate higher levels of resilience. In the present sample, ω was 0.90.

Procedure

This study was approved by the Ethics Committee of the University of Malaga (masked for peer review) and was conducted in accordance with the ethical standards of the Declaration of Helsinki. The sample was recruited following a convenience sampling strategy. All participants signed an informed consent form specifying that the information collected was anonymous and confidential and would be used for research purposes only. Without this acceptance, it was not possible to continue with the completion of the questionnaire. All participants were volunteers, and participants did not receive any incentives. Psychology professionals and professional or volunteer personnel involved in emergencies from Spain and other Spanish-speaking countries were invited to participate. All the questionnaires described were administered through an online link and in a single session. There were no missing data as the questionnaires could be not be submitted electronically unless all items had been responded to.

Data analysis

A descriptive cross-sectional study design was used. First, a descriptive analysis of the sample characteristics was carried out. To obtain evidence of validity based on the internal structure of the CEISS, an exploratory factor analysis (EFA) has been carried out to obtain evidence of the one-dimensional structure, which was subsequently tested by means of a confirmatory factor analysis (CFA). These analyses were carried out using the R lavaan33 statistical package. The estimation method used was diagonally weighted least squares (DWLS) estimation with the polychoric correlation matrix, which has been shown to provide accurate parameter estimates when dealing with categorical items. The chi-square statistic (χ2) and the following fit indices were calculated: the comparative fit index (CFI)34, nonnormative fit index (NNFI)35, root mean square error of approximation (RMSEA)36 and 90% confidence interval (CI). These indices were interpreted according to the following criteria: CFI and NNFI values equal to or greater than 0.95 were considered a satisfactory fit37; RMSEA values between 0.06 and 0.08 were considered a reasonable fit, and RMSEA values below 0.06 were considered a satisfactory fit36.

Subsequently, a reliability analysis of the CEISS scores was performed. Reliability was measured by evaluating internal consistency, which was calculated using McDonald’s omega coefficient (ω), with values equal to or greater than 0.70 considered satisfactory. An item analysis was also performed, and the corrected item-total correlation coefficient was calculated, with values greater than 0.40 considered satisfactory.

Finally, validity tests were performed based on the correlations with other variables. These relationships were determined by calculating the Pearson correlation coefficient between the score on the CEISS and the scores on TMMS-12 and the CD-RISC 10. According to Cohen’s criteria, coefficients close to | 0.10| were considered low, those close to | 0.30| were considered moderate, and those close to | 0.50| or higher were considered strong 35.

Results

Descriptive analysis

Table 1 shows the mean, standard deviation, skewness and kurtosis statistics for each item and the total CEISS score. Some skewness and kurtosis values indicate a deviation from normality.

Table 1 Descriptive statistics for the CEISS items and the total score (N = 117).
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Evidence of validity based on the internal structure (construct validity)

The AFE results indicated the existence of a one-dimensional structure (χ2 (27) = 93.82, p < 0.001), with Kaiser-Meyer Olkin index (KMO) value of 0.87 (p < 0.001), all values of measure of sampling adequacy (MSA) were greater than 0.78, and the variance explained being 50%.

The results of the CFA for the one-dimensional structure showed that all the fit index values were satisfactory according to the previous criteria (Table 2). The standardized factor loadings were all significant and are shown in Table 3.

Table 2 Fit index values for the one-dimensional structure of the CEISS.
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Table 3 Standardized factor loadings for the one-dimensional structure of the Crisis and Emergency Intervention Skills Scale (CEISS) and corrected item-total correlation.
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Reliability and item analysis

The results showed that the reliability of the scores of the CEISS was satisfactory, with a ω value equal to 0.90. The item analysis showed corrected item-total correlation values above the cutoff point of 0.40 (Table 3).

Evidence of validity based on relationships with other variables

The results showed that the scores on the CEISS were positively correlated with resilience and with the three dimensions of emotional intelligence evaluated in the TMMS-12 (Table 4).

Table 4 Correlations between Crisis and Emergency Intervention Skills Scale (CEISS) scores and scores on the other study variables.
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Discussion

The objective of this study was to develop and analyse the psychometric properties of the Crisis and Emergency Intervention Skills Scale (CEISS). The results showed the existence of a one-dimensional structure that is consistent with the construct that is intended to be valued and that encompasses a capacity composed of a sum of skills to intervene and provide assistance in crisis situations. The skills proposed by the experts in this area have been operationalized in the items that reflect behaviours that indicate these skills.

Likewise, the results showed that the reliability of the scores was very satisfactory, with a value of ω = 0.90. On the other hand, the corrected item-total correlations showed values above the cutoff values, indicating that the items show satisfactory homogeneity in the measurement of skills for intervention in crises and emergencies. These results show that the CEISS items contribute to accurately measuring this ability or capacity to intervene in crisis and emergency situations.

Finally, the results revealed positive and statistically significant correlations between the CEISS score and scores on tests evaluating resilience, attention, clarity and regulation. In this sense, the direct relationship with resilience observed is consistent in this work context, since, as Truffino16 points out, resilience promotes positive adaptation and coping with adverse situations. Resilience affects not only self-care ability but also the ability to care for those affected, especially in contexts of continuous exposure to human suffering18.

High scores on the CEISS correspond to high emotional intelligence, which is associated with good mental health28. The mental health of the professionals who assist in this context is undoubtedly relevant, given the scenarios where they will perform their work.

Among the factors that make up emotional intelligence, we found that the understanding of emotions and emotional recovery from critical events were those that are most strongly associated with the measure of skills (CEISS). Emotional attention, that is, the identification of one’s own emotions, presents a weaker association (0.20).

These correlations with the construct measured by the CEISS further strengthen the importance of the ability to work in a context where the suffering of affected people is perceived. This ability can be a protective factor against emotional contagion, as individuals are able to better understand the emotions of those affected and, at the same time, adequately manage their own recovery after the intervention.

Although attention to one’s own emotions is still important, we could even consider it desirable that the respondent does not focus excessively on themselves when their effort is aimed at gaining the attention of those affected.

In summary, construct validity corresponds to the dimension that is proposed to be evaluated, and the evidence of validity with relevant variables such as resilience and the components of emotional intelligence—attention, clarity and regulation—are statistically significant and make sense for this questionnaire. The high internal consistency shows a good contribution of the items that constitute an adequate measure of the skills of professionals for intervention in crises and emergencies.

The level of skills was independent of the duration of experience and did not differ according to sex.

Among the limitations of the present study, it should be noted that the population and selected sample restrict the external validity. In future studies, it will be necessary to expand the study population to include a wider range of professionals and a larger sample.

To complete the profile of the professionals involved in psychological assistance in crisis and emergency situations, other personality variables could be added to the factors already measured.