Tag: Public Safety

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Forewarned is forearmed: First Responders and Traumatic stress

The ancient Latin saying, ” Praemonitus, praemunitus,” later in 16th century England became “Forewarned is forearmed” can apply to a wide variety of situations. For this post I’ll be discussing the importance for first responders to learn about the potential dangers of their work to their mental health.

Before I begin it is important to note that each individual will process their experiences differently. Not everyone who is exposed to a traumatic event will end up with a traumatic stress related injury. Advance knowledge of Post Traumatic Stress Disorder (PTSD) and related disorders can help first responders help themselves and their co-workers.

Post Traumatic Stress Disorder (PTSD) is fully explained on the website of the National Institutes of Mental Health. I encourage all first responders to read the information on their site.

For the purpose of this entry I share the criteria the NIMH list on their site for a diagnosis of PTSD below. In the last paragraph the BOLD type was added by me for emphasis:

“To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.”

It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.“

I added the bold type above to emphasize the fact that feeling off or experiencing any of the reactions listed above immediately after a traumatic event is normal. The phrase often used is, “It is normal to feel abnormal .” If the reactions do not lessen after a month or so, that is a sign to seek additional support from a therapist or doctor.

First responders, like service members, often hesitate asking for help. No one wants to be taken off of active duty, or to say they are struggling. Fortunately in the military great strides are being made in de-stigmatizing asking for and seeking help. Due to increased awareness of suicide rates among first responders, steps are now being taken by public safety administrators to increase peer support programs and enhance employee assistance programs. More work need to be done in this area.

Administrators of public safety departments need to lead in the realm of education on mental healthcare for their department.

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What is Traumatic Stress

Thanks to the public information campaigns of a number of organizations supporting veterans the term PTSD, or Post Traumatic Stress Disorder is now widely known. After almost 20 years of learning and lecturing about PTSD I have learned that while the name is well known there is still very little general understanding of the criteria a person has to meet to be given the diagnosis of PTSD.

Several years ago a chaplain friend of mine asked me to speak to the oncology department at his hospital. The topic was traumatic stress and self care. The nurses attended the didactic thinking they were there to learn how to care for their patients who may be traumatized. What my friend guessed and what I learned after this experience is that some of the nurses experience and struggle with the traumatic events they deal with in the course of their work.

What I wrongly assumed is that medical professionals would know and understand the toll their work takes on them personally, they did not. That lecture led to an invitation to another conference of medical professionals. In the three years I’ve served as a chaplain for the Roswell Fire Department I’ve had conversations about traumatic stress with our public safety employees in the fire, police and 911 dispatch areas. Many know their jobs expose them to trauma, but few know what it takes to meet the criteria for a PTSD diagnosis.

For a comprehensive explanation of PTSD you should read through the National Institute of Mental Health web page on Post Traumatic Stress Disorder. In summary there is a list of conditions that must be present to meet the criteria for a diagnosis. After experiencing or witnessing a traumatic event it is normal to feel unsettled, upset and have trouble processing the experience. If after a month or two after an event, or after responding to a number of disturbing events in the case of public safety personnel, you are struggling with symptoms that interrupt your normal ability to function, you should seek help from a professional trained to diagnose and help people who experience traumatic events.

Much has been done in this field the past 20 years. Therapies have shown to greatly reduce the symptoms of traumatic stress and allow the person with the diagnosis to function at a very high level. There is such a high success rate that professional in the field are working to change the name from Post Traumatic Stress Disorder to Post Traumatic Stress Injury. The word disorder has a connotation that it is a pre-existing condition where as the word injury more correctly fits the symptoms since we now know people can recover and heal from their experiences. In a letter to the American Psychiatric Association, Drs. Frank Ochberg and Jonathan Shay outline their reasoning for the change from disorder to injury. I encourage you to go to the website, Post Traumatic Stress Injury, and read through the various links.

I do need to mention that I look to Dr. Ochberg and Dr. Shay as mentors in the field of traumatic stress. I had the opportunity to meet both in 2003 at the International Society of Traumatic Stress Studies. Both are very generous with their time and knowledge and helped me learn early after I graduated from seminary about traumatic stress and related diagnosis. I have had the opportunity to attend a few other meetings over the years with both doctors, and others like Dr. Charles Figley who wrote the book on Compassion Fatique. You will note several resources on the Resources for First Responders entry are related to these three doctors.

For an easy to understand, and listen to, webcasts about PTSD and related topics, see this webpage from Gift From Within .