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Trauma Response and EMS – Ten Years Later
Edited, 1998
As many of you are aware,
it has been more than 10 years since Post Trauma Resources
began providing post-trauma services to emergency medical and
other public safety personnel. In that time much has changed and
it is now routine for debriefing and other services to be available
after potentially traumatic events. The purpose of this article
is to provide a brief update on the state of knowledge of trauma
among emergency personnel and to make recommendations based on
the current technology.
Ten years ago, the number of mental health and emergency medical
professionals interested in psychological trauma numbered a few
dozen. I remember attending one of the first trauma conferences
in Chicago in 1983 and being one of six people participating in
a session on stressors among emergency personnel after natural
disasters. There were few data at that time on the psychological
impact of trauma on emergency workers and the technology for treatment
and debriefing was in its infancy. Today, much more is known about
the chronic and traumatic stress among emergency personnel. Research
is now clear while most personnel manage their work effectively,
a small but stable number of personnel will experience post trauma
symptoms. These symptoms may be exacerbated by chronic stress
or psychological problems and can contribute to a "post-trauma
decline" that impacts career and personal life. Another area
of investigation has surrounded those skills which facilitate
or exacerbate recovery after exposure to traumatic events. Hartsough
(1985) has identified barriers to the management of traumatic
events including unrealistic expectation for an incident's outcome,
denial of emotions concerning potentially traumatic events and
long term reluctance to discuss feelings and symptoms. Resolution
seems to be enhanced by cohesiveness within the organization (increased
social support), commitment to the profession and desire for self-
improvement. Susan McCammon and colleagues (1988), researchers
from Eastern Carolina University, have identified patterns in the
thoughts of emergency medical workers who make successful recoveries
after traumatic events. These include thoughts concerning a search
for meaning for difficult events, the desire to discuss the incident
with others in the field, recognizing the importance of non-work
related activities and acceptance of symptoms and feelings after
an event.
Services for emergency personnel have also changed significantly.
Trauma response took place only after large scale disasters if
at all; interventions for one unit or a few personnel were unusual.
The attitude among most managers was still "if you can't
take the heat, get out of the fire" and it was the rare administrator
who was knowledgeable or interested in post trauma services. Today,
there is not a major emergency medical or other public safety
department that does not offer or mandate trauma management services
for its personnel. Rather than the provision of isolated debriefings
after large scale disasters, models for services including multiple
services have been developed (we have labeled our model the "Continuum
of Care" (1985). Such programs are seen as critical in managing
the costs of workers' compensation claims for psychological impairment
that are costing departments millions of dollars anually. The
technology for debriefings has also changed dramatically. Where
simple debriefing services focused to a large extent on peer support
with outside assistance by mental health professionals, there
are multiple models for post trauma services depending on the
timing of the response or the intensity of the event, number impacted,
etc. (i.e. psychological and educational debriefings). Increasingly,
the techniques for assisting emergency personnel are becoming
more sophisticated and data-based.
What does all this mean for today's emergency medical workers
and administrators:
- Keep current. When you see those new psychology-related articles
in the EMS journals, don't skip them to look for new tools for
opening airways. It is just as important to keep up with the new
behavioral technology as it is the medical information that is
critical to your department.
- Learn about the impact of psychological trauma on your workers'
compensation costs. The trend in workers' compensation is for
the compensibility of more psychological injuries. The S.C. legislature
is considering a definition of work-related stress that will include
much of what we think of as a critical incident or trauma. It
is become increasingly difficult to financially justify not responding
to work-related trauma.
- If you do not have an active program for stress and trauma
management, start one. If you are on the street, insist on the
availability of post trauma services. It is important that the
program be planned and be flexible enough to respond to events
impacting one or a few of your personnel. If you wait for the
"big one" to occur, you will miss most of the trauma
in your organization.
- Let the buyer beware. With the increase in information concerning
trauma in EMS, there has also been an explosion in providers of
services. Some offer post-trauma services as a no-cost, "loss-leader"
for psychiatric services or include "debriefings" as
part of an employee assistance (EAP) package. Shop for post-trauma
services just like you do for vehicles and medical equipment --
carefully. It is perfectly acceptable to ask for personal interviews,
proposals and references.
The past ten years has been important for the recognition, prevention
and intervention of trauma related symptoms in the emergency services.
We have appreciated the opportunity to work with many of your
during some difficult times and appreciate the job you do.
References:
Barnett-Queen, T and Bergmann, L.H. (1988). Postrauma response
programs. Fire Engineering, Vol 141, (8).
Hartsough, D.M. (1985). Emergency organization role. In National
Institute of Mental Health, Role Stressors and Supports for
Emergency Workers, p. 59.
McCammon, Susan et al (1988). Emergency workers' cognitive appraisal
and coping with traumatic events. Journal of Traumatic Stress,
Vol 1, (3) 353-372.
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