There's been a lot in the news lately about PTSD. EMS providers and public safety workers are especially prone to PTSD because of their jobs.

 

Have you ever experienced PTSD?

 

Do you have tips on how to cope -- or how to avoid it -- that you can share with your colleagues?

 

Also, check out our recent articles on the subject:

 

Battling PTSD at Brattleboro (about a public-safety specific program in Vermont)

Heroes to Hometowns (about PTSD and EMS in Phoenix)

Tears for a Baby (about Editor-in-Chief A.J. Heightman's own experiences)

Tags: PTSD

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When I worked as a 911 dispatcher I went to two “debriefings” during my 911 career due to some tragic events that took place that really hit home with the public safety workers in the county. Whenever a severely tragic event occurred, especially one that involved fellow co-workers, there would a “debriefing” as we called it within 24 hours that included everyone that was involved with the incident. There was a team that was set up through the counties mental health system and people that were within the Fire/EMS departments that were trained to help deal with these incidents. So say there was a tragic event that took place, within 24 hours a “debriefing” team was put together and everyone that was involved somehow with the incident were all brought together to talk about what happened so that everyone had a chance to get their emotions out and could get help to cope with the incident. Unless you were directly involved with the incident someone then you were not allowed into the “debriefing”. If you required further help then the county mental health center was available for further help if needed.

I worked at 911 for 3 years as an EMS/Fire/Police dispatcher and was a volunteer firefighter for 6 years. In that time I saw a lot of bad things that I will never forget. However I found that what made things easier to deal with was that everyone within the department always backed each other up. We knew when someone was having an issue with something and we did everything we could to make sure they got the help they needed.


For me, my father spent 25 years in the fire service. The first few years he was on the fire department he was assigned to the ambulance. Whenever I had an issue about something I could always go to him for help or advice. I also have a fantastic fiancé that has always listened whenever she knew I was having a problem with something. While she has no experience in the emergency services, she still did the one thing that really helped the most. SHE LISTENED. She knew that sometimes all I needed was just to be able to talk about things and get them off my chest. It helped a lot.

So I guess my point is that in my opinion, or at least in my experience, what helped the most was just having someone to talk to. For the most part it was good to have someone who was also involved in emergency services that knew where you were coming from to be able to talk to. Cops can talk to other Cops, Medics can talk to other Medics, and Firefighters can talk to other Firefighters.

However, one major rule that was enforced by our “debriefing” teams was that even if someone, say a Paramedic, was trained to be a PTSD debriefer that if they were directly involved with a serious incident as well then they were not allowed to be a part of the actually debriefing team. For instance, if there was a MCI and a debriefing team was put together to help the responders that were involved, if a medic who was also a trained PTSD debriefer was at the scene then they were not allowed to be a part of the actual debriefing team. Instead they were made part of the people being debriefed. You could not be directly involved with the incident to be part of the debriefing team.

That’s just my 2 cents. Hope that helps a little.

I haven't found PTSD to be the least bit helpful. My impression was that it was too structured. However, I know lots of people who feel differently.

I also agree that it's always important to have fellow colleagues to talk to about difficult things like PTSD, but I think it's also critical for providers to consider outside help. Sometimes things like this take a while to fully develop, and then when they do, they can be even more intense and serious. Another recent JEMS article also discusses this topic: http://www.jems.com/article/features/suicides-affect-patients-ems-p

Our service has been a leader in emotional and mental health first aid for employees. One of our founding Psychologists from our crisis counselling unit formed the group below.

Many of our operatinal staff are "peers" extracurricular roles in mental health first aid if you like for employees. We have sentinel events that they make contact with crews for and ePCRs can also be used to activate their involvement in crew welfare follow up.

 

PTSD is a disorder. Awareness, support and intervention or referral is paramount before post traumatic stress becomes an interruption to someone's life. Recognising normal reactions to abnormal or compounding stressors like we all encounter is useful too. not every flair up or withdrawal is an automatic trip to the shrink.

 

It's not about avoiding PTSD: if it happens it happens. More importanlty it's about support from around that prevents normal reactions from becoming pathological.

 

Critical Incident Stress Management Foundation of Australia

You are right. Sometimes it takes awhile for things to build up inside you before you start showing any signs or affects of PTSD.

When I was working at 911 I took a call for an infant not breathing. I instructed the person on the phone how to do CPR. But in the end, even after a deputy got on scene and took over CPR and after an ALS unit treated the baby, the baby did die. Then the very next shift I took another call for a infant that was not breathing. Again, in this case the baby died again after everything that was done for it.

At first it bothered me a little, because it was infants that were involved, but the feelings passed quickly. But it was not until about 2 weeks later when the full affect of the emotions came back. I was having an argument with my fiancé about something and all of a sudden this horrible feeling just came over me. Right in the middle of us having our disagreement I broke down and had one of the hardest cries I have ever had in my life (yes I am a man and I am afraid to say I cried). My fiancé did not know how to react. When she asked me what was wrong I told her about the two babies and what happened. What she did do though was listen to me while I got my emotions and feeling out. I was holding in something that I needed to release and was able to do so finally. After my cry and talking things over with her I felt A LOT better.

So I believe, as I said before, sometimes the best things to do is simply talk to someone about how you feel. Find someone who you can talk about things to that you know is really going to listen to you and offer support. For me it is my dad (who was a firefighter for 25 years) and my fiancé.




Allison Moen said:

I also agree that it's always important to have fellow colleagues to talk to about difficult things like PTSD, but I think it's also critical for providers to consider outside help. Sometimes things like this take a while to fully develop, and then when they do, they can be even more intense and serious. Another recent JEMS article also discusses this topic: http://www.jems.com/article/features/suicides-affect-patients-ems-p

I have been to debriefings myself. The first one I went to like 8 months after it happened, and I didnt want to do it in a group of people. I was afraid of what people might think of me.." weak, cant handle the job, wuss..etc" I live in a very small rural area where everyone knows everyone, and everyone knows what happened within minutes. Anyway...I met with this counselor, 1 on 1 and Im glad I went. I talked with him several times, and actually have become very good friends with him. I found out that the feelings I was having about what people might think is normal, and so was all the other things I had going on. I was part of another one after that, which was a group meeting, and I found that very helpful as well. And because of these meetings, our crew really comes together now to help each other out. We are always calling or talking to each other after we know they have a bad call just to see how they are doing. Because we live in a community where we all know each other, it makes it really hard when its something bad, not only do we have to live with what we saw on the call, but we see their family members everyday, and have to look try and look them in the eye. Im all for PTSD counseling. Dont be afraid or think your to macho !!! 
I understand. When I worked for 911 we worked in a county of about 40,000 people (give or take a few thousand). It was on of those situations where everyone knew everyone, especially within the public safety departments. We had a medium sized police, fire and sheriff’s departments. The ambulance service was run by the fire department. Then we also had 6 volunteer fire departments in the county. We handled 911 service and dispatch for all emergency services in the county. So everybody knew everybody, and when something bad happened it affected everyone.

The two debriefings I went to was because of incidents that involved people we worked with. One was a deputy and the other was a volunteer firefighter. The first debriefing was held about 8 hours after the incident, and the 2nd debriefing I went to was about 12 hours after the incident. It was encouraged that everyone who was involved to attend the debriefing, but some people chose not to come to it. The debriefings lasted about an hour. It gave everyone an opportunity to get their feelings off of their chest. But we were also told that if we needed any further help who we could contact so 1-on-1 meetings could be set up.

This isn’t high school and people who make fun of other people because they expressed their emotions, especially when it a fellow EMT or Paramedic, need to grow up. People need to realize that EMT’s and Paramedics are just human beings and they have emotions also. If you cant turn to your fellow EMT’s and Paramedic’s for help then what do you expect to happen when things start to build up?




Todd Propson said:
I have been to debriefings myself. The first one I went to like 8 months after it happened, and I didnt want to do it in a group of people. I was afraid of what people might think of me.." weak, cant handle the job, wuss..etc" I live in a very small rural area where everyone knows everyone, and everyone knows what happened within minutes. Anyway...I met with this counselor, 1 on 1 and Im glad I went. I talked with him several times, and actually have become very good friends with him. I found out that the feelings I was having about what people might think is normal, and so was all the other things I had going on. I was part of another one after that, which was a group meeting, and I found that very helpful as well. And because of these meetings, our crew really comes together now to help each other out. We are always calling or talking to each other after we know they have a bad call just to see how they are doing. Because we live in a community where we all know each other, it makes it really hard when its something bad, not only do we have to live with what we saw on the call, but we see their family members everyday, and have to look try and look them in the eye. Im all for PTSD counseling. Dont be afraid or think your to macho !!! 
I have been in the business for approx. 22 years. From my understanding, it can be a one time event or a cumulative effect. PTSD can lead to many other issues, depression, drug and alcohol issues, relationship difficulties and all the other "-isms". I had an experience with depression, through cognitive behavior therapy I was able to recognize certain thoughts and change them. I am a big proponent of professional counseling. My counselor introduced me to a provider that utilized Eye Movement Desensitization and Reprocessing. This process help  the brain to reprocess the feelings that occurred at the time of the emotional trauma. It worked very well in my case. There are web sites that discuss the process. (http://www.emdr.com/index.htm) I was leary at first, then I scheduled an appointment to discuss the therapy and gave it a try. I am so glad I did. I have worked through so many issues that I feel so much happier, alive, and care for my family and those around me, including the ones I help to treat. It is interesting the Dr. Bledsoe has an article on "CISD" on his web site. Please read it. If I can help anyone please feel free to contact me.  

Here is another good video...

http://www.youtube.com/watch?v=zBtqWrs2-K0

John Flynn said:

I have been in the business for approx. 22 years. From my understanding, it can be a one time event or a cumulative effect. PTSD can lead to many other issues, depression, drug and alcohol issues, relationship difficulties and all the other "-isms". I had an experience with depression, through cognitive behavior therapy I was able to recognize certain thoughts and change them. I am a big proponent of professional counseling. My counselor introduced me to a provider that utilized Eye Movement Desensitization and Reprocessing. This process help  the brain to reprocess the feelings that occurred at the time of the emotional trauma. It worked very well in my case. There are web sites that discuss the process. (http://www.emdr.com/index.htm) I was leary at first, then I scheduled an appointment to discuss the therapy and gave it a try. I am so glad I did. I have worked through so many issues that I feel so much happier, alive, and care for my family and those around me, including the ones I help to treat. It is interesting the Dr. Bledsoe has an article on "CISD" on his web site. Please read it. If I can help anyone please feel free to contact me.  

I see a lot of confusion here about PTSD and relating it to CISD.  The two are completely different and often employers or the responders themselves think that a debriefing 12-24 hours out from the incident is appropriate.  I spent a year plus treating Soldiers, Iraqi Civilians, and even insurgents in Iraq in 2004-2005.  Afterwards I spent a considerable time in counseling from 2007-2009 through the VA for PTSD.  To the day I die I will have to "deal" with everything I experienced from being "lucky" I came home unscathed to dealing with the daily trauma of being in an ER.

 

PTSD can be brought on by one bad incident or like in my case, the constant grind of seeing massive trauma every day for months on end without any way to deal with it.  In a combat situation if you let your feelings intrude into your work you will become combat ineffective.  There was a scene in the series Band of Brothers where an Officer was telling a Private that the only way to be effective was to act without compassion, without remorse, and without empathy.  I say that for two reasons; it is true and it is something we have to watch out for in ourselves and coworkers.  This could be the first and best indication there may be something wrong.  I reached a point that I felt that this was never going to end and I shut down all emotions and did my job as a mechanic would repair your vehicle, not as a human being caring for another human being.  This was the only way I could effectively do my job.

 

Things to look out for in yourself and others would be; easily angered, overreacting to things that would not warrant the response from you or others under normal circumstances.  Depression, having a general feeling that nothing matters and possibly suicidal thoughts or warning signs in others.  Inabilities to eat, sleep, or take care of simple hygiene tasks.  A big one we see in our profession is dangerous sexual activity.  Excessive alcohol use or use of other recreational drugs and being jumpy or hyper aware, especially after an experience that made someone fear for their life.  These are just a few signs, I experienced some of them.

 

How to avoid PTSD?  I feel it is not possible to avoid it.  We chose a profession that will expose us to the experiences that will cause PTSD.  More importantly we need to understand it.  I may take some heat for this comment but, a CISD session will not help you avoid it or cure PTSD.  CISD is a good time to share feelings and maybe start the process of dealing with the event or events but it is the tip of the iceberg only.  Coping with PTSD is a long and never ending process.  A support group like the one I have been involved with is also a very important tool.  Not coping or seeking treatment cost me a marriage and almost cost me a job.  Every day I have to make a decision to live my life.  I made a decision to drink in moderation when the memories start alcohol really does not help but, makes it worse.  Counseling is a must, talking through the trauma and having a competent person to teach you what to do with the anger and other feelings in a constructive manner is the most important thing you can do.  I do not think you can ever be cured of PTSD and I will have the dreams, sleepless nights, and anger in me till the day i die.  Through the decisions I have learned to make I can be productive and even better i have learned to see the good in all of it by taking what I learned and applying it to the patients I have today. 

 

I think there may be some confusion as to semantics. PTSD is a systemic condition, not really something one experiences once, twice or now and again. I think the OP was probably talking about CSID. 

 

Generally, i'm cautious about who i talk to about stuff that happens in the street. I find that the more you tend to say to colleagues around the dinner table or the ER bay, the deeper the hole you dig yourself.

 

I'm fortunate enough to have a very close and very senior paramedic with me to confide in. He's played a big role in my success as both a  paramedic and as a human being. I know i can confide in him and i know the advice and feedback is genuine and thoughtful. 

 

As far as something relating directly to a particular call, i recall my first pediatric arrest. At the time it happened i was halfway through a 24 and only felt mildly phased by the experience at the time. I finished the 24 (rather busy overnight if i recall properly) and went about my days and weeks to come. The circumstances surrounding the arrest were accidental and it was clear from the beginning that it wasn't going to turn out positively. I was never really offered CSID or anything, and don't think i would have taken it to be honest.

 

Long story short, about 2 maybe 3 months later i was driving home from something and just started crying. One of those almost inconsolably bouts of crying that we all do as little kids. It took me a few to sort out what i thought the root cause was. I actually drove to a catholic church and spoke at length (2 hours?) with the pastor. I'm catholic by default but since college i haven't really haven't done much with it. The pastor was understanding and thoughtful in his handling of me. 

 

Thats what worked for me. I try and not bring the work home, besides i'm not sure they would understand. 

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