There has been increasing media coverage about PTSD over the past several years, particularly with the number of Canadian and US soldiers returning from the Middle East reporting high levels of psychological distress. Highly-respected Canadians such as Lieutenant General Romeo Dallaire and Lieutenant Colonel Stéphane Grenier have courageously opened up about their own battles with PTSD.
PTSD however, is not a new concept. Although not an official diagnosis until 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), descriptions of clusters of symptoms in response to trauma have been noted for many years. It is not limited to soldiers – PTSD symptoms can develop in individuals from all walks of life exposed to different types of traumas (some examples include motor vehicle accident, assault, natural disaster).
So, what exactly is PTSD? As per the DSM-5, symptoms can be grouped into clusters, which include:
• Intrusive – these might include memories, nightmares, triggers
• Avoidance of memories or triggers
• Negative changes in thoughts or mood – these might include negative beliefs about self or others, blaming of self or others, forgetting parts of the trauma, persistent negative emotions, emotional numbing, detachment from others, loss of interest in things normally enjoyed
• Marked changes in arousal and reactivity – these might include irritability, recklessness, hypervigilance, strong startle response, concentration or sleep difficulties
What constitutes a “trauma” can vary somewhat, but it typically involves witnessing deaths of others, or experiencing or witnessing violence or significant threats to the safety of oneself or another. The very nature of first responders’ work lends itself to exposure to potentially traumatic incidents on a regular basis.
First Responders: They run in when everyone else runs out
First responders are people who respond to the scenes of emergencies, and include police, firefighters and paramedics, among other emergency personnel. Because their work by definition often involves witnessing deaths and injuries, the number of potentially traumatic scenes they attend to in one week may be more than what some people experience in their lifetime! While they may become used to such scenes, particular calls may cause more distress, such as the deaths or major injuries of children. First responders have typically worked in a “suck it up” culture – not only for others, but for themselves as well. Thus, various types of stress reactions or even posttraumatic symptoms can gradually and progressively build up over time. Increasing numbers of traumatic incidents can result in cumulative trauma. The stigma associated with being a “helper” who then asks for help has tended to be prevalent in first responder organizations and can be a significant barrier to seeking much needed help.
Other factors can impact distress in first responders as well, including shift work, disruptions to family and social lives, and organizational support, which we’ll discuss in a future blog.
Often, first responders may have continued to work for a long time despite reduced ability to cope, and continue to be routinely exposed to potentially traumatic situations. Eventually, they may reach a “breaking point”, even after what may appear to be a relatively minor event. A comparison can be made to injuring one’s ankle. If one continues to walk on the ankle without allowing it to heal, the ankle may become vulnerable to re-injury, even to lighter levels of stress.
Historically, first responders have, at times, experienced difficulty having this cumulative impact of stress recognized by employers and worker’s compensation boards. Some have even had compensation claims denied due to difficulty identifying one single event that could be considered atypical in a first responder’s work duties that contributed to the PTSD.