When we ask our OFA and PHEC students, “Whose safety is most important at an emergency scene?” The answer, without exception, is always “Mine.” And right you are. If we could define our primary function it would be ‘to not let things get any worse.’ This approach helps us to assess and manage risk while pushing towards positive patient outcomes. Once we’ve made sure the scene is safe, we go about assessing, treating and transporting our patients to further medical care.
Whilst providing patient care, our brains work overtime on patient care processes, whilst problem solving environmental and extraction challenges in the outdoors. In this elevated mental state, it can be difficult to recognise another very real risk to emergency responders – the psychological effects of trauma. The psychological effects of traumatic and repeated emergency management experiences can have a prolonged and detrimental influence on the state of our mental health if not managed well.
In our industry we regularly meet people who have been part of a rescue, who continue to experience flashbacks, have difficulty controlling their mood swings, are very anxious and on high alert for another traumatic occurrence. People who have been diagnosed with PTSD (Post-Traumatic Stress Disorder) can find it difficult to distinguish between past memories and present thoughts – meaning they can become extremely elevated in situations that have similarities to previous traumatic experiences.
Mind, the UK mental health charity says anyone can get PTSD, but people working for the emergency services are at greater risk. Its research found 92 percent of emergency personnel said they had suffered stress, low mood and poor mental health at some point, and 62 percent had experienced a mental health problem, such as depression or PTSD.
In 2015, an Australian publication began estimating that around one in ten emergency workers were currently suffering from PTSD, although rates were likely to be even higher if retired emergency workers are considered. (Harvey, S, Bryant, R, 2015)
Anyone who responds to emergencies is potentially at a higher risk of stress related illness, whether emergency response is their profession, or they have responded to emergencies in their work or private lives. Responding to emergencies doesn’t necessarily mean a person will become unwell or need psychological support, but like all risks, PTSD should be identified and control measures implemented to minimise its impacts.
An individual with PTSD typically has four clusters of symptoms: re-experiencing symptoms; avoidance symptoms; negative cognitions and mood associated with the traumatic event; and arousal symptoms, including insomnia and irritability. It should also be recognised that PTSD regularly presents with co-morbid conditions such as Major Depressive Disorder and Alcohol Use Disorder.
Here at Peak, our team are regularly exposed to emergency scenes requiring medics to think and act professionally to ensure the best possible patient outcomes. As such we have a policy that recognises the psychological risks associated with outdoor emergency response and outlines a process to control them.
Typically this includes both formal/operational debriefs followed by an informal debrief that allows individuals to verbalise their experience. The former seeks to identify what went well (what we would keep for next time) and where we could improve (what we would do differently next time.) This needs to be conducted in a way that ensures healthy outcomes both operationally and individually (avoiding blame or opportunity for guilt).
The informal debrief might involve a beer, even a laugh, but has a serious focus on what each person involved was experiencing during the response and what they have experienced since. By talking about what happened, in a safe environment, we give our brains a chance to reprocess our experiences in the hope they will ‘store’ those memories in a healthy manner – resulting in less likelihood of stress related problems.
We watch for anyone who is unwilling to participate, or who is present but hesitant to contribute. This can sometimes be a sign that they are struggling to accommodate their experience mentally or emotionally.
Like any risk management approach, we aim to take preventative steps to reduce the potential loss related to a particular hazard, in this case stress. Meditative activities like mindfulness help reduce the parts of our brain (amygdala) that become enlarged following periods of high stress or activity.
In particular, if people are struggling with flashbacks of previous traumatic events, or are experiencing inappropriate levels of anxiety around what may occur in the future, then having the simple ability to be present brings us back to what is known as the Task Positive Network, the here and now part of our brain. By being present, it becomes impossible for the opposite part of our brain, the Default Mode or Ruminating Network, to be active, meaning our levels of negative thoughts and emotions are also reduced. Neuroscience now gives us the ability to accurately measure the physiological and psychological benefits of these practices. Check this out if you want to learn how mindfulness works.
We would also encourage any of our team to seek professional help if they are struggling to manage symptoms of trauma related stress.
Harvey, S., Bryant, R. (2015) Expert guidelines: diagnosis and treatment of post-traumatic stress disorder in Emergency service workers https://www.phoenixaustralia.org/resources/emergency-services-ptsd-guidelines/