# PTSD and Paramedic Research



## TheScientist (May 11, 2017)

Dear Users,

I am currently a PhD student researching trauma and PTSD in paramedics, and ways in which we can use prior psychological training to help reduce this beforehand rather than trying to catch up afterwards with traditional therapy. The title of the study is “Self-taught cognitive resilience in paramedic workers: Is prevention as effective as treatment for trauma-related disorders?”

The prior psychological training aims to be cost-effective and time-flexible in order to fit in with the schedules and work demands of paramedics. A prototype of this may be available for forum users here to test. 

My intention is to read participant’s posts in this forum, especially in the Mental Health section, in order to gain more first-hand experience of the area. Prior research suggests that the work stress and experience of traumatic events can lead to occupational trauma and secondary mental illness in paramedics. As part of the research I hope to obtain more information on this.

As part of the foundation of my research I am asking any paramedics here for their input, ideas and experiences. Please feel free to talk about anything related to this area, whether it's your own personal experiences with occupational trauma, ideas as to what the psychological training may include or even criticism of the project itself (in qualitative research, any information is useful information). As part of my research I may include posts on this forum thread as qualitative data in the thesis and also in a journal article. All personal data will be kept anonymized, including usernames. Additionally if anyone creates a post and does not want this to be included in analysis or publication could you please let me know by either replying to that post, or privately messaging me through the private message feature within this forum, or by email at KBaqai@uclan.ac.uk. Posts will not be included in the study if users do not make it clear that they consent to allow this.

The content in the following thread may contain information that triggers PTSD symptomology in those who may suffer from this. For those who do suffer from PTSD, or related disorders, caution should be taken before proceeding through the thread. Ethical approval for this study was obtained on 02/03/17 from the UCLan STEMH Ethics Committee. Permission from the forum admins was obtained on 12/04/17.


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## akflightmedic (Jun 11, 2017)

Herein lies one significant problem within EMS. You made a solid post, identified a very real issue, desire to study it and are going about it all the right way. Yet you have zero responses. However, if I were to post which "stethoscope should I get" or "which batman utility belt should I buy" there would literally be dozens of replies within hours.

Mental health in my opinion is overlooked (somewhat intentionally) within our field and I will even expand this to our Fire Services as well. There are many reasons for this some of which are machismo, career ender if I say anything, perception of weakness, martyr complexes, super human complexes, and so on. This field itself and the characters it attracts is fascinating unto itself.

Regardless, I would love to see some training/education/techniques in a proactive and positive format as opposed to all the crap that goes on afterwards/re-actively. I do think aside from eating our young, those who survive the feasting are then set up for ultimate failure. I have seen it on these forum and others over the years...if anyone laments about how bad they feel, there will always be someone who chimes in and essentially says "suck it up" or "this is not the career for you". We pride ourselves on being tough, mentally strong and able to see and deal with anything. There are those among us who know we need a life outside of EMS with positive hobbies and non-medical circles of friends. There are those among us who turn to drugs, alcohol or vice of the day for solace. Then there are those who leave the career or leave the planet, their mind/spirit in shambles.

It is not all doom and gloom, many of us do recognize the value of mental wellness as much as we value our physical wellness. I have seen a trend in my 20+ years of EMS where it has become "ok" to speak up or seek help. Employers make resources available and do not penalize those who seek them. However, as much as I have seen some positive action, I still see a deeply ingrained culture of "we do not need that mumbo jumbo pansy wansy shyte"...

Good luck on your research and thesis. If you have anything specific or desire follow up, message me and we can go from there.


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## mgr22 (Jun 11, 2017)

Three things I wonder about:

Is it possible to quantify the effectiveness of prevention or treatment of trauma-related disorders, or the degree to which we suffer from them?
To what extent do trauma-related disorders become more likely through third-party efforts to prevent them?
At what point does organized, methodical treatment of trauma-related disorders interfere with sufferers' ad hoc and possibly therapeutic reactions to distress?


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## Carlos Danger (Jun 11, 2017)

An interesting and worthy project, OP. I find the idea that folks could inoculate themselves from future psychological stress by exercising their cognitive resilience similarly to way you'd exercise your muscles and skeleton pretty fascinating.

After spending most of the past 20 years in EMS & HEMS and a bit of ED nursing, PTSD from job-related stress is foreign to me personally. I mean sure, you'd have a call now and then that bothered you some and you'd think about it a little more than you'd like for a little longer than you'd like. But aside from the CISM stuff we'd be forced to sit through occasionally, the idea of someone developing real, chronic problems as a result of things they'd seen on a call was pretty unheard of in my circles. It wasn't until the past few years when I started seeing folks talk about it on forums such as this one that I even knew it was a thing, to be honest. 

I wonder what the difference is between 10, 20 years ago, and now. Did we have more problems dealing with things than we'd admit, and just refuse to talk about it? Are EMS folks these days exposed to more psychological stress? Has there been a cultural / generational shift that somehow causes more susceptibility to problems like this? I don't know at all, but I have wondered quite a bit.


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## Luno (Jul 12, 2017)

OP, in my few years in the field, I've found that one of the biggest "kick saves" is the original trainer (not the EMT/Medic school one) but the FTO that can help guide through what they're going to be going through.  My first loss was 3 days on an ambulance, a 42 y/o female that I was looking into her eyes when they went blank.  It was an epic f'up with the circle of genii all agreeing that it was anxiety and she just needed a BLS ride to the hospital.  We worked her in the back of that van with her mother crying in the front seat.  It took a good 6 months of nightmares and drinking to get past that one.  I was not ready for that, I was ready to assemble an O2 bottle, take a BP, backboard and c-collar a patient, but I wasn't ready to take care of myself.  In the years afterwards when I worked as the senior medic, the FTO, or the supervisor, I spent the time getting people ready for what they had no idea was coming.  I spent the time to work with them one on one, besides the CISM/CISD that we all had to sit through.  I think that the first line of defense is to prepare them in school with stress coping mechanism, this followed with appropriate and dedicated supervision would help to get them to the point where it still affects them temporarily, but doesn't carry the long term penalties.  I will say that even now, there are some that I know are going to affect me, I also know the "ride" and I know what's on the other side when I get through it.  Anything I can help with on this, send me a PM. -Luno


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## StCEMT (Jul 12, 2017)

@Remi, as part of the younger generation, I am not so sure it's more susceptibility as it is openness about it. At least not based on what I hear from more season folks. Then again, there are plenty of limp wristed people my age who can't handle difficult things, so maybe it's a little of both.

I do know that for me, realistic expectations make it very easy. I do my best and recognize not all things can be fixed. That mindset has so far served me well, I have yet to lose a bit of sleep over the bad calls I've had. Doesn't mean I don't sympathize or empathize with certain situations, I just see them for what they are and leave it at that. That's just me though, I can't speak for us all.


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## ThadeusJ (Jul 13, 2017)

Interesting that this just came up in Canadian news the other day (tragic case all around):

http://www.cbc.ca/news/canada/montr...-cnesst-workers-compensation-denied-1.4198986


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## TheScientist (Aug 10, 2017)

mgr22 said:


> Three things I wonder about:
> 
> Is it possible to quantify the effectiveness of prevention or treatment of trauma-related disorders, or the degree to which we suffer from them?
> To what extent do trauma-related disorders become more likely through third-party efforts to prevent them?
> At what point does organized, methodical treatment of trauma-related disorders interfere with sufferers' ad hoc and possibly therapeutic reactions to distress?




Some pretty interesting questions. In terms of quantifying treatment and symptomology of trauma-related disorders, most psychologists tend to use self-report questionnaires. There are also some more biological markers, such as electroencephalogram (EEG) which can indicate abnormal brain waves in those with PTSD.
As for third party efforts to prevent truama disorders being counter-productive, there's a pretty good article called 'Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?' that suggests that talking about issues such as depression and suicide reduces such disorders, rather than facilitating them.
Hope this provides some answers


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## TheScientist (Aug 10, 2017)

ThadeusJ said:


> Interesting that this just came up in Canadian news the other day (tragic case all around):



Thanks for the link! The story really is tragic. It's almost equally as tragic that a health and safety board shrugs off PTSD as 'part of the job'


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## TheScientist (Aug 10, 2017)

Remi said:


> An interesting and worthy project, OP. I find the idea that folks could inoculate themselves from future psychological stress by exercising their cognitive resilience similarly to way you'd exercise your muscles and skeleton pretty fascinating.
> 
> After spending most of the past 20 years in EMS & HEMS and a bit of ED nursing, PTSD from job-related stress is foreign to me personally. I mean sure, you'd have a call now and then that bothered you some and you'd think about it a little more than you'd like for a little longer than you'd like. But aside from the CISM stuff we'd be forced to sit through occasionally, the idea of someone developing real, chronic problems as a result of things they'd seen on a call was pretty unheard of in my circles. It wasn't until the past few years when I started seeing folks talk about it on forums such as this one that I even knew it was a thing, to be honest.
> 
> I wonder what the difference is between 10, 20 years ago, and now. Did we have more problems dealing with things than we'd admit, and just refuse to talk about it? Are EMS folks these days exposed to more psychological stress? Has there been a cultural / generational shift that somehow causes more susceptibility to problems like this? I don't know at all, but I have wondered quite a bit.



Hmm, this is pretty interesting. Personally, I suspect that PTSD symptomology has always been higher in emergency services than the general population, and the more recent increase in reports are simply due to people being more aware of what PTSD is, and more willing to talk about it. However, from other paramedics I've been talking to (in the U.K. at least) the profession itself has become more stressul over the past 10 years or so due to factors like cutting in funding, longer working hours, expansion in stations (making it harder to talk to the people you want to) and working overtime without pay. I imagine things like this has also caused an increase in reports of PTSD in paramedics overtime.


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## TheScientist (Aug 10, 2017)

Thanks for all the responses so far. Keep going if you have anything else to add!
As part of my research I have made a pilot program designed to help educate paramedics about trauma and PTSD, as well as information and tasks related to fostering psychological resilience. If you would like to help with the development of this, then you can download the pilot of this from the link below (this runs on PowerPoint, so hopefully should work on most people’s computers, tablets etc.), and provide some feedback on it. The link also contains the information sheet, consent form and the feedback sheet. Any help with this would be greatly appreciated. Also, if you would rather retain your online anonymity then you can give your EMT Life username on the consent form instead of your actual name (same for the signature). 

The information should all be on the link and its respective documents, but let me know if you have any questions. 


Link: https://www.nwaslearningzone.net/Paramedic_Zone/Research_Project.php?UID=10


Thanks again!


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## Jon4010 (Nov 21, 2017)

You shouldn't just include paramedics, granted they do so much and I'm in no way trying to discredit them. I hold the up most respect for the medics I work with. I'm only a EMT basic, but work with a medic running primary 911 in two cities. I have also worked with something called CCT with a number 1 trauma center, CCT standing for critical care transport. I have been doing this for several years. I have nightmares sometimes to the point where I wake up sweating, but I don't really consider myself with PTSD. It is nice to talk to people that I can relate with sometimes, though.


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## TheScientist (Dec 11, 2017)

Jon4010 said:


> You shouldn't just include paramedics, granted they do so much and I'm in no way trying to discredit them. I hold the up most respect for the medics I work with. I'm only a EMT basic, but work with a medic running primary 911 in two cities. I have also worked with something called CCT with a number 1 trauma center, CCT standing for critical care transport. I have been doing this for several years. I have nightmares sometimes to the point where I wake up sweating, but I don't really consider myself with PTSD. It is nice to talk to people that I can relate with sometimes, though.




I do agree with you. When I first proposed this study, I did aim to include a wide range of population groups vulnerable to stress-related mental illness. However, my supervisors felt that it would result in too much work for a three year PhD project. Therefore we scaled it down to paramedics in order to make it feasible. Depending on the results of this study, a follow-up project on other population groups could be instigated.
However, given that EMT's such as yourself have very similar experiences, I would be more than happy for you (and any other EMT's or closely related professions) to participate in the above study


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## Gurby (Dec 11, 2017)

My heartrate jumps by 30bpm every time I hear a phone ring in public or a voice coming through an overhead like at the airport or in a store.  Can I get an amen?


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## luke_31 (Dec 11, 2017)

Gurby said:


> My heartrate jumps by 30bpm every time I hear a phone ring in public or a voice coming through an overhead like at the airport or in a store.  Can I get an amen?


I get anxiety all the time when my cell phone goes off and I'm not at work. It's even worse at work and the bedside phone rings waking me up. I guess it's normal for us, but I'm pretty sure that the heart rate should not be increasing more than a couple beats when a phone rings.


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## Jon4010 (Dec 11, 2017)

Gurby said:


> My heartrate jumps by 30bpm every time I hear a phone ring in public or a voice coming through an overhead like at the airport or in a store.  Can I get an amen?



Alarm clock rings too, I’m about jumping out of the bed cause of it lol. Amen.


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## Summit (Dec 11, 2017)

Phone ring to anxiety... are you dispatched by phone call?

PA systems clicking on (particularly with any tone) = freeze, listen, heart pounding, breath held


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## VentMonkey (Dec 11, 2017)

If I sleep too deeply, and our quick calls goes off, my RHR goes from about 45 bpm’s to 140 bpm’s.

Moral of the story: we’re all knocking 10-20 years off of our lifespan. Hooray for a higher calling...thankya’ geezuz...


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## Jim37F (Dec 12, 2017)

Summit said:


> Phone ring to anxiety... are you dispatched by phone call?


Yup, that was my last companies station pre alert....the telephone ringing. It was a nice shrill high pitched ring (and liked to go off seemingly the moment you got back into station and lay down) Our local hospitals had pretty much the same ring on their ER phones....yeah it was a little unerving and made me jump a little every time I heard it whilst holding the wall after midnight and was dead tired, and had to remind myself that no, I'm NOT supposed to go answer those phones (even if it kept ringing, which could result in a write up if we ignored the station phone ha)


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## DrParasite (Dec 12, 2017)

http://codegreencampaign.org/

From the fire side:

www.ffbha.org/
www.iaff.org/behavioralhealth
https://www.firerescue1.com/fire-ch...Firefighter-mental-health-Stop-sucking-it-up/
http://www.fireengineering.com/arti...hter-mental-health-the-job-is-killing-us.html
https://www.nvfc.org/focus-on-fire-service-behavioral-health-in-may/
https://www.everyonegoeshome.com/16-initiatives/13-psychological-support/

From the EMS side:
https://www.ems1.com/mental-health/...d-know-about-seeking-mental-health-treatment/
https://www.ems1.com/ems-products/f...MS-handles-its-own-with-mental-health-issues/
http://www.huffingtonpost.com.au/jo...c-left-me-with-a-mental-health-em_a_22076604/


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## DrParasite (Dec 12, 2017)

TheScientist said:


> The title of the study is “Self-taught cognitive resilience in paramedic workers: Is prevention as effective as treatment for trauma-related disorders?”
> 
> The prior psychological training aims to be cost-effective and time-flexible in order to fit in with the schedules and work demands of paramedics. A prototype of this may be available for forum users here to test.


How do you prevent PTSD in paramedics?  How do you prevent people from seeing certain things?  From remembering them?  And as another poster said, it isn't just paramedics; many people in EMS (including the EMTs & 911 dispatchers) have been found to suffer form PTSD, so focusing on paramedics (which you might be using to describe anyone on an ambulance)  might be limiting your focus a bit.

You can't unsee child abuse victims, you can't forget the smell of burning flesh, doing CPR in an infant, walking up and finding three shooting victims, two of whom are kids, one who was just in the wrong place at the wrong time.  You can't forget the time you walked up to the patient whose family called you to help him, only to have him attack your partner.  

I look forward to seeing what your study finds


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## Carlos Danger (Dec 12, 2017)

DrParasite said:


> How do you prevent PTSD in paramedics?  How do you prevent people from seeing certain things?  From remembering them?  And as another poster said, it isn't just paramedics; many people in EMS (including the EMTs & 911 dispatchers) have been found to suffer form PTSD, so focusing on paramedics (which you might be using to describe anyone on an ambulance)  might be limiting your focus a bit.
> 
> You can't unsee child abuse victims, you can't forget the smell of burning flesh, doing CPR in an infant, walking up and finding three shooting victims, two of whom are kids, one who was just in the wrong place at the wrong time.  You can't forget the time you walked up to the patient whose family called you to help him, only to have him attack your partner.
> 
> I look forward to seeing what your study finds



It isn’t about preventing paramedics from seeing certain things, and it isn’t about forgetting them. As he explained, the study is looking to see if prior conditioning might reduce the negative psychological impact of those experiences.


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## Summit (Dec 12, 2017)

Remi said:


> It isn’t about preventing paramedics from seeing certain things, and it isn’t about forgetting them. As he explained, the study is looking to see if prior conditioning might reduce the negative psychological impact of those experiences.


Exactly. Resiliency training is used elsewhere. 

http://ajcc.aacnjournals.org/content/23/6/e97.full

"This mulitmodal resilience training program was feasible to conduct and acceptable to ICU nurses. Both nurses randomized to the treatment group and nurses randomized to the control group showed a significant decrease in PTSD symptom score after the intervention."

It's not exactly robust, but it is suggestive of a direction to be looking with more research such as what OP is doing.


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## TheScientist (Jan 16, 2018)

Some thoughts on the more recent posts here:

Several people noted that loud noises similar to the dispatch calls cause their heart rates to go up even while off work.  I get that the alarms are suppose to get emergency workers fired up and ready asap, but it may be worth investigating and possibly changing it if it’s doing more harm in the long term. After a quick search, there doesn’t seem to be any research testing the possibility of changing the alarm types in order to see the effects. A follow-up study from this could be to look at different alarm types. Maybe use different types depending on how big the call appears to be, like ‘code red’ etc. 

And yeah, the research above is similar to what I’m doing. The main focus at the moment is to test the possibility of providing some form of resilience training to trainee emergency workers to see if it has any effects on reducing PTSD symptomology later in their careers. A key difference is that the above study (like most similar studies) is using resilience training in those who already have PTSD symptomology. So they’re using it more like a cure than a prevention, while mine is testing the prevention rather than cure.


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## DrParasite (Jan 16, 2018)

TheScientist said:


> I get that the alarms are suppose to get emergency workers fired up and ready asap, but it may be worth investigating and possibly changing it if it’s doing more harm in the long term.


then you don't get it at all.  alarms are not supposed to get emergency workers fired up..... it is supposed to get their attention and possibly wake them from sleep, similar to an alarm clock. To my knowledge (and if someone knows more than me, please chime in), they aren't supposed to do anything other than notify a rescuer that there is a call for them to respond to.


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## Carlos Danger (Jan 16, 2018)

DrParasite said:


> then you don't get it at all.  alarms are not supposed to get emergency workers fired up..... it is supposed to get their attention and possibly wake them from sleep, similar to an alarm clock. To my knowledge (and if someone knows more than me, please chime in), they aren't supposed to do anything other than notify a rescuer that there is a call for them to respond to.



Really man? Lol


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## Jim37F (Jan 16, 2018)

When I worked for an FD that had station alert tones, there was the occasional talk about adjusting the tones volume, i.e. turn them down, so as to be less jarring, but still enough to wake you up. One station had notoriously quiet tones that were easy to miss, some of the firefighters said the only reason they woke up for middle of the night calls was because the lights were programmed to come on as well....amd there was also the occasional talk about that....i.e. some guys wanted dimmers on the lights so instead of snapping on they turned on gradually (over a second or two)....basically the general idea was to get the system tuned so that it woke you up over the course of a couple of seconds...vs jarring someone awake right then and there.


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## beaucait (Jan 20, 2018)

TheScientist said:


> Dear Users,
> 
> I am currently a PhD student researching trauma and PTSD ...



For mental health, I have used many outlets to help myself in times that are tough. I used to go to the gym but quickly found that my anger or frustration through the day was being transferred into my workouts, causing me to go too hard and causing injuries... The gym is a good place but only if you are in the right mindset. I have seen some of the most mentally unhealthy people at the gym coping with problems much bigger than they can handle because they "can just work it out at the gym". 

Dealing with mental illness such as post traumatic stress and anxiety are hard in everyday life.. considering the busy schedule people have. In spare time I usually journal, read or play guitar, paint, draw,... but sometimes you can get into a slump and just feel terrible and not want to do any of those things. I consider myself proactive regarding mental health. I have only been in EMS 2 years and I see myself dealing with trauma everyday....

 I think that there is a significant lack of education regarding mental health and rehabilitation in some populations. Trauma and recivery is not easy. And let's be honest, who actually goes to a counselor for these issues. This could be a direct correlation to why rates of post traumatic stress are so high. Like someone else mentioned there is usually some kind of substance abuse component. I know for a while I was abusing marijuana and alcohol as my relaxation outlet. It definitely did not help and I became numb to what was going on around me. After educating myself about substance abuse, mental health, and trauma and recovery, I have learned healthy ways to cope. 
Humor seems to work, as well as just talking about things to someone. Sometimes having a good support system can make all the difference. 

I have also seen the incidence where EMS treat each other badly. The same goes for any healthcare profession. There is a standard and if you do not reach that standard you aren't good enough. I have had many a breakdown and failure due to people in healthcare being rude or inconsiderate. This is not saying that everyone is, but we need to incorporate and foster an environment for new EMS people to take steps to learn the ropes without being torn apart.

I was literally let go from an agency because they said "The other EMS personnel would eat you alive... you don't have enough experience". 
That is all..  /endrant


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