PTSD and Paramedic Research

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TheScientist

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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.
 
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.
 
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?
 
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.
 
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
 
@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.
 
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?
Click to expand...


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
 
ThadeusJ said:
Interesting that this just came up in Canadian news the other day (tragic case all around):
Click to expand...

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'
 
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.
Click to expand...

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.
 
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!
 
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.
 
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.
Click to expand...


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 :)
 
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?
 
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?
Click to expand...
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.
 
Phone ring to anxiety... are you dispatched by phone call?

PA systems clicking on (particularly with any tone) = freeze, listen, heart pounding, breath held
 
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...
 
Summit said:
Phone ring to anxiety... are you dispatched by phone call?
Click to expand...
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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