Posttrauma Response Programs
FEATURES
HEALTH AND SAFETY
Instead of playing catch-up with posttrauma stress, departments should implement an ongoing program.
The psychological result of exposure to duty-related trauma is now receiving considerable attention in the emergency services. Articles, workshops, and other presentations concerning posttraumatic stress disorder, or critical incident stress, are now common. However, information concerning the planning, development, implementation and maintenance of posttrauma programs is lacking. This is the first of three articles that will focus on the practical lessons we’ve learned by assisting fire, emergency medical, health care, and corrections organizations to develop and maintain posttrauma programs.
This article will review basic information concerning duty-related trauma, the benefits of posttrauma programs, and how they’re planned and developed.
Before planning a program, it’s important to have some knowledge about the impact of trauma on emergency personnel.
Emergency personnel are likely to face potentially traumatic experiences while on duty. Events which involve death, exposure to extensive destruction, severe injury, or threat to life will be traumatic for many. In our training sessions, emergency personnel have identified certain incidents as most likely to be traumatic: death or injury of children, particularly multiple deaths of children; unsuccessful rescue attempts after great effort; certain types of injuries such as burns or amputations; and responding to calls where friends or family members are the victims. Catastrophic events such as the death or severe injury of fellow emergency workers and mass casualty events are also often mentioned and will likely be experienced as traumatic.
Posttraumatic stress disorder may cause normal psychological consequences in many emergency personnel. These usually fall into three general categories:
- Reexperiencing consequences include flashbacks, anxiety, fear of reoccurrence, hyperalertness, and thoughts of the event.
- Withdrawal consequences include emotional numbing, depression, withdrawal from family, friends, and important activities and avoidance of activities that are reminders of the event.
- Other consequences include irritability, sleep difficulties, problems concentrating, and exaggerated startled response.
In most cases posttrauma psychological consequences aren’t long-lasting and don’t seriously impair emergency personnel. However, long-term problems, including severe depression, substance abuse, divorce or family problems, or chronic anxiety, may develop.
Such problems may be prevented through a combination of preincident training that provides information about duty-related trauma; offers support within the organization; and encourages the use of specific coping skills. Effective coping skills for personnel should include the ability to predict potentially critical events and to realize that the onset of posttrauma psychological consequences is normal.
Reducing the impact
Adequate research isn’t yet available to substantiate the effectiveness of posttrauma programs used by emergency-response departments. However, work with other groups, such as Vietnam veterans and crime victims, has shown that intervention following traumatic events is helpful. Effective interventions seem to have certain common features, including administrative support, the opportunity to discuss the event, the support of other personnel and family, and the availability of posttrauma mental health services.
There’s no substitute for a planned and coordinated posttrauma program that includes trained and experienced peer and mental health personnel working with prepared and educated emergency personnel. Yet unfortunately, a posttrauma response is most often planned after a particularly devastating critical incident. Such “reactive” responses may lack departmental support, be poorly coordinated, use mental health personnel who aren’t experienced with posttraumatic stress, risk poor personnel participation, and may not include adequate follow-up.
In general, posttrauma program effectiveness relies on a combination of careful planning, implementation, and training. Administrators and mental health professionals may hesitate to provide posttrauma services after incidents which impact only an individual or a single crew. Locating knowledgeable mental health professionals, shuffling work schedules, and planning follow-up meetings are time-consuming tasks. However, valuable time can be saved if groundwork for the posttrauma program is done ahead of time. With a functional program in place before the critical incident occurs, all members of the department-regardless of number—can be helped.
Basic elements
Four services should be included in a complete posttrauma program.
- All personnel should receive duty-related trauma training to provide basic information concerning CIS/PTSD and the department’s posttrauma program.
- A peer support component that uses trained personnel from all ranks should be available to monitor potentially traumatic incidents, remain in supportive contact with those involved in incidents, and assess the need for debriefings and posttrauma counseling.
- Debriefings (structured group meetings with mental health professionals and peer supporters in attendance) provide opportunities to discuss critical incidents and learn coping skills necessary for the prevention of long-term psychological consequences.
- Posttraurna counseling provided by trained mental health professionals allows those in need of additional assistance to have special support.
Through this combination of services, the needs of each individual can be met, regardless of the seriousness of the posttrauma psychological consequences.
Size and administration
Should the program include other departments? There are some obvious advantages to joining forces with other emergency organizations. Initial training expenses can be shared. Mental health professionals and peer supporters have the opportunity to provide more posttrauma services; as a result, they can keep intervention skills current. Peer supporters can themselves receive support from other departments.
However, there may be drawbacks to large programs. These include difficulty in responding to individuals and small crews, as well as difficulty in developing a close relationship with mental health professionals. Moderately sized programs tend to be more flexible and responsive to incidents of varying intensity.
Once the question of whether the program will serve one department or several, realize that there’s more than one way to organize it.
Some departments find that an informal organization coordinated by the chief or other administrators is most effective. Others use an advisory committee representing all facets of the department to coordinate the program. It’s also possible for the department or municipality’s employee assistance program to assume coordination responsibilities. The program’s administration relies on its size, the specific needs of the departments), and finances.
Who will pay?
As you make plans for program implementation, plan for the costs of all services, including training, printing, and public relations. Try to predict the approximate number of debriefings your department will have by reviewing calls during the past year that might have benefitted from instruction. It’s also important to have sufficient funds for the unexpected traumatic event.
Determine the cost of mental health professionals. Some are paid a flat fee; others are paid by the hour. Be sure to shop around. Fees vary greatly and you may be able to locate competent professionals at relatively low cost. Some may even volunteer their time.
Be creative in obtaining financial support; grants, workers compensation funds, insurance carriers, and donations from private business have all been utilized to support posttrauma programs.
The mental health professionals—psychologists, counselors, psychotherapists, social workers, psychiatric nurses, psychiatrists, and pastoral counselors—are required for debriefings and posttrauma counseling. Each has a specific area of expertise. These services require established generic mental health skills as well as special posttrauma skills.
Not all mental health professionals have worked with those experiencing posttrauma consequences. Fewer have experience with emergency service professionals. Before agreeing to work with any mental health professional or agency, ask them about their posttrauma and emergency services experience. If they haven’t provided such services, make sure that they receive proper training. This could delay the start of the program, but the correct training is essential. Mental health professionals should also have the right kind of personality. They shouldn’t be stuffy or use psychological jargon with personnel. Look for a combination of good professional skills, posttrauma experience, and an ability to relate well to emergency personnel.
Some final advice: Don’t rush implementation; while you can make adjustments and changes in your program, errors such as breaches of confidentiality can seriously impact effectiveness.
In the second part of this series, we’ll discuss issues important in the implementation of posttrauma program, including training, publicity, and policies.
