Effects of Posttraumatic Stress Disorder on Paramedics

Introduction

Ambulance paramedics are probably the most important people in many societies. These are the people responsible for the healthy wellbeing of the public at night when some incidents are least expected. Because these personnel usually respond to emergencies, they suffer the most from post-traumatic stress after handling such incidents. Besides the horrifying incidents they have to witness, these paramedics work for a long. They sometimes work late into the night and during night shifts. This means that they get less sleep than normal medical personnel. Sleep deprivation has health consequences. It is not surprising that paramedics suffer most from the effects of posttraumatic stress disorder.

An understanding of the effects of posttraumatic stress disorder, factors that make it conducive for paramedics to suffer from the disorder, and ways that the effects of the disorder can be reduced are important. This will help keep paramedics healthy by arming them with information that can help them avoid the disorder. Healthy paramedics will be able to carry out their duties with efficiency and accuracy. They will be able to assess the health needs of patients, administer the right medication for the ailments, ensure the safety of the patient as they transport them to the hospital, and the paramedics will remain healthy.

It is common for persons suffering from posttraumatic stress disorder to act in a weird manner. Some of these behaviors can cause them to inflict injury upon themselves and those close to them. Helping them deal with and manage the effects of posttraumatic stress disorder ensures the health and safety of the paramedics, the patients under their care, family, and friends of the workers.

The purpose of this paper is to search, read, and critically review scientific literature already published on the subject of the effects of posttraumatic stress on paramedics. Through the analysis of the literature, the paper shall identify the much that is already known and recorded about the topic, the usefulness of various aspects as recorded in the research papers, the various limitations of the studies in terms of scope, methodology, data gathering and analysis criteria, the relationship between the various studies, and the knowledge gaps that exist among the various studies and how they can be filled.

Materials for this study will be selected based on merit. Peer-reviewed articles are highly preferred because of their quality and credibility. These sources have been read and approved by experts and will provide useful information for the study. Besides, only recent articles will be used. These are articles written not later than 2005 to ensure that they capture the most recent aspects of posttraumatic stress disorder among paramedics.

Body

Various databases were searched through the internet to find the right articles with the required information.

Methodological Issues

Elhai et al (2005) gives a methodological platform for the study of the effects of posttraumatic stress disorder. Elhai and the rest set out to gather evidence on the experiences of paramedics and how the experiences affect them emotionally and lead to PTSD. The study surveyed 227 participants through the internet. The study subjects the participants to assessment instruments in clinical and research settings. The most common research tests done include Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder Scale, Impact of Event Scale-Revised, and the Trauma Symptom Checklist for children.

The most useful aspect of this research is the assessment of the level of traumatic stress registered among paramedics with various qualifications. According to the study, the level of education among paramedics does not affect the effects of PTSD incurred during work. Paramedics who have worked for a short time and those who have worked for a long time handle trauma differently. PTSD among these groups is less differentiated.

This study is limited in scope as it emphasizes tests of measuring the effects of PTSD and less on the effects themselves. The research needs to look more into the effects of PTSD and how they can be minimized and controlled to enhance the health and safety of paramedics and their patients.

Lowery and Stokes (2005) conducted an exploratory study among 25 paramedic students. The study was aimed at testing and predicting the importance of the reverse buffering hypothesis of social support and PTSD. This study was in the larger context of trauma-related symptomatology. Similarly, the study by Porter and Johnson (2008), and Lowery and Stokes (2005) subjected participants to performance of self-assessment reports measuring PTSD. Factors under study were the impact of peer social support, and one’s attitude towards the expression of emotional stress. Regression analysis did not support the hypothesis under test by the study. Therefore, it was established that there exists a direct relationship between the exposure of trauma during work, poor social support from peers, and negative attitude by students towards expression of one’s emotions.

It is necessary and healthy for paramedics to openly express their emotions during and out of work to trusted friends and colleagues. Inhibiting such an expression is an avenue for the development of PTSD.

Porter and Johnson (2008) carried out a similar study to the one done by Elhai and the rest. Using a randomized controlled pre-test and post-test design, Johnson and Porter seek to establish the factors that make one susceptible to PTSD. These factors can be produced both internally and externally. They include support from peers, one’s attitude toward emotional expression, and one’s coping capabilities. The study also seeks to find out the interventions that are most effective between the group and personal counseling.

A significant number of correlates were identified through the study. The trends that emerged from the study imply that internal factors are more influential in exposing one to PTSD than external factors. Support from friends, trusted colleagues, and family, plays a great role in limiting the possibilities of occurrence of PTSD among paramedics. Emotional resilience was the greatest factor in controlling PSTD.

Porter and Johnson were limited in the scope of the study. The study used students in their final year of college to solicit the information. This approach is problematic because these students have not gained sufficient exposure. Most of their practical experiences in the field are controlled and under the supervision of their superiors. This denies them the chance to fully experience the impacts of traumatic experiences. This gap would be filled by a study on accomplished paramedics, who have spent a substantial amount of time in the field and handled major operations. This would give a clearer picture and analysis of what factors can enhance or limit the possibility of PTSD.

Contributing Causes of PTSD

Schaefer et al (2007) studied factors that led to PTSD. Their focus was on the stability of environments that paramedics worked in and how stability or lack of stability led to paramedics suffering PTSD. According to the study, the rate of PTSD in unstable societies is higher than that in stable societies. Paramedics who work in unstable societies, such as those of Africa and Asia, showed increased signs of PTSD than those who worked in the relatively stable societies of Europe.

Unstable societies experienced a large number of traumatic events, which increased the level of PTSD among paramedics who tended to these events. These societies exhibited the following factors that led to an increased level of PTSD among paramedics: depression, functional impairment, and a high number of traumatic events. These factors were relatively less in stable societies. These results help inform paramedics of places of work that are highly likely to make subject them to PTSD.

Alden et al (2008) explore the effects of witnessed and direct trauma on paramedics and how the two contribute to PTSD. Most studies indicate that PTSD is largely caused by traumatic experiences by a paramedic upon self. Alden and the rest state that paramedics who witness a traumatic event upon a patient suffer PTSD in equal measure as if they experienced the event themselves.

There are differences in the symptoms that the two will exhibit. Those who experience traumatic events in person will tend to be more fearful, experience arousal symptoms, and have higher levels of job dissatisfaction. Those who witness the event, on the other hand, will direct the PTSD symptoms experienced to personal weakness and their inability to deal with what they saw.

This research only touches on the different responses to the different types of trauma. There is a need for a more comprehensive study on the various types of traumatic stressors, the various responses by paramedics to the stressors, and the varying chances they have for causing PTSD and the severity of the PTSD they can cause. This will make it easier for paramedics to fight PTSD.

Balducci et al (2009) describe mobbing as one of the contributing causes of PTSD among paramedics. Most paramedics experience and take part in mobbing events while on duty. They experience mobs in accident scenes, fires, and persons acting ill in public. Balducci and the rest set out to show that the paramedics who experience mobbing develop neurotic components that elevate on the scales of 1, 2, and 3. This carries a paranoid component as indicated by elevations of up to 6. According to this study, there is a positive correlation between the frequency of one’s exposure to mobbing and the occurrence of PTSD.

People who get exposed to mobbing more frequently and to extreme extents show higher symptoms of suicidal ideation and behaviors. They also suffered the greatest PTSD, and depression was the common among them. This study, however, does not highlight ways of dealing with PTSD or give ways that paramedics can use to reduce incidents of mobbing. It only identifies the causes. There is a need for a way of reducing incidents of PTSD to be identified.

Gallagher & McGiloway (2009) say that one of the causes of PTSD among paramedics is Critical Incident Stress (CIS). In spite of the accomplishments of paramedics in handling stressful events well, they still inhibit feelings of emotional exhaustion and become detached from themselves. CIS has a negative impact on paramedics, and if they are not well counseled, paramedics exposed to CIS are highly likely to develop PTSD. Occupational health and hospital psychologists need to provide routine support for paramedics who experience CIS to prevent them from developing PTSD.

Symptoms of PTSD

Price (2007) identifies ego defenses and core schemas that act as symptoms to one having PTSD. People with PTSD will exhibit some or all of the four core schemas: defectiveness, dependency, enmeshment, and failure. On the other hand, they will exhibit the following defense mechanisms; splitting, rationalization, and projection. Persons with PTSD will naturally find ways of coping with traumatizing situations, because their systems are already traumatized and stressed.

These people will tend to be fearful of meager things, and seek the help of their companions or family members with virtually everything because of fear. They will attempt to defend their actions, even when they are not right. This is because they fear the consequences, they depend on others, and will mostly fail in things they do because they lack self-confidence. These core schemas and ego defenses are consistent with the present cognitive and psychodynamic conceptualizations of PTSD. This calls for further research into more symptoms of PTSD to enable early detection of PTSD and quick medical intervention.

Effects of PTSD on Paramedics

LeBlanc et al (2005) acknowledge that paramedics face several stressors in their line of duty. These stressors can have devastating effects on the paramedics, affecting the quality of their job performance. Their research focuses on the effects of stress, including PTSD on their emotional response and performance during work. Comparing the effectiveness of dosage calculation between two groups of paramedics, the research found great disparities caused by stress. One group of paramedics calculated dosage in a quiet stress-free room, while the other calculated the same in a noisy room with commotion. The group in a noisy room had a mean accuracy of 45%, while that in a quiet room was at 95%.

One evaluation also was whether the level of work experience affected the level of accuracy in both groups. In the end, neither work experience nor level of education mattered in the amount of accuracy exhibited. Performance was solely dependent on the level of stress that one had. This study indicates that occupational stress and PTSD increase possibility of medical errors. Stress acts indiscriminately and can affect even the most experienced and educated persons. Persons with PTSD stand a higher chance of committing more medical errors during work.

There is a need for more studies on the mechanisms through which stress and PTSD influence medical performance. This can help in the development of technological interventions for the tasks mostly affected when paramedics act under stress.

Interventions for PTSD

Berger et al (2007) carried out a survey on the impact of PTSD among paramedics in Brazil. A high number of male paramedics who suffer full PTSD are not married. The figures stand at 76% compared to the 43% who were married. This shows that the family has remedial values for paramedics and helps to reduce the impact of trauma. One of the reasons for this is that a married man has someone close to them, with whom he can share his experiences.

Paramedics who have PTSD show signs of impairments in the physical and emotional domains. Such impairments can include emotional instability, lack of attention and alertness, inability to concentrate, and possible memory loss. The extent of the impairment varies, depending on the amount of trauma experienced and personal resilience to deal with the trauma.

Prati et al (2010) propose the stress and coping theory as a possible intervention for PTSD. The interaction between primary and secondary appraisal helps in determining how one copes with stressful events and the resultant quality of life. According to the social cognitive theory, self-efficacy serves as a buffer zone for the impact of stressful encounters and the quality of life in one’s profession. Paramedics who had self-efficacy, and applauded their actions and those of their colleagues reduced the possible harm of PTSD.

Such appraisal acts help to boost the ego and spirits of the paramedics, in spite of the stressful situation. High spirits of the paramedics elevate the feelings of failure and any bad memories of the event, thus reducing the effect of the witnessed trauma. There is need for a more elaborate scientific research to show how appraisal and self-efficacy work in the body of an individual to alleviate stress.

Drewitz-Chesney (2012) infers from the Ottawa charter to come up with a solution on PTSD among paramedics. Hospitals need to institute mandatory counseling services to call paramedics to help them deal with PTSD at initial stages. Paramedics are encouraged to support one another during operations and out of work. Establishing good relationships amongst themselves is important in helping them to deal with emotional lock-ups that can eventually lead to PTSD. Paramedics who attend frequent counseling are better equipped to cope with PTSD compared to those who do not. Male paramedics are the ones who are affected most because of an increased negative attitude towards emotional expression among them. Female paramedics, on the other hand, talk about the trauma they experience, thus reducing the harm.

Shifting paramedics often in places and the nature of the assignment is another intervention that can reduce the harm of PTSD. Changing operations help the paramedic forget and let go of some of the trauma inside. New experiences will charm him up, reducing the impact of PTSD.

Conclusion

From the study above, it is clear that paramedics have high chances of developing PTSD because of the high levels of trauma they get exposed to in duty. The traumatic events that paramedics experience directly and those they witness on patients are the leading causes of PTSD. Individual body mechanisms and the amount of internal resilience in one play a big role in determining the rate at which they develop PTSD and the severity of the condition. Social relationships play a big role in mitigating the effects of trauma. Paramedics who share the traumatizing events with those close to them have reduced chances of developing PTSD compared to those who do not open up. It is for this reason that more male paramedics suffer from PTSD than female paramedics.

The effects of PTSD range from simple to severe and can cause problems for paramedics in the workplace. As the accuracy levels of paramedics with PTSD reduce, so does their ability to effectively serve patients. Therefore, paramedics with PTSD are not fit to take part in critical tasks on their own, such as prescribing medicine. There is a need for more extensive research on the types of trauma and their various resultant effects on individuals using scientific proof. This will enable paramedics and counselors to access the right information and interventions for PTSD.

Reference List

Alden, L., Regambal, M., & Laposa, J. (2008). The Effects of Direct Versus Witnessed Threat on Emergency Department Healthcare Workers: Implications for PTSD. Journal of Anxiety Disorder, Vol. 22(8): 1337-46.

Balducci, C., Alfano, V., & Fraccaroli, F. (2009). Relationships Between Mobbing at Work and MMPI-2 Personality Profile, Posttraumatic Stress, Symptoms, and Suicidal Ideation and Behaviour. Violence & Vicimst, Vol. 24(1): 52-67.

Berger, W.,Figueira, I., Maurat, A., Bucassio, E., Vieira, I., Jardim, S., Coutinho, E., Mari, J., & Mendlowitcz, M. (2007). Partial and Full PTSD in Brazilian Ambulance Workers: Prevalence and Impact on Health and on Quality of Life. Journal of Traumatic Stress, Vol. 20(4): 637-42.

Drewitz-Chesney, C. (2012). Posttraumatic Stress Disorder among Paramedics: Exploring a New Solution with Occupational Health Nurses using the Ottawa Charter as a Framework. Workplace Health& Safety, Vol. 60(6): 257-63.

Elhai, J., Gray, M., Kashdan, T., & Franklin, C. (2005). Which Instruments are Most Commonly Used to Assess Traumatic Event Exposure and Posttraumatic Effects? A Survey of Traumatic Stress Professionals. Journal of Traumatic Stress, Vol. 18(5): 541-5.

Gallagher, S., & McGiloway, S. (2009). Experience of Critical Incident Stress Among Ambulance Service Staff and Relationship to Psychological Symptoms. Journal of Emergency Mental Health, Vol. 11(4): 235-48.

LeBlanc, V., MacDonald, R., McArthur, B., King, K., & Lepine, T. (2005). Paramedic Performance in Calculating Drug Dosages Following Stressful Scenarios in a Human Patient Simulator. Pre-hospital Emergency Care, Vol. 9(4): 439-444.

Lowery, K., & Stokes M. (2005). Role of Peer Support and Emotional Expression on Posttraumatic Stress Disorder in Student Paramedics. Journal of Traumatic Stress, Vol. 18(2): 171-179.

Porter, S., & Johnson, A. (2008). Increasing Paramedic Students’ Resiliency to Stress: Assessing Correlates and the Impact of Intervention. College Quarterly, Vol. 11(3): 43-56.

Prati, G., Pietrantoni, L., & Cicognani, E. (2010). Self-Efficacy Moderates the Relationship Between Stress Appraisals and Quality of life Among Rescue Workers. Journal of Anxiety Stress Coping, Vol. 23(4): 463-70.

Price, J. (2007). Cognitive Schemas, Defense Mechanisms and Post-traumatic Stress Symptomatology. Journal of Psychological Psychotherapy. Vol. 80(3): 343-353.

Schaefer, F., Blazer, D., Carr, K., Connor, K., Burchett, B., Schaefer, C., & Davidson, J. (2007). Traumatic Events and Posttraumatic Stress in Cross-cultural Mission Assignments. Journal of Trauma Stress, Vol. 20(4): 529-539.

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