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Vivid flashbacks, intrusive thoughts and physical sensations such as pain, sweating and nausea are some of the common symptoms of post-traumatic stress disorder (PTSD). Doctors coined the term “shell shock” for these types of symptoms suffered by soldiers returning from fighting in the first world war.
A century later, although PTSD is well recognised as a risk for those who have been in active military service, the condition is still poorly understood among civilian workers in emergency services, who are also frequently exposed to traumatic events through their work.
That is something Matthew Walton, a doctor, and Alan Lofthouse, who represents ambulance workers in the UK health workers’ union Unison, intend to change. Walton has joined forces with another doctor, Mike Christian, to spearhead an initiative designed “to just give a simple but mass education on acute traumas and the responses that you might have to them”, Walton says.
They released a film and package of materials at the World Extreme Medicine Conference in Edinburgh in November. The information, which they intend to build on, will eventually be available free to all ambulance, police, fire and emergency organisations around the world. It aims to educate first responders and encourage medical staff to share their experiences and seek help if needed.
Lofthouse, a former paramedic, suggests prominent discussion of the impact of PTSD on those who have served in the armed forces has raised its profile more generally. “It only affects a small minority of staff, but it can be fairly catastrophic,” he adds.
Lofthouse describes the case of a paramedic who had attended a woman who had just given birth, having tried to hide the pregnancy. “When the solo paramedic arrived, he had a baby to resuscitate, and a mother who was bleeding heavily as well, so also [had to be] resuscitated.
“They both survived, but he had a series of issues over the next three to four months that he didn’t recognise, and nobody else recognised.” Lofthouse adds that with hindsight, people “spotted some signs in him that something wasn’t right, but nobody knew how to mention it”. Fortunately, he says, the man’s GP diagnosed possible PTSD and was able to get him specialist help.
“It’s difficult to diagnose, and it needs specialist interventions. That’s the bit for employers that maybe they’re not quite so good at, because generally they offer a standard employee assistance programme, counselling services 24 hours a day, and four or five sessions with a counsellor, but it’s much more complicated than that.”
Walton says he first became interested in PTSD two years ago, working for the ambulance service when he was still a medical student. “We went to one job, a child fatality — basically a cardiac arrest from a trauma.” This intensely negative psychological experience, however, was mitigated by Christian with whom he was working.
“He was the first person to explain to me: ‘Following this, you’re likely to experience intrusive thoughts, remembering the event. It might last for quite a long time, and it could come out at unexpected moments, but that’s totally normal and you don’t need to worry about it’.”
Walton says this was something he had not been told about as a medical student, but that it was “helpful to have that really simple education”.
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 per cent said they had suffered stress, low mood and poor mental health at some point and 62 per cent had experienced a mental health problem, such as depression or PTSD. In response, Mind launched its Blue Light programme in 2015. This provides support services, including a confidential information line and training for managers to help them identify and support staff who might be struggling.
Emma Mamo, head of workplace wellbeing at Mind, says employers have a duty to help. Adjustments, she says, “needn’t be large or expensive — things like changes to hours, roles or responsibilities, providing quiet rooms and ensuring staff take regular breaks can all help”.
“There’s no one-size-fits-all approach to supporting co-workers affected by PTSD. It’s really important to ask people how they’re doing. Staff may not want to open up straight away, but at least they know they can talk when the time is right.”
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