How to Reduce and Avoid PTSD Among First Responders

 
In the treatment of PTSD, Cognitive behavioral therapy (CBT) has been proven to be among the most effective remedies for those exposed to a traumatic event. Early intervention and perception of traumatic events play a key role in recovery.

The author, Michael Coupland is a former emergency services psychologist in Canada, embedded for 20 years in city police and RCMP detachments, fire and ambulance service departments.  Michael is the co-author of the American College of Occupational and Environmental (ACOEM)’s Psychological Fitness for Duty toolkit & an American Medical Association (AMA) Guides textbook and is a former AMA Faculty Member for Mental Impairment Rating Training. Michael is the CEO and Network Medical Director for Integrated Medical Case Solutions, which provides Post-Traumatic Stress Disorder (PTSD) assessment and treatment for first responders throughout the United States.

 

The aftermath of a traumatic event is a crucial time for anyone exposed. With proper support and treatment, most individuals can move past the horrific experience and get back to their lives. But those who must fend for themselves and don’t have access to proper care can develop full-blown Post-Traumatic Stress Disorder.

It is with that knowledge that states are increasingly adopting and expanding workers’ compensation coverage for first responders who have experienced a traumatic event and show symptoms of PTSD. Florida recently changed its law to include indemnity as well as medical benefits for traumatized first responders. The new law combined with preventive strategies shown to mitigate or avoid PTSD symptoms could make a significant difference for workers affected by traumatic events as part of their jobs.

 

Posttraumatic Reactions

An important aspect in treating someone who has experienced a traumatic event is helping him understand what he might feel, and strategies that can help. It is also imperative to ensure these workers are aware of techniques that, while seemingly effective, can actually have a negative impact.

People use a variety of coping strategies to help them avoid and eliminate PTSD symptoms. Some use emotion-focused methods, where they try to change the negative interpretation of the situation and reduce the intensity of their emotions by daydreaming, distraction, diversion or other techniques to avoid thinking about the event.

Unfortunately, this doesn’t work and may even exacerbate symptoms. A Canadian study of police officers who had experienced traumatic events showed some officers had engaged in this behavior and encouraged others to also.

The researchers found this ‘passive management of emotional reactions’ was ineffective at best. In fact, it became a risk factor for developing PTSD. Some who used this strategy required additional help to eliminate this technique and use other, more effective methods.

There are additional risk factors that may occur after the fact that must be understood and monitored to prevent PTSD. Having an insufficient amount of time off work to recover, dissatisfaction with the support offered in the workplace and the lack of support outside of work after the event were predictors of symptoms. Negative life events that occur subsequent to the trauma, such as marital difficulties, financial problems, or the illness or death of someone close were also identified as post-traumatic risk factors for developing PTSD.

A trained professional with experience helping workers post-trauma can recognize these and other risk factors and help the individual cope with his stress. After immediate and secondary treatment has been provided, a focus on the longer-term help for the first responder is needed.

Tertiary Help

 
The clinician’s goal should be to reduce the person’s risk factors and help him acquire techniques that protect him from PTSD symptoms. That requires understanding the specific needs of each individual, as there are a variety of factors that may be at play. It cannot be a one-size-fits-all mentality.

For example, the first responder may have comorbidities, such as major depression. The person’s current psychological state and possible co-occurring conditions must be taken into consideration to design the proper treatment.

Additionally, the risk factors and protective mechanisms may be different for different populations of first responders — men vs. women, or EMTs vs. police officers — and may vary because of the type of trauma involved.

Among the actions the clinician can take to help the first responder are:

• Showing them effective coping strategies.
• Helping them build their sense of self-efficacy.
• Working with them to change their negative or unrealistic thoughts; such as blaming themselves for the event.
• Helping them become more resilient by emphasizing situations where they have some control.
• Urging them to regard stressful situations as challenges.
• Encouraging them to commit to important goals.

While the treatment for each person will be different, it must be based on empirical evidence. Cognitive behavioral therapy (CBT) has been proven to be among the most effective remedies to help people who have been exposed to a traumatic event.

CBT is short-term and goal oriented. The person engaged in CBT learns valuable techniques to manage his stress and symptoms. Even first responders who have multiple PTSD symptoms generally recover within a few months when they are given CBT.

 

Conclusion

Working with first responders who have been exposed to a traumatic event can be a very rewarding as I see them recover and get back to their lives. The message I would send to any state considering full workers’ compensation coverage of PTSD for first responders is to make sure these workers have access to the best treatment immediately after a traumatic event. That is how we can best protect those who deal with horrific events in the course of their work.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.