Emergency Services Personnel & Chronic PTSD

 

Personnel within Police, Ambulance, Fire and Rescue and the voluntary emergency organisations of  State Emergency Services (SES), rural fire service, coast guard and lifesavers are repeatedly  exposed to potentially traumatic experiences while carrying out their work, including witnessing individuals who have been badly hurt, seeing deceased bodies, witnessing suicide attempts, motor vehicle accidents, extreme acts of violence and drug abuse. They may be directly threatened or as is the case for Police, have to wound or kills others to successfully carry out their duties. It is not surprising therefore, that many emergency services personnel develop a special type of PTSD called chronic PTSD.

Unlike single episode PTSD or complex PTSD, chronic PTSD is characterised more by anger and guilt than fear or horror of traumatic experiences, and develops as an accumulation of distress over time and traumatic events. Symptoms including sleep disturbance, nightmares, feeling numb and detached from others, being keyed up and on edge and finding it hard to wind down, being easily startled, and turning to substances like alcohol to self-soothe are common. These symptoms tend to build over a prolonged period of time but they can also occur after a single traumatic event also. Many emergency services personnel, due to the nature of their work, become sensitised to traumatic events and display more extreme responses in severe situations while lesser severe traumatic experiences that would not normally cause distress begin to generate mental health problems. Sometimes subsyndromal symptoms of PTSD can exist which means that the emergency services personnel may have the same symptoms of chronic PTSD but to a lesser intensity. However, once these symptoms are present, they can become chronic over time and cause greater anger and hostility, higher rates of co-morbid depression and suicidality in addition to impacting professional and personal life.

Unfortunately, there is a stigma surrounding chronic PTSD in emergency services personnel that is not helped by the ‘suck it up’ culture of the emergency services organisations in Australia, and the complexities of diagnosis and treatment when there are multiple mental health disorders. However, unsurprisingly, a lot of emergency services personnel with chronic or subsyndromal PTSD are reluctant to openly seek help from their doctor or psychologist due to the fear of losing their career.

With the right psychological treatment, it is not only possible to recover from chronic PTSD or subsyndromal PTSD but it is also possible to make a meaningful return to work even if in a partial capacity. If a collaborative, understanding and respectful approach can be built between the treating psychologist, doctor, psychiatrist, return to work coordinators and insurer, and the employer, then it has been possible for many of my clients to return to normal operational duties or else find alternative deployment within their organisation or launch new careers in aligned professions with the support of workers compensation.  Chronic PTSD in emergency services personnel is not necessarily a quick fix within 6-12 sessions of trauma-focused CBT, CPT or EMDR, but a tailored treatment plan that uses these evidence based approaches can heal traumatic memories and the the posttraumatic symptoms that have evolved over time as a result of repeated and prolonged exposure to traumatic events.