Post-Traumatic Stress Disorder Among EMS Providers
PTSD is becoming a serious problem amongst EMS providers. In fact, since 9-11 the numbers of providers affected has become so large that we are experiencing an all-time high of providers who turn to drugs, alcohol, violence, and even suicide in order to cope with the things that they have experienced on the job. The DSM-5 recently changed what the criteria for PTSD is and moved it to its own specific trauma related category. EMS providers in FL have been fighting for workman’s comp in order to receive counseling services since the massacre at Pulse nightclub. Because PTSD was never defined as a physical injury, lawmakers in FL have been apprehensive to give EMS providers workman’s compensation to cover those costs. Recently the University of Central Florida has developed a clinical program funded by the Department of Defense to help first responders suffering with PTSD. After years of debate, the Florida senate finally passed a new bill that allows first responders to apply for workman’s compensation benefits as well. The government finally realized that while first responders are the caregivers in the wake of such horrific events, that the also often need care following these events, and people are finally able to get the help that they need in order to move on and live a normal life again. In order to talk about PTSD, we have to define what PTSD actually is.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) moved PTSD away from the “anxiety disorders category, ” and placed it into a brand “new category named trauma and stressor-related disorders”. Not only did the DSM-5 change what category PTSD is under, they also added specific criteria labeled A through H which breaks down what constitutes as PTSD on a clinical level, all of which are required in order for a patient to be diagnosed with PTSD, which can make it hard for a person to actually get diagnosed, as not everyone has the same symptoms, which can lead to individuals not getting diagnosed and unable to get the help they desperately need. Some examples of what is needed to qualify for being diagnosed with PTSD are as follows, “direct exposure, witnessing the trauma, nightmares, flashbacks, physical reactivity, trauma related thoughts or feelings, feeling isolated, inability to recall key features of the trauma, aggression, risky or destructive behavior…”.
Other key features are that the person effected must show symptoms for at least one month, prove that they are impaired by said symptoms, and prove that the symptoms are not due to medications, whether prescriptions or substance abuse. Although there seem to be a lot of hoops to jump through to be diagnosed with PTSD, the new categorization has actually helped a lot of people define what they are experiencing and come away with a true diagnosis. When working in emergency medical services, you are bound to come across a scene that will put you through a great deal of distress, whether it happens at the beginning of your career or the end, it’s inevitable. Because first responders are the first ones on scene, they are often exposed to traumatic scenes, and can experience a great deal of stress. It has been estimated that “exposure to traumatic events was reported to be between 80% and 100% among EMTs, and rates of PTSD are greater than 20%.
Imagine going to work every day and seeing people dying on a regular basis, how would you cope with that? Most first responders turn to drugs, alcohol, and other high-risk activities to numb them from what they went through throughout their shift, which typically last 24 hours. Once they get home from their long shift, they are expected to be providers for their families, take care of the household, and be pillars for their communities. But how can one be all of these things when they are having nightmares from seeing a pregnant woman be shot, or watching a child die from abusive parents? First responders need help. They need assistance in order to get the mental health care that they need and deserve in order to move past the awful things that they encounter and lead a healthy and fulfilling life. This includes immediate debriefing after traumatic events and ongoing counseling in order to maintain their sanity. We also need to let first responders know that it is ok to ask for help. According to an anonymous study done of 546 first responders in November of 2016, it is estimated that “only 55% of respondents have ever received any information or education about PTSD and only 13% of respondents ever sought treatment for PTSD”. This needs to change, in order for those affected to seek help, they have to know that there is help available and that it is ok to ask for help. Just because first responders spend their lives helping and caring for others, doesn’t mean that they shouldn’t receive the same care that they put forth.
One of the largest causes of PTSD in Florida is the Pulse nightclub shooting that happened in June of 2016. Not only did emergency medical crews respond to the disaster to provide care for those that were severely injured, many also spent hours preparing bodies to be sent to the morgue. According to Josh Granada, a paramedic for the Orlando Fire Department, him and his partner “spent the night ferrying 13 people who had been shot at Pulse to the hospital. Before showering, they threw away their uniforms” as they didn’t want to “put that much blood in the washer. ” According to Brian Stilwell, an EMT also working for the Orlando Fire Department who was one of the first on scene, when the sun came up he noticed “a pool of coagulated blood in front of the station. ” Knowing that it must have come from a victim of the Pulse massacre, he “wondered if the man survived the night. Than with a bucket of bleach and water, he helped clean the blood off the concrete. ” Even police officer Gerry Realin was extremely affected by the events. He states that he was called in from vacation to help sort and prepare the bodies for the morgue. Once he was able to go home, not till the next morning, he checked on his wife and children before heading to the shower. While in the shower his “wife overheard him crying and saying over and over again how sorry he was for the victims”. These are only three small examples of those affected by the Pulse massacre in Orlando. Many others are still battling from PTSD after working the Pulse nightmare, and many will still battle with PTSD symptoms for a very long time, if not forever. In order to combat those that were affected by the Pulse nightmare, UCF developed the UCF Restores clinic, which puts first responders through three weeks of exposure therapy. “In total, 26 Pulse first responders have been evaluated by or treated at the UCF Restores clinic, out of those 26 an estimate of 60 to 70 percent no longer meet the diagnostic criteria for PTSD”. This clinic is one of the first of its kind in the state of Florida and has received federal and state funding, as well as private donations and now has a staff of fully licensed clinicians.
Prior to the Pulse massacre, the clinic didn’t even have a psychiatrist available and was run mostly by students. The UCF Restores clinic “uses exposure therapy, which repeatedly puts PTSD suffers in situations that make them anxious. When nothing bad happens, their fears of the triggers lessen, and the panic goes away over time”. The Restores program even uses specialized technology such as virtual reality headsets and specialized scents to recreate each scene. For example, a firefighter suffering from PTSD may put on a virtual reality headset and be asked to navigate through a building that is set on fire, virtually of course. The firefighter would see the fire and then smell the smoke coming out of the specialized headset and be asked to put out the fire and return his team to safety, thus lessening the fear he may have had when he first started his therapy sessions. “So far, they’ve treated about 260 military veterans and 40 first responders”. In addition to exposure therapy, PTSD suffers can also have one on one sit downs with a counselor or go to a group therapy session. The Restores clinic also offers anger management classes and gives tips and tricks for falling asleep when one is feeling anxious. Because the program is still new, Doornbos explains that “the success rate among firefighters is too early to measure, but two studies of military personnel have proved successful with only a 4% relapse. What UCF did for the community is truly remarkable, and hopefully someday soon it will be available worldwide.
While anyone can go to the UCF Restores clinic to be treated, there are still thousands of first responders that are searching for care, as most states do not require employers to pay for PTSD issues through workman’s compensation. This issue has been hotly debated in the state of Florida for some time now. Because the state didn’t see PTSD as a physical issue or illness, they would refuse funding, but all of that has recently changed. As of late March 2018, Governor Rick Scott signed the SB376 bill that now allows first responders to apply for workman’s compensation benefits due to PTSD related events “even if they do not sustain a physical injury”. The new bill allows those affected to even recover lost wages under special circumstances. With this in place, thousands of those affected will finally be able to get the help they need in order to recover from PTSD and move on with their lives. Hopefully other states will take notice and follow suit. With all the help in the world, first responders are still going to be at a high risk for developing PTSD. We can’t stop at fixing those that have already been affected. It’s time to take a stand and offer classes on PTSD and how to prevent this disorder before it even happens.
The change needs to start in EMT school, I believe that there should be a dedicated class directed to violence that can be encountered in the field, and how one may feel after losing a patient. These are things that we aren’t going to be equipped to deal with if we aren’t taught coping mechanisms in the first place. Because the suicide rate is so high among first responders after major incidents, this is something that should be brought to the forefront and not just something discussed in one day simply because it’s a single chapter of our textbook. I am however grateful that there is somewhere to go and receive help if I ever encounter an event that could give me PTSD, and that I would be covered under state law if need be. Hopefully that never happens, but it’s nice to see that Florida is really making a great change for all first responders and their futures.
