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Feature Article

PTSD in emergency service workers. When rescuers need rescuing

JOHN COOPER, ANDREA PHELPS, SAMUEL B. HARVEY
OPEN ACCESS

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Abstract

The prevalence of post-traumatic stress disorder (PTSD) among emergency service workers is more than twice that in the general population, yet diagnosis is often delayed. GPs can ensure patients with PTSD receive best-practice clinical care by being aware of how they can present, knowing how to enquire about symptoms among those who have been exposed to trauma and following new expert guidelines.

Key Points

  • One in 10 currently active emergency service workers will have symptoms suggestive of post-traumatic stress disorder (PTSD). Rates may be even higher among retired workers.
  • An emergency worker with PTSD may present with typical symptoms or other related problems, such as anger, relationship problems, sleep difficulty, substance abuse or a more general mental health crisis.
  • Repeated nonspecific presentations by current or former emergency service workers should raise suspicion of PTSD and prompt questions about trauma exposure.
  • Use of appropriate screening tools can increase the likelihood of PTSD being recognised.
  • It is often beneficial to obtain a second opinion from a mental health professional who has experience in managing emergency service workers or military personnel.
  • Gold-standard treatment is one of the trauma-focused psychological treatments such as trauma-focused cognitive behavioural therapy or eye-movement desensitisation and reprocessing.
  • Australian guidelines outline circumstances in which medication should be considered as a treatment option for an emergency service worker with PTSD.
  • Awareness of the increased risk of suicide associated with PTSD, especially among emergency service workers, is crucial.

When people are exposed to potentially traumatic events (PTEs), most demonstrate resilience; however, a minority can develop significant mental health problems. Posttraumatic stress disorder (PTSD) is the ‘signature’ mental health disorder that can occur after exposure to traumatic stress, yet other disorders including depression, anxiety disorders and substance abuse occur just as often. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has separated PTSD from anxiety disorders into a separate category, trauma- and stressor-related disorders.1

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PTSD and trauma

PTEs can be directly experienced or witnessed, or indirectly experienced by learning about a PTE having happened to a loved one. They include actual or threatened death, serious injury and sexual violence. Repeated occupational exposures to aversive details that regularly confront emergency service workers (e.g. collecting body parts or being exposed to the details of child abuse) are now also recognised as PTEs in the DSM-5 diagnostic criteria for PTSD.1

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Dr Cooper is a Consultant Psychiatrist at Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne. Associate Professor Phelps is a Clinical Psychologist and the Deputy Director of Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Vic. Associate Professor Harvey is the Chief Psychiatrist at the Black Dog Institute, Sydney; and Head of the Workplace Mental Health Research Program run jointly by the Black Dog Institute and UNSW Sydney, Sydney, NSW.