Public Safety professionals are exposed to potential psychologically traumatizing events on the job every day.  Workers in this industry see horrific scenes involving injury or death to their fellow man. Some may face a life-threatening event on the job, involving violence or the use of fire-arms.  The potential for psychological trauma in these professions should therefore be expected, and all measures of support should be granted, without question, to Public Safety Professionals and to the agencies that employ them.

It's estimated that through the course of human life, each of us will experience at least a single traumatic event.  The most common sources of trauma in the civilian population include witnessing someone being badly injured or killed; being involved in a fire, flood or natural disaster; or being involved in a life-threatening accident.  For most, resolution of such trauma will come naturally; however, an estimated 8% of persons who experience psychological trauma will go on to develop mental health disorders, the most common of which is Post Traumatic Stress Disorder (PTSD) (Carleton, 2014).

It's now accepted that soldiers who've experienced the traumatic stress of combat will develop this condition.  In the United States alone estimates suggest that of the 2.7 million veterans returning from service in Iraq and Afghanistan, over 500,000 will have PTSD as a consequence of their service (Veterans and PTSD).  Estimates of prevalence of PTSD in the general population worldwide are conservatively set at 8%.  In Public Safety Professions, prevalence of PTSD is determined to be 20-30% above the general population, a significant number (Carleton, 2014).

Currently in North America, acceptance of this consequence in Public Safety is fragmented at best.  Although change is starting to move in agencies who employ this group of professionals, much still needs to be done.  There are clear necessities that need to come to fruition for these workers and their families. 

​Should traumatic events in this workforce be mishandled, and PTSD develops, this can impose an end of career and life-long disability on a worker and on her family.

First of all, what's needed is education.  Many Public Safety workers report very limited training in regards to traumatic events on the job.  Few agencies have developed formalized education initiatives. 

Policies and Procedures as to what to do when one has experienced a trauma on the job are reported to be lacking as well.  So, the first things needed to better protect the well-being of these workers is quality education, and policies within organizations that reflect a full appreciation of the necessity to provide trauma-informed care.

Secondly, should a traumatic event on the job in this workforce lead to an onset of PTSD, workers need the full support of both their employer and their peers.  Any mental health condition in North American society comes with a mark of stigma.  Stigmatization leads many who may suffer psychological injury to not seek any form of helpful treatment at all. 

Given that this culture of stigma is quite evident in Public Safety Professions and Organizations, anti-stigma campaigns need to be included in any education initiatives brought forth to deal appropriately with this issue.

Many workers who are psychologically injured due to trauma report abandonment by both their employer and their peers.  Some say that this betrayal is more damaging than the initial trauma itself, adding insult to injury, making recovery that much more difficult to achieve.

It's important that this profession finds way to break down the barriers that such a culture of stigma can erect.

Finally, key to recovery from trauma in Public Safety Professionals is the receipt of appropriate treatments.  There are now some quality studies from military sources to support a variety of treatment modalities. 

​Cognitive Behavioural Therapy, delivered by trauma informed clinicians, is the most studied and accepted mode of available treatments. 

Eye Movement Desensitization and Reprocessing is another.

(Treatment of PTSD: National Center for PTSD).

The list of alternatives is actually quite vast, and given that each worker will respond to treatment differently, it's important to make available as many options as possible.  Trauma and PTSD take specialized provisions of care.  Regardless of delivered modality, it's therefore important that any care-provider is certified to practice and deliver fully trauma-informed services. 

There are biological, psychological, and social influences that lead to PTSD developing following exposure to trauma on the job.  It's therefore warranted that any such care be holistic, utilizing a Bio-Psycho-Social model in provision of appropriate supports (Dogar, 2007).

Traumatic experiences and potential consequences to the mental well-being of Public Safety Professionals are highly prevalent in the work.  Due to lack of education and the prevalence as well of stigma, many who experience trauma in the course of employment will develop PTSD, and some who are injured to this extent will never seek treatment.  Such issues in this workforce should be expected. 

Those who employ these workers need to therefore provide appropriate education, ant- stigma campaigns, and treatment supports, without question, for these workers.  These professionals are there for us, often in our own darkest hours of human need.  It's time we step up in society and address this issue by encouraging employers, and our Governments, to better support the evident need. 

These workers are there for all of us. 

Perhaps it's time we make necessary supports more available to them.

References
​
Veterans Statistics: PTSD, Depression, TBI, Suicide. (2015, November 25). In   Veterans and PTSD  . Retrieved, November 25th, 2015, from: http://www.veteransandptsd.com/PTSD-statistics.html

Facts About PTSD by National Center for PTSD. (2015, November 25). In Psych-Central.   Retrieved, November 25th, 2015, from: http://psychcentral.com/lib/facts-about-ptsd/
PTSD and First Responders. (2014, August 5).  Dr. R. Nicholas Carleton: In   The Conference Board of Canada: Hot Topics in Security and Safety.  Retrieved, November 25th, 2015, from: http://www.conferenceboard.ca/topics/securitysafety/commentaries/14-08-05/ptsd_and_first_responders.aspx

Treatment of PTSD. (2015, November 25).  In   PTSD: National Center for PTSD  .  Retrieved, November 25th, 2015, from:   http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp

Bio-Psycho-Social Model. (2007, January).  Dr. Imtiaz Ahmad Dogar In   Punjab Med. Review  .  Retrieved, November 25th, 2015,  Retrieved from: 
http://applications.emro.who.int/imemrf/Ann_Punjab_Med_Coll/
Ann_Punjab_Med_Coll_2007_1_1_11_13.pdf

Food for thought on Mental Health Injury by Ken McLeish

Virtually all of us who have chosen a first responder vocational path have done so because we have witnessed the successful actions of a service oriented professional, have been raised in empathetic families or have followed a desire to make a difference in the community where we live.

Mental Health Injury is an insidious and devastating injury changing the individual’s life in every way imaginable. Throughout my years as a paramedic I represented countless paramedics with health and wellness injuries; the most challenging were unequivocally associated with mental health stress reactions to situations occurring out of and in the course of their duties resulting in permanent disability.

It has been estimated that 24% of all first responders suffer from PTSD.

In recent years we have seen statistical leaps in suicidal completions in paramedics, firefighters, peace offers, emergency dispatchers and other related community support workers.

This unquestionably deserves the attention of the employer and the support services that are assume to be available. These terrible losses have occurred in relatively new workers,
seasoned active workers, as well as those in retirement. Post traumatic stress disorder knows  no boundaries.

What we see, what we do, what we are aware of, and what we do about it are the most
important considerations of our livelihoods. All of us come from different places with different  presets loaded into the foundation of our emotional resiliency.

​A psychological trigger for one individual is most often quite different for another.

A first responder suffering from post traumatic stress disorder is usually in denial before it is evident that something is very wrong. By the time the person understands the issues and seeks help they often have lost that professional vitality that was initially enjoyed.

They have lost their ability to perform and their judgement to be effective at work or at home. Families fail. A career is lost along with self respect and the ability to thrive.

One of the most unfortunate issues associated with work related mental health injury is the attitude of those we work with. With the self perceived shame the injured worker feels comes ridicule, isolation and harassment as those around them actively ignore what they do not understand.

I suspect much of that activity is fear based on what they do not understand about
themselves and their own well being. A first responder in trouble needs to be validated and recognized. No stones should be thrown as you never know if you might be next.

The optimistic view of this injury is that, if detected early and treated appropriately by an
informed health care professional, there is a good chance that life will be whole again with the support of family, friends and coworkers.

Stay well. Be a first responder to those you work with and around. Please share this as you see fit.

We need to see things change.

​​Ken McLeish

​Editor's Note: 

For the sake of those coming into service now from behind this member of the old-guard:
​
Those who haven't made it through psychologically unscathed need to see now a response that promises towards this issue that things will finally change.

​We want you all to stay safe.  Self-Care is far too often overlooked.

Consider this a duty, working together to enact such change.

Serve with honour, and leave not one psychologically injured first responder behind.

Always, every shift remember:

"​There but for the grace . . . . .."
​
Ken McLeish is a retired workers advocate and former paramedic with the British Columbia Ambulance Service now living a quiet life with his wife Audrey along the Sunshine Coast in British Columbia Canada.

Ken's Kayak and his pooches are always for Ken close by.
​
Thank you Ken for your service.  Enjoy your retirement.
​
Be Well and please, always . . . . . .
​
Mind How You Go.
​
​Please Join Our Campaign Calling on the Government of British Columbia to provide "Presumption of Illness" for PTSD as a provision granted BC First Responders under the Workers Compensation Act.