Traumatic Stress Traumatic Stress ReactionsReactions

Objective:Objective:

To be able to recognize PTSD & To be able to recognize PTSD & ASDASD

Related DisordersRelated Disorders

PTSDPTSDPost traumatic Stress DisorderPost traumatic Stress Disorder

Definitation:Definitation: An experience affecting human behavior An experience affecting human behavior

over a over a period of timeperiod of time outside the range or outside the range or normal experience that most people would normal experience that most people would consider upsettingconsider upsetting

PTSDPTSDContinuium Symptoms Continuium Symptoms

Different reactions in everyone:Different reactions in everyone: Many will resolve the trauma with out Many will resolve the trauma with out

assistanceassistance Symptoms subside after talking about Symptoms subside after talking about

trauma trauma TimeTime Early symptoms stay or worsenEarly symptoms stay or worsen Result in personality changes Result in personality changes Chronic symptomatic presentationChronic symptomatic presentation

PTSDPTSDContinuum SymptomsContinuum Symptoms

Secondary conditionsSecondary conditions Personality changesPersonality changes Dependency on drugs and alcoholDependency on drugs and alcohol IsolationIsolation Coping skillsCoping skills DenialDenial Affects anyone regardless of age, rank, Affects anyone regardless of age, rank,

experience experience

ASDASDAcute Stress Disorder Acute Stress Disorder

Definition:Definition: An An immediate stress reactionimmediate stress reaction outside the outside the

range or normal experience that most range or normal experience that most people would consider upsetting.people would consider upsetting.

ASDASDAcute Stress DisorderAcute Stress DisorderContinuim SymptomsContinuim Symptoms

Fear and anxiety Fear and anxiety (not stand alone symptoms)(not stand alone symptoms)

Racing heartRacing heart SweatingSweating Shallow breathingShallow breathing FearFear Intrusive memory of eventIntrusive memory of event SadnessSadness Mild anxiety-Mild anxiety-(normal reaction)(normal reaction)

ASDASDAcute Stress DisorderAcute Stress DisorderContinuim SymptomsContinuim Symptoms

Not wanting to talk about the incident is Not wanting to talk about the incident is normal.normal.

Thinking about the event over the next few Thinking about the event over the next few days is normaldays is normal

Talking about it may help work threw the Talking about it may help work threw the problem.problem.

Post incident debriefing.Post incident debriefing. Kitchen table in the fire house.Kitchen table in the fire house. Gallows humorGallows humor

ASD & PTSDASD & PTSDCrisis Intervention awarenessCrisis Intervention awareness

Discussion:Discussion: What are we looking for in ourselves and or What are we looking for in ourselves and or

fellow firefighters.fellow firefighters. Define Acute and ChronicDefine Acute and Chronic What is your next step over and above What is your next step over and above

“normal” reactions.“normal” reactions.

DTSD& ASDDTSD& ASDClinical ClasificationsClinical Clasifications

Anxiety DisordersAnxiety Disorders Main features include symptoms of anxiety Main features include symptoms of anxiety

and avoidance behaviors. and avoidance behaviors.

Difference:Difference: Predominant symptom is not anxiety bt re-Predominant symptom is not anxiety bt re-

experiencing of a traumatic incident through:experiencing of a traumatic incident through: Intrusive recollectionsIntrusive recollections flash backsflash backs NighmaresNighmares

Recurrence of SymptomsRecurrence of Symptoms

ASD & PTSDASD & PTSDDon’t wait until it is broken to Don’t wait until it is broken to

fix it!fix it! Next Step:Next Step:

When the thoughts and feelings begin to When the thoughts and feelings begin to interfere with a persons life, professionally interfere with a persons life, professionally or personally, or when they become or personally, or when they become distressing and do not subside over a period distressing and do not subside over a period of time , professional assistance should be of time , professional assistance should be sought out.sought out.

Extreme behavior?Extreme behavior?

ASD & PTSDASD & PTSDClinical ClassificationClinical Classification

Anxiety Disorders:Anxiety Disorders: Normal anxiety and behavior featuresNormal anxiety and behavior features

Difference:Difference:– The predominant symptom is not anxiety but the The predominant symptom is not anxiety but the

re-experiencing of a traumatic incident:re-experiencing of a traumatic incident: Intrusive recollectionsIntrusive recollections FlashbacksFlashbacks nightmaresnightmares

ASD & PTSDASD & PTSDNecessary Conditions Necessary Conditions

Person must have:Person must have: experiencedexperienced WitnessedWitnessed Been presented with-Been presented with-

– A threat to ones self or another personA threat to ones self or another person

ASD & PTSDASD & PTSDNecessary ConditionsNecessary Conditions

Regardless of the level of exposure, Regardless of the level of exposure, at the time of trauma the person will at the time of trauma the person will have experienced a sense of terror, have experienced a sense of terror, horror, or helplessness: Thenhorror, or helplessness: Then

– Feelings will be experienced again and again in Feelings will be experienced again and again in the days, months, and years following the traumathe days, months, and years following the trauma

ASD & PTSDASD & PTSDThree main dimensionsThree main dimensions

In order for a person to receive a In order for a person to receive a diagnosis of either ASD or PTSD, the diagnosis of either ASD or PTSD, the person must experience symptoms person must experience symptoms alone these three dimensions:alone these three dimensions:

IntrusionIntrusion AvoidanceAvoidance ArousalArousal

ASD ASD PTSDPTSD

Requires fewer Requires fewer avoidance systemsavoidance systems

Initial symptom & Initial symptom & responseresponse

Occours within the Occours within the first monthfirst month

Lasts for min-2 daysLasts for min-2 days Sense of numbing Sense of numbing

detached.detached. Normal things seem Normal things seem

unrealunreal

Avoidance and denialAvoidance and denial

Long term-”delayed Long term-”delayed onset”onset”

One month toseveral One month toseveral months before onsetmonths before onset

ASD can become PTSDASD can become PTSD Survival mode- unable Survival mode- unable

to return to normalto return to normal

Three dimensions for diagnosisThree dimensions for diagnosisIntrusionIntrusion

Trauma is persistently re-Trauma is persistently re-experienced.experienced.

Extreeme cases are relivedExtreeme cases are relived Intrusive thoughts and /or images Intrusive thoughts and /or images

associated with the eventassociated with the event– Read and Discuss example in book p33Read and Discuss example in book p33

Recovery of badly burned child.Recovery of badly burned child.

Three dimensions for diagnosisThree dimensions for diagnosisAvoidanceAvoidance

Persons efforts to avoid reminders of Persons efforts to avoid reminders of the incident.the incident.

Refusing to talk about itRefusing to talk about it Avoiding places and people associated with Avoiding places and people associated with

the incident.the incident. Change topic of discussion.Change topic of discussion. Feelings of detachment or estrangementFeelings of detachment or estrangement Decreased interest in significant activities.Decreased interest in significant activities.

Three dimensions for diagnosisThree dimensions for diagnosisAvoidanceAvoidance

Avoidance may be a non-conscious Avoidance may be a non-conscious action.action.

Change path to workChange path to work Avoid reminders of the traumaAvoid reminders of the trauma No longer wanting scanners in the house No longer wanting scanners in the house

and carand car Change crews or jobsChange crews or jobs Avoid certain apparatus.Avoid certain apparatus.

Three dimensions for diagnosisThree dimensions for diagnosisArousalArousal

Difficulty falling asleep and staying Difficulty falling asleep and staying asleepasleep

Ability to concentrate.Ability to concentrate. Exaggerated state of response.Exaggerated state of response. ““on the edge”on the edge” AngryAngry IrritableIrritable

– You only hurt the ones you love.You only hurt the ones you love.

Three dimensions for diagnosisThree dimensions for diagnosishow to use the toolshow to use the tools

Who finally decides that professional Who finally decides that professional help is needed:help is needed:

This is not like a broken arm that you can This is not like a broken arm that you can see. There is a stigma attached in a bravado see. There is a stigma attached in a bravado environment.environment.

The firefighters boss.The firefighters boss. Best friendBest friend SpouseSpouse ChildChild

Three dimensions for diagnosisThree dimensions for diagnosishow to use the toolshow to use the tools

Usually in the form of an ultimatum-Get help or Usually in the form of an ultimatum-Get help or elseelse

Other disorders Commonly Other disorders Commonly associated with PTSDassociated with PTSD

Co-morbid psychological disordersCo-morbid psychological disorders Affective disorders-Affective disorders-

Major depressionMajor depression

Substance related such as drugs & alchol Substance related such as drugs & alchol abuse or dependanceabuse or dependance

Depressed and disconnected from their Depressed and disconnected from their careercareer

Other disorders Commonly Other disorders Commonly associated with PTSDassociated with PTSD

Secondary and tertiary disorders Secondary and tertiary disorders may ultimately bring person suffering may ultimately bring person suffering from PTSD and/or ASD to public from PTSD and/or ASD to public health officials.health officials.

Example:Example: The chief/union may turn the other The chief/union may turn the other

way with sick time abuse but not for way with sick time abuse but not for showing up for work drunk. showing up for work drunk.

DepressionDepression

Depression : DefinitationDepression : Definitation

Must be present for 2 weeks or Must be present for 2 weeks or longer and either produce significant longer and either produce significant distress to the individual or impair distress to the individual or impair social or occupational functioning.social or occupational functioning.

DepressionDepressionSymptomsSymptoms

Loss of interest or Loss of interest or pleasure in pleasure in previouslypreviously enjoyable enjoyable activities.activities.

Significant changes Significant changes in appetite and in appetite and weight.weight.

Difficulty sleepingDifficulty sleeping Inappropriate guiltInappropriate guilt Depressed moodDepressed mood

FatigueFatigue

Slowness of movementsSlowness of movements

Difficulty concentratingDifficulty concentrating

Feelings of Feelings of worthlessnessworthlessness

Thoughts of suicideThoughts of suicide Memory imparementMemory imparement

Substance Dependence and Substance Dependence and AbuseAbuse

Dependence is considered more Dependence is considered more serious than abuse.serious than abuse.

AbuseAbuse Continued use of psychoactive substance Continued use of psychoactive substance

knowing it causes:knowing it causes: Physical problemsPhysical problems Difficulty in social relationshipsDifficulty in social relationships Continued use in hazardous situationsContinued use in hazardous situations Regular drinking for a month or longerRegular drinking for a month or longer Abuse can lead to dependenceAbuse can lead to dependence

Substance Dependence and Substance Dependence and AbuseAbuse

DependenceDependence Has built up a tolerance to the substance.Has built up a tolerance to the substance. Requires larger and larger amounts to achief Requires larger and larger amounts to achief

the same effect over a period of time.the same effect over a period of time. Unsuccessfully tried to stop.Unsuccessfully tried to stop. Expends a great deal of effort obtaining, Expends a great deal of effort obtaining,

using, or recovering.using, or recovering. Is frequently intoxicated or in with drawl Is frequently intoxicated or in with drawl

when expected to perform other roles.when expected to perform other roles. ContCont

Substance Dependence and Substance Dependence and AbuseAbuse

Has given up other social or occupational Has given up other social or occupational activities in order to use.activities in order to use.

Continued to use despite the resulting social Continued to use despite the resulting social or occupational problems.or occupational problems.

Experienced withdrawal or continues using Experienced withdrawal or continues using to avoid withdrawal.to avoid withdrawal.

Traumatic Stress in Traumatic Stress in FirefightersFirefighters

Many firefighters who experience a Many firefighters who experience a traumatic stress injury may not traumatic stress injury may not report it for fear it will be viewed as:report it for fear it will be viewed as:

Sign of weaknessSign of weakness Negatively impact careerNegatively impact career Has difficulty dealing with truma- EMS & fireHas difficulty dealing with truma- EMS & fire May take early retirementMay take early retirement Acceptable to go out on a physical rather than Acceptable to go out on a physical rather than

a psychological disability.a psychological disability.

Impact of Traumatic StressImpact of Traumatic Stress

Stress among emergency workers Stress among emergency workers may reduce performance to the may reduce performance to the extent of endangering both the extent of endangering both the professionals and civilians at an professionals and civilians at an emergency scene.emergency scene.

Personal indicators of stressPersonal indicators of stress

Memory problemsMemory problems Inability to make decisionsInability to make decisions Difficulty keeping cleanDifficulty keeping clean Mental instabilityMental instability Interpersonal conflictsInterpersonal conflicts AlcoholismAlcoholism DepressionDepression SuicideSuicide

Department indicators of Department indicators of stressstress

Decreased performanceDecreased performance Proneness to accidentsProneness to accidents Decreased moralDecreased moral Chronic absenteeismChronic absenteeism High medical costsHigh medical costs Increased staff turn-overIncreased staff turn-over

SummarySummary

Discussions of stress heightens our Discussions of stress heightens our awareness for crisis intervention, critical awareness for crisis intervention, critical incident stress, conflict resolution.incident stress, conflict resolution.

Tools to better understand how to help Tools to better understand how to help firefighters get through traumatic firefighters get through traumatic stress.stress.

PTSD and ASD affect all groups- Group PTSD and ASD affect all groups- Group dynamic model of 25-50-25. dynamic model of 25-50-25.

More research needs to be done, More research needs to be done, relatively new awareness. relatively new awareness.

SummarySummary

Discussions of stress heightens our Discussions of stress heightens our awareness for crisis intervention, critical awareness for crisis intervention, critical incident stress, conflict resolution.incident stress, conflict resolution.

Tools to better understand how to help Tools to better understand how to help firefighters get through traumatic firefighters get through traumatic stress.stress.

PTSD and ASD affect all groups- Group PTSD and ASD affect all groups- Group dynamic model of 25-50-25. dynamic model of 25-50-25.

More research needs to be done, More research needs to be done, relatively new awareness. relatively new awareness.