Posttraumatic Stress Disorders in Ambulance Paramedics - Literature review Example

Post-traumatic stress disorder in ambulance paramedics Introduction Post-traumatic stress disorder has been into existence for as long as mankind has lived. It is one of the many anxiety disorders, where affected people experience prolonged feelings of distress and fright for no clear reason (Feder, 2008). As the name suggets, it is caused by traumatic incident involving threatened demise or serious injury to a person. A literature review was conducted to institute the degree of literature on interventions for post-traumatic stress disorder in ambulance paramedics. The fundamental intervention that was used for literature review was the critical incident stress debriefing, though many debated over this intervention. Content Critical incident stress debriefing is an intervention that is purposed to promote the effective processing of distressing events through normalization of reactions and preparation for anticipated future experiences (Feder, 2008). There is a treatment that is designed to take care of the emergency service personnel who could attend the critical incident session voluntarily or when instructed by a superior. The main aim of the review that was conducted was to identify literature that is related to interventions aimed at preventing and treating the disorder. Though emergency work is rewarding, the emergency personnel are more vulnerable to post-traumatic stress in long term and short term. This is because they are supposed to deal with potentially traumatizing circumstances. Some of the distressing situations include: mass incidents, major fires, burns patients, murder scenes, violent scenes, accident involving children, cot death and many others (Frieman, 2003). It is clear that emergency medical technicians are at higher risk of stress compared to other medical professionals and fire-fighters; they normally get involved in disasters and may be at high risk of severe stress disorder, which can lead to post-traumatic stress. Research shows that the victims of tragic road accident are vulnerable to post-traumatic disorder; 80 percent of the victims developed acute stress which may lead to post-traumatic disorder (Kessler, 2006). The symptoms of post-traumatic disorder include: anxiety, depression, sleep deprivation and undue worry. Various research methods were used in this review and it is clear that, various databases were performed and research strategy made as wide as possible. These research methods included hand searching for journals, internet searching, keywords to search online database among others. The research that was done showed that the mass disasters are the major contributors of stress and that emergency workers are always the victims of this disorder (Feder, 2008). Medical study was carried to evaluate the risks of stress and to summarise the methodological limitations of the conducted research. The limitations found include: varying degree of trauma, small sample size and lack of uniformity, low response rate, sampling bias, non-prospective studies, no control group and timing variance. The researchers concluded that, it was not possible to fully determine the effectiveness of critical incident stress and it was cautious to conduct a proper evaluation. A recent review recommended that research should be on psychological debriefing of emergency attendance as a main concern for the study. According to Brewin (2005), methodological matters concern with determination of the level of psychological impairment after a disastrous incident. The methodological issues include: comparability issues and dimensions of disaster. The discussion of these issues was done, including the need to precisely define the study cases and population. Some researchers were concerned with the interpretation of questionnaire and the interview results; these can give different psychopathological estimates. Moreover, the type of data that was collected varies broadly and this leads to problems of generalisation of results. The aspect of time is another concern, as it is mostly based on practical considerations rather than scientific ones. Critical incident debriefing was promoted through non-mediated journals and convention speaking. A slight research was conducted to support the models of the review (Berger 2006). Four evaluations of impacts of debriefings were conducted by an Australian team. Many health welfare personnel were the major concern of evaluation. Two evaluations dealt with debriefings and the other two were concern with methodological issues. Other studies evaluated the evidence for critical incident debriefing. Stress debriefing have received a very high interest in literature of emergency services (Mandrey, 2003). The research on debriefing reveals that debrief was significant to oneself and others. Debriefing among emergency workers that were involved in mass shooting was evaluated; data was collected a few days after the incident and 87 percent of response was achieved (Fagan, 2007). However, the questionnaire was coarsely designed without negative values in its scale. The victims who had less social support accessible to them were more likely to admit that critical incident debriefing helped them to adapt the situation. There is a possibility that critical incident debriefing attendees differ from the non-attendees in one way or another. It is also clear that critical incident debriefing attendance is a matter of choice and not a random allocation. According to Brewin (2005), Hutt conducted a study of the effects of the post-traumatic disorder as part of PhD thesis; a group of thirty four emergency workers, who were debriefed, were compared to another group of nineteen who were not debriefed. This was a kind of comparison of critical reports of traumatic response. He found that there was no vital difference in regulation between the two given groups. In addition, there was no justification of benefits of critical incident stress debriefing (Bryant, 2005). However, the study was not done randomly and relies on virtually small size sample, which may be too small to demonstrate a medical effect. Studies involving evaluation of debriefing seem to have limited evidence, therefore evaluation in many fields seem to have been methodologically flawed. For both clinical and research purposes, quality control measures that are aimed at quality and consistence debriefing sessions need to be implemented. It was proposed that stress debriefing is not likely to be successful if not combined with other stress management services. Moreover, research reveals that compulsory debriefing can lead to passive involvement and antipathy (Nutt & Jonathan, 2008). Omer interviewed critical event intervention strategies for emergency personnel the emergency service personnel include: nurses, fire-fighters and ambulance personnel. The literature is divided into three areas epidemiological studies, clinical descriptive studies and the features of incidents that result to stress. Clinical descriptive studies dealt with the psychological and the physical reactions of the affected group. Epidemiological studies looks at the incidence as well as the prevalence (Bryant, 2005). Significant comments about the value of the existing research were given alongside with the directions for future study (Fagan, 2007). Fundamental psychological implications that ware found included: intrusive anxiety, depression and defensive psychological reactions. Many other positive reactions were also described, for instance increased personal confidence and sensation a renewed appreciation. The intensity and duration of the exposure to stressor was considered the most consistent and reliable forecaster of post-traumatic stress. Some other predictive factors were identified in this review; they include high mortality rates, identification with victims, infant deaths, child abuse, body handling, large fires and mass casualties (Berger 2006). Factors such as individual differences, risk to personal safety and role conflict may also contribute to post-traumatic stress. Psychological support provided such as critical incident stress debriefing is discussed. Omer could identify one systematic evaluation of guiding and counselling service for emergency groups such as ambulance personnel. The main concern is to look into the future; the research and practice that are concerned with the future (Fagan, 2007). The management need to acknowledge the range of reactions that may be possible according to critical incident, and that the workers are at risk of the outcome. Despite the common difficulties in research, quality evidence of effectiveness and efficiency of critical incident stress debriefing should be called for (Bryant, 2005). Studies throughout this review experience some limitations; they include: inadequate sample sizes, poor reporting, sampling bias and low response rates. Some of these factors are sometimes not avoidable, therefore limit the ability to replicate and generalise research. In studies that deal with evaluation of interventions, methods for evaluating the effectiveness of interventions should be considered (Bryant, 2005). This can be done by taking repeated measures of symptoms, especially from treatment and control group as well as developing debriefing eminent control measures. The intended future research is meant to improve the methodological quality. Future research can be developed through methods relating to the way research is reported; future reporting should be complete and accurate (Schiraldi, 2004). Conclusion According to Bryant (2005), methods of monitoring consistency and quality of intervention should be developed into the design of the study. Studies should take the form of randomised controlled trial, in order to give the most precise and quality information possible. It is a need to calculate the sample size before conducting a trial. In addition to that, investigation for the effectiveness and efficacy of different treatment packages is very crucial. These may include less recognized strategies such as peer support. The other important area where consideration should be taken is the preventive measures, which may include expanding the information on stress management in training programs and looking for reinforcement methods (Berger, 2006). Reinforcement methods are meant for strengthening information throughout the course of a paramedic. In general, critical incident stress debriefing, as a basic intervention used, is the best as it promotes the emotional processing of the distressing incidents for preparation for future experience. References Berger, P.L. (2006). Diagnosis related to post -traumatic disorder. Perth: Puncher and Wattman Brewin, C.G. (2005). Posttraumatic stress disorder in ambulance personnel. New York: Mc-Graw-Hill. Bryant, R., Harvey, A. D. (2005).Treatment of acute stress disorder. London: Express publishers. Fagan, B. M. (2007). Stress faced by medical attendance and intervention developed. Liver pool: Amy Elise press. Feder, K. L. (2008). Post-traumatic stress disorder: tragic incidents and debriefing of the victims. New York: Mayfield Publishing Company. Frieman, M. J. (2003). Latest assessment and treatment strategies. Sidney: Schwartz Publishing Kessler, R.A. (2006). Critical incident stress debriefing. London: Lulu press, inc. Mandrey, C. (2003). Sources of stress among emergency medical technicians. Chicago: R R Donelly and sons company Nutt, J., Jonathan, R.T. (2008). Post-traumatic stress disorder: diagnosis, management and treatment. Darwin: Brimstone press. Schiraldi, R.G. (2004). Healing, recovery of post-traumatic stress disorder. New York: Robert international inc. Read More