Course:SPPH381B/Essay 3/Administrative Control: PTSD-Alex

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Post Traumatic Stress Disorder

PTSD (or Post Traumatic Stress Disorder) is a psychiatric disorder caused by a traumatic event, such as sexual assault or natural disasters. It affects approximately 8% of the American population at some point in their lives, with women being twice as likely to be affected [1].

The symptoms of PTSD can be broadly placed into three categories: re-experiencing symptoms, avoidance and numbing symptoms, and arousal symptoms. Re-experiencing symptoms involve re-living the traumatic event, for example by having ‘flashbacks.’ Avoidance and numbing symptoms involve feeling emotionally empty, and often involve avoiding places and situations that remind them of the traumatizing event. Shortly after the event, people are often much more alert and suffer from insomnia, which is known as arousal symptoms [1]. Other common symptoms associated with PTSD include depression, substance abuse, and anxiety [2]. Typically, these symptoms also affect interpersonal relationships with family, friends, and work colleagues [1].

Occupational Risk of PTSD

While PTSD may occur in anyone, certain occupations have a higher risk of exposure to traumatic events, thereby increasing the risk of developing PTSD. Military personnel and emergency responders show higher rates of PTSD, with estimates that 12-20% of Iraq war veterans experienced PTSD [1]. Furthermore, it is estimated that emergency workers are twice as likely to experience PTSD as the general population [3], and that 22% of all paramedics will develop PTSD at some point [4].

While many emergency workers are exposed to traumatic events in their occupation, not all develop PTSD, due to individual variability. Socio-demographic, biological, and psychological factors all influence the likelihood of a person developing PTSD, as well as exposure to non-occupational traumatic events and specific job tasks [5].

Additionally, certain influences, deemed ‘protective and resiliency factors,’ have been associated with lower rates of PTSD, including: sense of community, collective efficacy, self-efficacy, positive coping strategies, and compassion satisfaction [6].

Administrative Controls and PTSD

Since there is an evident correlation between rates of PTSD and certain occupations, there is a need for appropriate hazard controls. Unfortunately, it is not possible to completely eliminate traumatic events in many occupations, but certain administrative controls can help decrease the likelihood of developing PTSD following trauma.

The Canadian Centre for Occupational Health and Safety defines administrative controls as “controls that alter the way the work is done, including timing of work, policies and other rules, and work practices such as standards and operating procedures (including training, housekeeping, and equipment maintenance, and personal hygiene practices)” [7]. For example, administrative controls for painters would involve training on use of PPE, chemical hazards or paint, equipment (depending on the type of painting), as well as standard operating procedures. Monitoring and adjusting procedures to enhance them is also part of administrative controls.

Administrative controls to prevent PTSD focus on employing feelings associated with aforementioned ‘protective and resiliency factors,’ using programs such as Critical Incident Stress Debriefing (CISD) and peer support programs [8].

Critical Incident Stress Debriefing

CISD is a “is a specific, 7-phase, small group, supportive crisis intervention process,” and is part of the Critical Incident Stress Management (CISM) program [9]. It acts as a ‘psychological first aid’ after traumatic events, with groups consisting of peer support volunteers and a mental health professional [10].

While there have been numerous successes in preventing PTSD using CISD, some are critical of the program. Firstly, the success of CISD relies on volunteers and professionals to strictly follow CISM standards. Additionally, there is little data supporting the efficacy of CISD, with one study citing that “CISD was minimally associated with lower reports of of posttraumatic stress and aggression” when compared to other programs [11].


Limitations in Administrative Controls for PTSD Prevention

While many workplaces offer programs that help employees work through their trauma, there are still many hindrances to the proper utilization of these programs. For one, mental health is often stigmatized, especially in the emergency response sector, so people may not reach out when in need [12]. Furthermore, employers have been accused of not providing enough support and encouragement of the programs, further hindering workers from reaching out. There is also a knowledge gap about the number of people affected by PTSD, and follow-ups after the programs, so that the successfulness of the PTSD prevention programs is not fully understood [13].

One relatively successful program in preventing PTSD has been the Peer Support Network utilized by the Calgary Police Service (CPS), which relies on peer support volunteers who work formally and informally to assist officers who have recently experienced a traumatic event. As the volunteers themselves have experienced traumatic events, the program is particularly successful in de-stigmatizing mental illness, thereby encouraging more ‘patients’ to reach out [14].

References

  1. 1.0 1.1 1.2 1.3 The Nebraska Department of Veteran Affairs. (2015). What is PTSD (Posttraumatic Stress Disorder)?. Retrieved from http://www.ptsd.ne.gov/what-is-ptsd.html
  2. AnxietyBC. (2016). Posttraumatic Stress Disorder. Retrieved from https://www.anxietybc.com/parenting/post-traumatic-stress-disorder.
  3. CTV News. (2014). Emergency workers twice as likely to suffer from PTSD. Retrieved from http://toronto.ctvnews.ca/emergency-workers-twice-as-likely-to-suffer-from-ptsd-1.1660817.
  4. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf
  5. Ede, L. Assuncao, A. (2011). [Prevalence and factors associated with Posttraumatic Stress Disorder (PTSD) in emergency workers: a systematic literature review]. Rev Bras Epidemiol. 14(3): 537.
  6. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf
  7. Canadian Centre for Occupational Health and Safety. (2017). Hazard Control. Retrieved from: http://www.ccohs.ca/oshanswers/hsprograms/hazard_control.html
  8. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf
  9. Info-Trauma. Critical Incident Stress Debriefing (CISD). Retrieved from: http://www.info-trauma.org/flash/media-f/mitchellCriticalIncidentStressDebriefing.pdf.
  10. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf
  11. Adler, A. et al. (2008). A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers. Journal of Traumatic Stress. 21(3): 252-263.
  12. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf
  13. Global News. (2015). In Harm’s Way: The PTSD crisis among Canada’s first responders. Retrieved from http://globalnews.ca/news/1798015/in-harms-way-the-ptsd-crisis-among-canadas-first-responders/.
  14. Centre for Suicide (2015). Prevention. First Responders – Trauma Intervention and Suicide Prevention. Retrieved from: https://www.suicideinfo.ca/wp-content/uploads/2015/05/First-Responders-Toolkit-WEB.pdf