Course:SPPH381B/Essay 3/Administrative controls and PTSD - Rachael

Administrative controls

The Canadian Centre for Occupational Health and Safety (CCOHS) states that administrative controls are those that alter the way work is done . This is achieved by controlling the timing of work, policies and other rules, as well as work practices such as standards and operating procedures, for example, training, housekeeping, equipment maintenance and personal hygiene practices . The example of training as an administration control relates to occupational, health and safety (OHS) programs within the workplace. It may also include joint Health and Safety Committees across industries, as well as information and education regarding Material Safety Data Sheets (MSDS’s) and topic-focused sessions . Within the hierarchy of control, administration is the second last method of controlling a hazard, therefore should be preceded by elimination, substitution and engineering control attempts. However, within some workplaces the prior steps for control are not feasible.

First Responders

For first responders, administrative controls are vital for the occupational health of the workers. Occupational hazards vary daily for first responders, and their health differently affected. First responders are responsible for providing first aid or CPR to sustain life, prevent further injuries and care for illnesses and injuries until the next level of medical personnel arrives . For example, one day a first responder may be responsible for transporting an elderly person, and another day they may be required to respond to an attempted suicide . Within this role, first responders may be exposed to a variety of traumatic situations, which may lead to the health condition Post-Traumatic Stress Disorder or PTSD .

PTSD

PTSD is a disorder that, as stated, develops among people who have had exposure to a shocking, scary or dangerous event . The onset of PTSD can be acute, in which symptoms can occur within three months of the incident, however in other cases they begin years afterwards . To be diagnosed with PTSD it must be consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a person must exhibit the following symptoms for at least one month; one re-experiencing symptom, one avoidance symptom, two arousal and reactivity symptoms and two cognition and mood symptoms . These may come in the form of nightmares, uncontrollable memories, persistent fear and severe anxiety . The symptoms must be severe enough to interfere with relationships or work, and can last from six months to a longer term, chronic condition. Anyone can develop PTSD, and age is not a predisposing factor . However, first responders are twice as likely to experience PTSD in Canada . Sadly, experiencing PTSD also presents as a high-risk factor for subsequent suicidal behaviour . Thus, it is necessary for effective administrative controls to be in place.

PTSD and First Responders

To combat the problem of PTSD among first responders in Canada, the Centre for Suicide Prevention (2015) has provided a ‘toolkit’ which contains a variety of interventions. A trauma intervention includes Critical Incident Stress Debriefing (CISD) – which is basically a seven-phase small group supportive crisis intervention process . A peer support intervention is also offered, consisting of volunteer officers who themselves have experienced trauma or work-related stress. Additionally, following the amendment that states PTSD as presumed to be work related, by the Public Services Health and Safety Association – which tailors to the needs of each first responder sector in Ontario . The image below presents a framework that takes a holistic approach to PTSD prevention and management, within an organisations’ overarching Occupational Health and Safety Management System .

PTSD Prevention Program Framework

This toolkit exhibits a comprehensive outlook on an administrative approach to controlling the occupational health risk that is PTSD among first responders. However, some weaknesses of the aforementioned ‘toolbox kits’ exist.

Critique

While effective, these toolkits and programs contain caveats against complete effectiveness. The peer intervention program for example, functions on the principle that first responders seek help when recognising symptoms of PTSD . However, this fails to recognise a primary symptom of PTSD – which is avoidance, and thus inhibits those with PTSD from accessing the help provided. Also, not everyone experiences PTSD following the same exposure, and some will not experience it at all ;. PTSD can be seen then as an extremely personalised mental health condition. This raises various criticisms of the CISD. For example, as CISD has a set phase progression, it does not allow for debriefing that is specific to what the first responders may have experienced or are struggling with . Additionally, it fails to address other mental health issues which may arise for trauma victims, such as depression . Additionally, there is uncertainty to the effectiveness of CISD in lowering levels of PTSD. One study claimed that “CISD was minimally associated with lower reports of of posttraumatic stress and aggression" . Thus, the following recommendations must be considered, to improve the occupational health of this population.

Recommendations

The World Health Organisation (WHO) suggests that cognitive behavioural therapy (CBT) with a trauma focus for adults with PTSD is effective in reducing PTSD diagnosis following treatment . The WHO also suggests eye movement desensitization and reprocessing (EMDR) which is an easier treatment that does not require the person to verbalize details of the traumatic event . Stress management is also proposed by the WHO, and has value in that it can be learned relatively easily by para-professionals. The Centre for Suicide Prevention (2015) toolkit also highlights upon the practice of trauma informed care – which is recommended as it emphasizes physical, psychological and emotional safety for both consumers and providers . Additionally, the protective and resiliency factors against trauma listed in the toolkit should not be overlooked – as they highlight key principles that should be adapted into the safety culture of any work organisation . For example, collective efficacy within first responders – to encourage feeling supported by peers in the workplace . All the suggested recommendations may be implemented as an administrative control within workplaces to elicit maximum occupational safety.

Conclusion

Therefore, the weight of PTSD among first responders is recognised as a serious issue. The importance of administrative controls in combating this issue have been highlighted, as well as criticisms identified. However, following adherence or recognition of recommendations, the health of first responders and their relationship with PTSD expectantly, should improve.