Scottish Medic can't help bleeding man

[DwayneEMTP]

Dwayne, the articles aren't bashing the paramedic, they're bashing the system of single crewed responses replacing double crewed vehicles. That's the way I read it, anyway.

Holy crap, I'm not sure what article I was reading...You're right of course, though I'm thinking the public will still be judging her, as an individual, as well as the service for the lack of treatement.

As for questioning her mettle, she finished her shift, and only went off when the court case came up and brought it all roaring back, along with the thought of having to face the boys family. We're not meant to be judgemental, we're supposed to treat everyone the same, so why shouldn't she have been feeling a lot of guilt over a 19 year old boy that because of the situation she wasn't allowed to try to save?

This is a sincere question, as I don't have the experience to make it a statement. Is not being allowed to treat, in fact it sounds as if she didn't even come into view of the patient until he was dead, so much different from being allowed to treat yet failing to save him?

If she'd treated him, yet failed to save him, would you have the same compassion for her mental issues when it hit the papers, or she was forced to face that family?

It's simply difficult for me to find the PTSD here. It's a pretty specific diagnosis, with potentially severe symptoms for those experiencing it...I'm just not able to see the ingredients necessary for it's creation in this article when regarding an experienced paramedic.

One of the very first mental tools I believe that I developed as a medic student was a place in my head for the fact that people die. Several times they died right in front of me without even giving me the consideration of allowing me to complete my best efforts to save them before doing so. As, in my layman's understanding, PTSD is created from the intense mental and/or physical trauma of a horrifying even, I just didn't see that happening in this situation with an experienced paramedic, and I get a little indignant at those riding on the coat tails of others that are truly suffering. See what I mean?

And lastly, I obviously pee'd all over myself in this thread... :wink:

I didn't read the article very thoroughly, as well, and this is important, I meant the 'mettle' comment in theory only. I know it wasn't presented that way, but that was the intent of my little pea brain when writing it.

I have an almost complete distrust of the news in regards to it every bringing me any real facts, outside of the possible accuracy of the 'yard sale' listings, so did not mean to judge this lady on the merits of the story, and apologize for making it appear so. My intent was to use the presented story as a mini scenario to explore the boundaries of PTSD in this situation.

Everything about this sucks for this medic. My heart goes out to her and her family...

Dwayne

[ccmedoc]

As, in my layman's understanding, PTSD is created from the intense mental and/or physical trauma of a horrifying even, I just didn't see that happening in this situation with an experienced paramedic, and I get a little indignant at those riding on the coat tails of others that are truly suffering. See what I mean?

I think the 'intense' part of the description you offer is correct, it is also very subjective. One person's intense is another's mundane..

It's simply difficult for me to find the PTSD here. It's a pretty specific diagnosis, with potentially severe symptoms for those experiencing it...I'm just not able to see the ingredients necessary for it's creation in this article when regarding an experienced paramedic.

If she had a rough career, or last couple of calls, this could have been enough.

I often think that the more experience a medic (or others exposed to human tragedy) has, the greater the possibility that they will develop a PTSD. By repressing, or avoiding, these unpleasant or traumatic memories..they build up. It only takes one more event for the memories and emotions to come rushing back..a flashback of sorts. This can be very debilitating and difficult to deal with.

It was obviously very hard on this person to be available and to not be allowed in to help. I would imagine that if she were allowed to treat this patient, and he died, she would have put the experience with all the others and continued the build up. Maybe the increased media attention was the trigger for the pent up remorse from the previous incidents..the final straw..

I agree with the irritation of the over dramatic individuals, when everything is too much to bear, but how do we identify these people..largely on history.

This is, of course, my opinion and I respect and appreciate yours also..PTSD is difficult to find in any scenerio, this I am still very cautious with CISD..Patients who don't know better ways of coping with their conflicts might actually get worse when those conflicts are rubbed in their faces if further steps are not taken to teach alternative coping methods...This needs to be done through professional means....

Hopefully a little different view, hopefully

[DwayneEMTP]

I Hadn't thought of it like that before cc...thanks for posting. I'll have to sleep on it and come back tomorrow to see if I can punch it full of holes! (I'm not holding out much hope)

Have a great day...

Dwayne

[Eydawn]

PTSD can develop at any time from any stimulus given the confluence of factors in someone's life. PTSD doesn't hit n00bs because they're young and unprepared, and our elder sages haven't failed in some way if they develop PTSD. You can be the most experienced person in the world, emotionally well adjusted, have dealt with several horrendous incidents and processed them without issue, and still develop PTSD from what seems to be a more minor incident.

Think about your normal day and the stressors you experience. You spilled the coffee and the dog got into the trash. You forgot to fill your gas tank up and now you're going to be late for work, and damned if the gas price hasn't gone up again! Your boss is chewing on you for no apparent reason... and your spouse is mad that you forgot *something* important, whatever that may be. Then, someone drives like an idiot and *nearly* kills you (literally) in traffic. That sucks.

On a normal day, that's just a crappy day.

Now, let's imagine that you've been running on 2 hours of sleep a night for the last week, you've had a family member die recently, you're struggling with different things emotionally (whatever that may be, we all have phases like that) and have some cumulative stress that you haven't been able to dispel... that crappy day culminating in the near-death traffic experience could be the *perfect* trigger for PTSD.

All of a sudden the traffic near-miss isn't just a near miss... it's a focal point for all of the stress and emotional distress and cements itself in your mind in a way that no-one, even you, could have expected.

Make more sense?

Wendy

CO EMT-B

[DwayneEMTP]

All of a sudden the traffic near-miss isn't just a near miss... it's a focal point for all of the stress and emotional distress and cements itself in your mind in a way that no-one, even you, could have expected.

Make more sense?

Wendy

CO EMT-B

I hear you and cc saying more or less the same thing, and far be it for me to argue with the two or you as individuals...but together! Hell no.... :wink:

But, I've spend a little time this morning looking into PTSD from your point of view, very little, and can't find any references to PTSD being the result of cumulative but more common stressors then triggered to become PTSD. The sources I've found all claim that it's genesis is (My words) "a horrific mental or physical event". Now I'm absolutely on board with the fact that horrific is going to be very subjective, but it also seems to me that we should be able to draw some sort of baseline based on a persons's age and experience, perhaps even sex, though that's just a guess.

So my logic goes something like this. An experienced medic is disallowed permission to treat and a patient dies. She's 35 (Again, only using the article as fodder for the discussion, not discussing this lady in particular), which I'm guessing in many people's lives, the age alone would disallow this being a horrific event. She's an experienced paramedic, which leads me to believe that she's no stranger to death. So that disallows horrific again along this line of logic. But combine the two, and I can't find horrific. See what I mean?

Can I see her being upset, WAY pissed (possibly), embarrassed, mentally/physically (though not clinically) depressed, sure. I just can't see her being horrified.

The young basic shot while driving his ambulance? I can see that...though he seems on the outside to be ok with it. (Videos in the 'news' section) But being forced to sit while someone dies, though it may suck, I just can't get to horrific.

Again, this is based on my not finding sources that site more mundane, but cumulative stressors predisposing one to PTSD. If those sources exist then I'm just talking out of my butt.

Dwayne

[ccmedoc]

Again, this is based on my not finding sources that site more mundane, but cumulative stressors predisposing one to PTSD. If those sources exist then I'm just talking out of my butt.

I don't think you are talking out of your butt, this can be a very heated issue and argument, as well as somewhat vague. Some people, professionals and otherwise, still believe that PTSD is bunk.. although the terms in these articles are not official diagnoses, most psychological professionals recognize them. They are variants of PTSD without a name, as of yet. Cumulative PTSD is very real and is coming to the forefront of public safety, emergency services, and military psychology. Here are a few excerpts with the pages for reference. I have not done an exhaustive literature search, just a few minutes..

First:

While it seems as though the final trauma is the one that affected you, it isn’t. Your PTSD would then be the combination of all the traumas you have experienced. This would take more time, because you would need to digest and master all the traumas you have experienced.

http://www.mental-health-today.com/ptsd/ptsdther/3.htm

Second:

The focus of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include:

• repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (eg bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in aeroplane disasters, etc)

• repeated involvement in dealing with serious crime, eg where violence has been used and especially where children are hurt

• breaking news of bereavement caused by accident or violence, especially if children are involved

• repeated violations such as in verbal abuse, physical abuse and sexual abuse

• regular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc

Where the symptoms are the result of a series of events, the term Prolonged Duress Stress Disorder (PDSD) may be more appropriate. Whilst PDSD is not yet an official diagnosis in DSM-IV or ICD-10, it is often used in preference to other terms such as "rolling PTSD" and "cumulative stress".

http://www.a2zgorge.info/prevention/PTSD.htm

Third article:

http://www.emich.edu/cerns/downloads/paper...e%20Officer.pdf

Although local to me and Police based, this research project illustrates the effects of multiple exposures resulting in cumulative PTSD. I do not advocate the CISD, based on my own research and experience, but to each his/her own, right?

Fourth:

Abstract:

Two and one-half years after the September 11, 2001 World Trade Center attack, 204 middle school students in an immigrant community located near Ground Zero were assessed for posttraumatic stress disorder (PTSD) symptoms as influenced by "dose" of exposure to the attack and accumulated lifetime traumas. Ninety percent of students reported at least one traumatic event other than 9/11 (e.g., community violence) with an average of 4 lifetime events reported. An interaction was obtained such that the dose-response effect depended on presence of other traumas. Among students with the lowest number of additional traumas, the usual dose-response pattern of increasing PTSD symptoms with increasing 9/11 exposure was observed; among those with medium to high cumulative life trauma, PTSD symptoms were substantially higher and uniformly so regardless of 9/11 exposure dose. Results suggest that traumas that precede or follow mass violence often have as much as if not greater impact on long-term symptom severity than high-dose exposure to the event. Implications regarding the presence of continuing or previous trauma exposure for post disaster and early intervention policies are discussed.

(Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack.

Mullett-Hume, Elizabeth; Anshel, Daphne; Guevara, Vivianne; Cloitre, Marylene

American Journal of Orthopsychiatry. 2008 Jan Vol 78(1) 103-108)

Variants to the ‘standard’ PTSD are inevitable. Everyone is affected differently depending on coping mechanisms, or lack thereof. More and more of what is being learned about these disorders is being refined into new diagnoses. Whether you choose to agree with the legitimacy of them is largely an individual preference..As with most psychiatric dilemmas. :wink: