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Ask the Mental Health Expert Archives 2001-2004

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Emergency Staff's Mental Health

Q. I am trying to find publications or case studies done on the mental health of emergency responders...EMTs, emergency room personnel, etc. The sites I've located on the Internet aren't pointing me in the correct direction. Suggestions?

A. I think there is growing evidence that emergency health workers, EMTs, and similar personnel are at risk for various psychological problems, mainly stemming from their exposure to stress and trauma. For example, one study by Clohessy & Ehlers (Br J Clin Psychol 1999;38:251-65) looked at post-traumatic stress disorder (PTSD) symptoms and coping skills in ambulance service workers. They found that 21% of subjects met criteria for PTSD, and 22% showed some type of psychiatric symptoms. (Rates of PTSD in the general population range from about 8-15%, with women usually in the higher end of the range).

Another study by Marmar et al (J Nerv Ment Dis 1999 Jan;187(1):15-22) examined the responses of 322 rescue workers to the Loma Prieta earthquake Interstate 880 Freeway collapse and to unrelated control critical incidents. Self-report questionnaires, including measures of incident exposure, peritraumatic dissociation and emotional distress, and current symptoms, were administered 1.9 years (initial) and 3.5 years (follow-up) after the freeway collapse.

Despite modest symptom improvement at follow-up, rescue workers were at risk for chronic symptomatic distress after critical incident exposure. The authors concluded that "...rescue workers, particularly those with more catastrophic exposure and those prone to dissociate at the time of the critical incident, are at risk for chronic symptomatic distress." These studies should provide you with additional references. For more information on PTSD and its risk factors, I recommend the book "Psychological Trauma", edited by Rachel Yehuda, American Psychiatric Press, 1998.

April 2001

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