Adelaide researchers look at why PTSD among paramedics is twice as high as other health workers

The rate of post-traumatic stress disorder among our paramedics is skyrocketing, with a team of Adelaide researchers desperately trying to determine the cause — and what can be done to prevent it.

Rebecca Baker, Sunday Mail (SA)

“If you think telling a parent their child has died is hard, try telling a child their parent has died.”

These are the sobering words from an Adelaide paramedic, offering a matter-of-fact insight into the reality of everyday work life as a medical emergency responder.

“I cannot drive past (the spot where a little boy was killed by a car) without feeling distressed and without seeing the images of his broken body in my mind and wondering how his family is going,” says an interstate colleague.

While for a mum-of-two paramedic, also interstate, the memory of being unable to resuscitate a tiny victim of SIDS is forever etched in her mind.

“This baby lived quite close to my own home and I see her house every day, so I think of that baby girl every day,” she says.

Also interstate is the paramedic who can’t forget the day she responded to a call, only to discover on arrival a child she knew had hung herself and could not be saved.

And this from one paramedic dad: “I went to a job with a little four-year-old (who was suffering a seizure), I picked her up and she looked like my daughter. I lost it. Gone.”

It is the real life stories of paramedics from across Australia and the globe a team of Adelaide researchers has drawn on as part of a newly-released study into how emergency medical service work affects paramedics’ psychological, physical and social well-being.

They’ve also considered qualitative literature and emerging local and international research as part of the review which finds PTSD (post-traumatic stress disorder) among paramedics is twice as high as other health professionals.

“Work-related stress goes far beyond coping with critical incidents,” says Flinders University’s Professor Sharon Lawn, lead author of the report.

“It also includes the impact of repeated stresses present in the nature of the work itself, including operational and work-culture factors producing an interactive effect with critical incidents,” she says.

The researchers found that traumatic incidents that occurred during paramedics’ routine call-outs had a negative impact on staff and were often cumulative in nature, particularly the

impact on their family life and relationships.

“The cumulative nature of some of the traumas and critical incidents paramedics and call takers (are exposed to) is insidious and the impact enormous,” Prof Lawn says.

Prof Lawn says while there are some parallels between the PTSD experienced by soldiers post-combat and paramedics, there are differences too.

“(Generally speaking) when you are a soldier you go off to another place and that is where the trauma happens but as a paramedic, ambulance officer or police officer, it is happening on your own turf — you drive home each night to your family, having to switch from one mode to another and processing it on a day-to-day process can be hard for some.

“So while a soldier’s PTSD might be triggered by watching movies, or reading war-related newspaper reports, the triggers for first responders are much more insidious because of the cumulative nature, they could be small things as well as critical incidents.”

Prof Lawn says paramedics and other first responders are facing ever increasing challenges due to the prevalence of crystal methamphetamine, or ice, and other drugs in the community.

“The complexities are becoming greater because it is no longer people just using marijuana, more people are using drugs that are creating much more violence and aggression,” she says.

“We are hearing stories of paramedics going out to help people who have overdosed and then getting assaulted by the person’s friends.”

In Victoria it is estimated a paramedic is assaulted on duty every 50 hours.

In January this year it was a “drug-affected young man” who allegedly put a female paramedic in a headlock, repeatedly punching her in the face in the back of an ambulance in Melbourne.

“Very suddenly and without anything to initiate it, he lashed out and put her in a headlock and punched her in the face … this was a brutal assault of a young female paramedic just doing her job,” CEO of Ambulance Victoria, Tony Walker, told media at the time.

And the rate of violence against paramedics in Australia continues to rise, according to recent research revealed in the latest edition of the Public Health Research and Practice journal, published by the Sax Institute.

“There is no occupational group in Australia that has a higher injury or fatality rate than paramedics,” says research project author, CQUniversity Professor Brian Maguire.

Closer to home, SA paramedic Amanda Martin has told how she has been assaulted three times while doing her job.

The first involved an incident in which a man on methamphetamines ripped the door off her ambulance and attempted to attack her and her partner.

The next two involved intoxicated women with Ms Martin king-hit during one incident.

“When I joined the job I didn’t even consider worrying about being assaulted … if I encounter any violence now I back right away. We have the police at 30 per cent of our jobs now,’’ she said in a NewsCorp interview in early July.

As part of the review, researchers considered submissions made to last year’s Senate inquiry into the mental health conditions experienced by first responders.

Some refer to high-profile incidents, such as Port Arthur Massacre.

Paramedic Peter James, in his submission, tells how images from that day remain chillingly crystal clear in his mind, more than two decades on.

“You walked in and blood was coming up over the rim of your shoes from the carpet,” recalls the veteran paramedic.

“People were mid-stride with burgers and things but the back of their heads were gone.

“It’s all vivid, I can see it every day.

“And I remember seeing this guy, his shoes stuck out underneath one of the sheets … they looked like my dad’s shoes and I had to look to make sure it wasn’t him.”

There are less public stories, too.

Ambulance officer Amanda Martin has been assaulted while on duty. Picture: Tait Schmaal

“The kids get you after a while.” Mr James writes in his submission.

“There was a little girl, her mother had cut her fingers off, broke both of her legs and arms.

“She had cigarette bums from head to toe and she had a fractured skull … she killed her daughter,” he says.

“I’ve been a paramedic for 41 years and after that long it’s all a soup, it all comes back at

different times of the day and night. You remember jobs you thought you’d forgotten.

“I feel as though I’ve seen and experienced things that no human should experience.”

Stevie Hickie provided this account.

“People outside this work environment think that trauma we are exposed to is blood and guts,” he says.

“(But) that’s what we’re trained for, we work with that all the time.

“The trauma for us is when you go to someone who (has) lost their loved one of 50 years … or a 35-year-old with Stage 4 melanoma (who is having a seizure) and his wife is there and his two little kids (are) running around … and I know I’m not going to be able to stop it and I know he’s going to die.”

Mr Hickie, who suffers from PTSD, says there are routine things he now struggles with.

“I can’t go into a child’s room with dolls lying on the floor, I have to pick them up and move them out of the way — I know they’re not children lying there and that it’s not normal,” he says.

An unidentified Queensland paramedic tells in her submission of the pain of attending “stressful paediatric jobs”.

“I find that I often have nightmares afterwards, usually involving my own children being injured (or) sick,” she says.

“When my children were newborns I was excessively worried about SIDS — I found it to be a highly stressful time rather than a joyful time.”

AEA secretary Phil Palmer. Picture: Mark Brake/AAP

Prof Lawn says the review reveals working and retired paramedics, ambulance officers and call-takers often aren’t given the support they need from the organisations they work with.

“Paramedics are not receiving enough help to overcome psychological injuries caused by accumulated traumas they confront in their work,” she says.

“Paramedics report that their access to appropriate care is made difficult through obstacles including a failure in the workplace to acknowledge stress, a lack of confidentiality, use of inappropriate therapies, poor return-to-work mechanisms, isolation, and stigmatisation — and compounded by concerted efforts to obstruct access to worker’s compensation provisions, and a lack of post-retirement support,” she says.

“The sense I get as an outsider is that these are some of the most committed people, they are extremely committed when they come into this profession and want to do the best job they can … clearly there needs to be an absolute improvement in the support and understanding these people receive because what has been done isn’t working — the issues are getting worse.”

Prof Lawn says the nature of the shift work and the pressure to go from one job to the next without breaks contributes to work-related issues and stresses reported by paramedics.

Dr Louise Roberts, who contributed to the review, believes it is important the scope of paramedics’ work is better understood.

“In the last five to 10 years, there has been increased acknowlegement of the toll of the work through stories coming out both here and internationally … I think the public understands what paramedics are confronted with in their day-to-day job but not necessarily the full extent of (what they face).

“I think people potentially have this perception that it is about constantly responding to emergencies involving blood and guts when it is actually going to jobs that (paramedics) are personally connected to, or that trigger a personal connection that often have the biggest impact.

“It could be attending a motor vehicle accident that reminds you of your neice or nephew, or your own kids — it is that sort of personal connection that sometimes has the biggest effect.

“And it can be hard for people in rural communities as well, where they potentially know the person, and know the person quite well, that is involved in a critical incident.

“What we’ve found is that it is incredibly important for people to have the time to step back, to view what has happened and potentially chat to colleagues to understand and manage an event.”

The report was commissioned by the Ambulance Employees Association and general secretary Phil Palmer says it is hard for most people to comprehend the scenes paramedics attend.

Off-the-record, with the understanding their stories wouldn’t be publicly shared for fear of identifying patients, several paramedics told the Sunday Mail of heartbreaking incidents — and harrowing scenes — they’ve attended, where they’ve witnessed the unimaginable.

“A paramedic will see more trauma, of all sorts, in one shift cycle than most people would see in a lifetime,” Mr Palmer says.

“On a daily basis, ambos will see human suffering, broken families, severe poverty and significant life-changing medical conditions — they directly witness the impact these things have on patients and their loved ones … death and horrific injuries to children (through) drownings, vehicle accidents, domestic violence (are examples).

“(They attend) horrifying murders including stabbings, shootings, bashings and sexual violence and see intense emotional trauma and suffering.

“There are assaults on ambos themselves — members have been stabbed, punched, kicked, death threats, and suffered verbal abuse.

“Ambos are not robots, any one of these things would traumatise any normal person but ambos see it all the time.”

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