1. Traumatic Stress Reactions
Objective:
To be able to recognize PTSD & ASD
Related Disorders

2. PTSD Post traumatic Stress Disorder
Definitation:
An experience affecting human behavior over a period of time outside the range or normal experience that most people would consider upsetting

3. PTSD Continuium Symptoms
Different reactions in everyone:
Many will resolve the trauma with out assistance
Symptoms subside after talking about trauma
Time
Early symptoms stay or worsen
Result in personality changes
Chronic symptomatic presentation

4. PTSD Continuum Symptoms
Secondary conditions
Personality changes
Dependency on drugs and alcohol
Isolation
Coping skills
Denial
Affects anyone regardless of age, rank, experience

5. ASD Acute Stress Disorder
Definition:
An immediate stress reaction outside the range or normal experience that most people would consider upsetting.

6. ASD Acute Stress Disorder Continuim Symptoms
Fear and anxiety (not stand alone symptoms)
Racing heart
Sweating
Shallow breathing
Fear
Intrusive memory of event
Sadness
Mild anxiety-(normal reaction)

7. ASD Acute Stress Disorder Continuim Symptoms
Not wanting to talk about the incident is normal.
Thinking about the event over the next few days is normal
Talking about it may help work threw the problem.
Post incident debriefing.
Kitchen table in the fire house.
Gallows humor

8. ASD & PTSD Crisis Intervention awareness
Discussion:
What are we looking for in ourselves and or fellow firefighters.
Define Acute and Chronic
What is your next step over and above “normal” reactions.

9. DTSD& ASD Clinical Clasifications
Anxiety Disorders
Main features include symptoms of anxiety and avoidance behaviors.
Difference:
Predominant symptom is not anxiety bt re-experiencing of a traumatic incident through:
Intrusive recollections
flash backs
Nighmares

10. Recurrence of Symptoms

11. ASD & PTSD Don’t wait until it is broken to fix it!
Next Step:
When the thoughts and feelings begin to interfere with a persons life, professionally or personally, or when they become distressing and do not subside over a period of time , professional assistance should be sought out.

12. Extreme behavior?

13. ASD & PTSD Clinical Classification
Anxiety Disorders:
Normal anxiety and behavior features
Difference:
The predominant symptom is not anxiety but the re-experiencing of a traumatic incident:
Intrusive recollections
Flashbacks
nightmares

14. ASD & PTSD Necessary Conditions
Person must have:
experienced
Witnessed
Been presented with-
A threat to ones self or another person

15. ASD & PTSD Necessary Conditions
Regardless of the level of exposure, at the time of trauma the person will have experienced a sense of terror, horror, or helplessness: Then
Feelings will be experienced again and again in the days, months, and years following the trauma

16. ASD & PTSD Three main dimensions
In order for a person to receive a diagnosis of either ASD or PTSD, the person must experience symptoms alone these three dimensions:
Intrusion
Avoidance
Arousal

17. ASD PTSD Requires fewer avoidance systems Initial symptom & response
Occours within the first month
Lasts for min-2 days
Sense of numbing detached.
Normal things seem unreal
Avoidance and denial
Long term-”delayed onset”
One month toseveral months before onset
ASD can become PTSD
Survival mode- unable to return to normal

18. Three dimensions for diagnosis Intrusion
Trauma is persistently re-experienced.
Extreeme cases are relived
Intrusive thoughts and /or images associated with the event
Read and Discuss example in book p33
Recovery of badly burned child.

19. Three dimensions for diagnosis Avoidance
Persons efforts to avoid reminders of the incident.
Refusing to talk about it
Avoiding places and people associated with the incident.
Change topic of discussion.
Feelings of detachment or estrangement
Decreased interest in significant activities.

20. Three dimensions for diagnosis Avoidance
Avoidance may be a non-conscious action.
Change path to work
Avoid reminders of the trauma
No longer wanting scanners in the house and car
Change crews or jobs
Avoid certain apparatus.

21. Three dimensions for diagnosis Arousal
Difficulty falling asleep and staying asleep
Ability to concentrate.
Exaggerated state of response.
“on the edge”
Angry
Irritable
You only hurt the ones you love.

22. Three dimensions for diagnosis how to use the tools
Who finally decides that professional help is needed:
This is not like a broken arm that you can see. There is a stigma attached in a bravado environment.
The firefighters boss.
Best friend
Spouse
Child

23. Three dimensions for diagnosis how to use the tools
Usually in the form of an ultimatum-Get help or else

24. Other disorders Commonly associated with PTSD
Co-morbid psychological disorders
Affective disorders-
Major depression
Substance related such as drugs & alchol abuse or dependance
Depressed and disconnected from their career

25. Other disorders Commonly associated with PTSD
Secondary and tertiary disorders may ultimately bring person suffering from PTSD and/or ASD to public health officials.
Example:
The chief/union may turn the other way with sick time abuse but not for showing up for work drunk.

26. Depression Depression : Definitation
Must be present for 2 weeks or longer and either produce significant distress to the individual or impair social or occupational functioning.

27. Depression Symptoms
Loss of interest or pleasure in previously enjoyable activities.
Significant changes in appetite and weight.
Difficulty sleeping
Inappropriate guilt
Depressed mood
Fatigue
Slowness of movements
Difficulty concentrating
Feelings of worthlessness
Thoughts of suicide
Memory imparement

28. Substance Dependence and Abuse
Dependence is considered more serious than abuse.
Abuse
Continued use of psychoactive substance knowing it causes:
Physical problems
Difficulty in social relationships
Continued use in hazardous situations
Regular drinking for a month or longer
Abuse can lead to dependence

29. Substance Dependence and Abuse
Has built up a tolerance to the substance.
Requires larger and larger amounts to achief the same effect over a period of time.
Unsuccessfully tried to stop.
Expends a great deal of effort obtaining, using, or recovering.
Is frequently intoxicated or in with drawl when expected to perform other roles.
Cont

30. Substance Dependence and Abuse
Has given up other social or occupational activities in order to use.
Continued to use despite the resulting social or occupational problems.
Experienced withdrawal or continues using to avoid withdrawal.

31. Traumatic Stress in Firefighters
Many firefighters who experience a traumatic stress injury may not report it for fear it will be viewed as:
Sign of weakness
Negatively impact career
Has difficulty dealing with truma- EMS & fire
May take early retirement
Acceptable to go out on a physical rather than a psychological disability.

32. Impact of Traumatic Stress
Stress among emergency workers may reduce performance to the extent of endangering both the professionals and civilians at an emergency scene.

33. Personal indicators of stress
Memory problems
Inability to make decisions
Difficulty keeping clean
Mental instability
Interpersonal conflicts
Alcoholism
Depression
Suicide

34. Department indicators of stress
Decreased performance
Proneness to accidents
Decreased moral
Chronic absenteeism
High medical costs
Increased staff turn-over

35. Summary
Discussions of stress heightens our awareness for crisis intervention, critical incident stress, conflict resolution.
Tools to better understand how to help firefighters get through traumatic stress.
PTSD and ASD affect all groups- Group dynamic model of
More research needs to be done, relatively new awareness.

36. Summary
Discussions of stress heightens our awareness for crisis intervention, critical incident stress, conflict resolution.
Tools to better understand how to help firefighters get through traumatic stress.
PTSD and ASD affect all groups- Group dynamic model of
More research needs to be done, relatively new awareness.