In this article I will discuss Post Tramtic Stress Disorder and Critical Incident Stress Management (Debriefing). In the 80's and early 90's when we as EMS directors along with our medical directors began paying more attention to this disorder, I feel we took it lightly, I know I was guilty of this at first as an EMS director.

After taking a few classes about PTSD however, I began paying more attention and researching PTSD more closely. I was convinced at this point this was truely a disorder I needed to incoporate into my services training program. I also began developing my services Critical Incident Stress Debriefing program at this point.

This is quite a long article so please bear with me. I am covering two topics in this article as I feel the two walk hand in hand.

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened. It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death or a threat to the patient's or someone else's life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined.

Fast Glance at Post Tramatic Stress Disorder
• An estimated 70 percent of adults in the United States have experienced a traumatic event at least once in their lives and up to 20 percent of these people go on to develop posttraumatic stress disorder, or PTSD.
• An estimated 5 percent of Americans -- more than 13 million people -- have PTSD at any given time.
• Approximately 8 percent of all adults -- 1 of 13 people in this country -- will develop PTSD during their lifetime.
• An estimated 1 out of 10 women will get PTSD at some time in their lives. Women are about twice as likely as men to develop PTSD.

Extreme Trauma Associated with PTSD
• PTSD may develop following exposure to extreme trauma. (such as emerency services professionals frequently encounter)
• Extreme trauma is a terrifying event or ordeal that a person has experienced, witnessed, or learned about, especially one that is life-threatening or causes physical harm. (often witnessed aby emergency services professionals)
• The experience causes that person to feel intense fear, horror or a sense of helplessness.
• The stress caused by trauma can affect all aspects of a person's life including mental, emotional and physical well-being.
• Research suggests that prolonged trauma may disrupt and alter brain chemistry. For some people, this may lead to the development of PTSD.

Recognizing and Diagnosing PTSD
    1. A specific number of symptoms from each of the three clusters have lasted for one month or longer.
    2. The symptoms cause severe problems or distress in personal life, at work, or in general affect daily life.

Clusters
• Re-living the event through recurring nightmares or other intrusive images that occur at any time. People who suffer from PTSD also have extreme emotional or physical reactions, such as chills, heart palpitations or panic when faced with reminders of the event. One or more of these symptoms must be present for diagnosis.
• Avoiding reminders of the event including places, people, thoughts or other activities associated with the trauma. PTSD sufferers may feel emotionally detached, withdraw from friends and family and lose interest in everyday activities. Three or more of these symptoms must be present for diagnosis.
• Being on guard or hyper-aroused at all times, including feeling irritable or sudden anger, having difficulty sleeping or a lack of concentration, being overly alert or easily startled. Two or more of these symptoms must be present for diagnosis.
• People with PTSD may have low self-esteem or relationship problems, or may seem disconnected from their lives.

Other problems that may mask or intensify symptoms include:

• Psychological problems such as depression or other anxiety disorders, including panic disorder.
• Physical complaints such as chronic pain, fatigue, stomach pains, respiratory problems, headaches, muscle cramps or aches, low back pain or cardiovascular problems.
• Self-destructive behavior, including alcohol or drug abuse, as well as suicidal tendencies.
• Responses to trauma vary widely and many people who experience extreme trauma do not develop PTSD. However, for those who do, PTSD symptoms usually appear within several weeks of the trauma, but some people don't experience symptoms until months or even years later.

Common signs and symptoms of excessive stress