PTSD and the Ambulance Service

I recently came across an article titled “Paramedics are nearly twice as likely to suffer Post Traumatic Stress Disorder (PTSD) than Soldiers coming back from war” This title seemed so emotive that I became instantly drawn into reading the article. Of course, in my head, I had already disregarded such a bold statement. Surely it was nonsense? I mean, I have never been a soldier, but I have spent over a decade working as a paramedic. It had never occurred to me until reading that very title, that PTSD could be something that a paramedic could suffer from. But hang on a minute….. why not?

The article I now found myself reading with real interest was based on a study carried out at Oxford University. It claimed that approximately 10% of paramedics could be at risk of the condition, compared to between 5-7% in soldiers. Even reading these figures, I was still questioning to myself how these statistics could be true. I cannot begin to imagine the horror of war and being on the front line. Where were these figures coming from?

But then I read the actual definition of what PTSD is and I began to re consider: “Post Traumatic Stress Disorder or PTSD is a disabling anxiety disorder that people may develop after experiencing one or more traumatic events. A trauma is an exceptionally threatening event during which the individual may feel like they (or someone very close to them) are about to die or experience serious harm.”

The key part of that sentence for me was the definition of trauma. I never felt like I was going to die at work, but I genuinely cannot count all the times that I have felt that the patient I was treating was going to die or experience serious harm. And of course, spending over a decade with the ambulance service, I witnessed that happen to many patients. Exchange the word ‘patient’ for ‘person’ or for ‘fellow human’ and now; to say instead of patient, that I have watched many people die (my other fellow humans) takes it from a clinical job to a human emotional experience. I started to realise that PTSD in the ambulance service could be a very real thing. As to who is most likely to suffer from PTSD between a soldier and a paramedic? Well I’ve not researched any further to find out and from reading just a few of the responses to the original article, it clearly has a divided reaction. It is not my intention to further that debate. But instead, what interests me more is finding out how our ambulance services are dealing with this. What help is available to our front line ambulance personnel?

The following is taken from a news article but I found it particularly accurate and well put:

“Paramedic levels of Post Traumatic Stress Disorder (PTSD) are soaring. Intrusive re-experiencing of events is a primary source of PTSD, where Paramedics (or others) relive the events of a traumatic incident over and over again in their mind. Such events for Paramedics include the screaming death of a child, watching a kindred person lose a partner, or a tragedy affecting a family. In most cases these images are a reflection of the Paramedic’s own personal circumstances.

When a Paramedic who is also a parent attends the death of a child that leaves a permanent mark. Attending a road crash where the victim is reminiscent of a parent, partner or loved one is similarly traumatic. A family ripped apart by tragedy, or a patient suffering a life threatening condition at a young age are but a few examples that can cause a Paramedic distress. Paramedic empathy for the tragedy they see is profound.

A second aspect of PTSD is the guilt associated with natural limitations. Trying to treat a patient under a guideline that assumes the patient has a face when they don’t makes it difficult. CPR on a patient with no legs seems futile, or airway management on a patient with blood pouring out of their mouth. However, the thought that you could have done more is a constant grind.

This is part of the daily life of a Paramedic. Taking those experiences home every day is a terrible burden. As a result, many Paramedics express difficulties dealing with loved ones, finding intimacy, struggling with anger issues, alcohol problems, or (far too commonly) suicidal thoughts. Sadly, many of these lead to suicidal actions, and Ambulance has one of the highest rates of suicide of any profession.”

Sadly, the content of that article does not surprise me. During my time with the ambulance service, I personally knew colleagues that had taken their own life and knew of many more. I witnessed colleagues have breakdowns and have to leave the service. I knew of many desperately looking for relief from a bottle of whiskey. So in fact, why PTSD in the ambulance service had never actually occurred to me, I don’t know. Perhaps it is because (possibly selfishly) I don’t believe I have ever come close to suffering from it. Or perhaps it is because it was never talked about during my years of employment.

As far as I can remember, the extent of counselling or help offered from the ambulance service was this: Control staff and/management staff on duty would recognise that a particular incident you had just attended was a “bad job”. If the demands on the service at that very particular time allowed, you got offered to back to station for a cup of tea. In the mess room would be a poster on a wall displaying a variety of faces with names and contact numbers. These were fellow colleagues you could contact to discuss any counselling issues you may have had. But what counselling qualifications did they actually have? In some cases, a de-brief was organised where by a number of staff with pips on their shoulders would arrive, sometimes with members from other services who had been involved with the same incident. But somehow, these always felt to me like an interrogation to make sure you had done everything right as opposed to genuinely checking on your well being. I accept that my recollection sounds negative but I cannot recall any other help being readily available. It certainly wasn’t an integral part of being inducted into the service. So maybe, I was never ‘taught’ to be aware of PTSD or other mental health issues which is why I now find myself pondering over its very existence within the ambulance service.

I decided to post a very casual status update on Facebook. It read: “NWAS friends. Can anyone inbox me what counselling/services are available to you should you feel you need it. Is it readily available? Are staff immediately aware of these options? Thanks”

It immediately proved to be a quick fire debate with some choosing to discuss their thoughts and experiences with each other by directly posting responses. Whilst at the same time I also received an unexpected number of private messages, sent to me by people telling me some of their experiences. I am not going to betray anyone’s very personal feedback that they kindly shared with me. But although a lot of it was still quite negative, I was genuinely pleased to read about so many positive experiences old friends and colleagues had to share with me. It does seem in fact that counselling has moved forward since I was an employee. Not all existing staff seemed to be aware of what was available to them or how to access help. Many too, were concerned with their own confidentiality, feeling that the ambulance service do not offer a wholly confidential service. This causes them to have concerns about management receiving information with regards their mental health and thus opening up a whole new discussion.From my own research I am pleased to find out that many ambulance services, including (I am told) my former employer, NWAS, are proactively looking into this and utilise, or are looking to implement very soon, a system used by Royal Marines called TRiM (Traumatic Risk Management) to look after their staff who have attended traumatic incidents.

This is what I have managed to find out about TRiM:

Taken from 2013: The East of England Ambulance Service NHS Trust (EEAST) has begun using a new system to look after staff who have attended traumatic incidents. Studies into traumatic risk management (TRiM), used by the Royal Marines, show that it is the most successful system in flagging, monitoring and managing traumatic stress. Resilience Manager Jackie King said: “Our frontline staff go to a lot of traumatic incidents including suicides, major incidents, and those involving children – which is the norm. “What we would like to make the norm is for colleagues to talk to and check-on each other because it can make a massive difference.” Any members of staff who feel the need to can speak with a TRiM practitioner confidentially – which is important adds Jackie because often crews fear they may be perceived as ‘not up to the job’.

Further information I uncovered was this:

“TRiM is a trauma-focused peer support system, the implementation of which has benefited many ‘at risk’ organisations – legally (by providing a duty of care); economically (by keeping people at work) and morally (by looking after personnel).

The TRiM model builds resilience by basing itself on keeping employees functioning after traumatic events by providing support and education to those who require it. Additionally, by training TRIM Practitioners at operational level throughout an organisation, TRiM aims to identify those who are not coping after potentially traumatising events and ensure they are signposted to professional sources of help. TRiM empowers organisations to discharge their duty of care while promoting a proactive and resilient stance to the effects of potentially traumatic events.

TRiM provides the processes and practices for organisations to ensure that they have “trained eyes and ears” throughout your organisation. Such individuals will have the skills to pick up, not only on traumatic stress, but on the occupational and work-related stress that can impair individual’s ability to work effectively. Our staff have repeatedly found that providing expert advice and assistance for ‘at risk’ organisations is considered to be a real benefit for ensuring those working in safety critical roles have access to support when they need it.

TRiM originated within the UK military as an evidence based alternative to previously-used reactive single session models of post incident intervention such as Critical Incident Stress Debriefing. Single session debriefing has been subjected to scientific scrutiny and shown to not just lack effectiveness but also have the potential to do harm. Founder and Director of March on Stress, Professor Neil Greenberg was at the forefront of developing peer-led traumatic stress support packages within the UK military and has helped many organisations to adopt TRiM and provide evidence based support to their staff.

Why TRiM?

There is ample evidence that people exposed to work related stress are likely to be less effective at work, more likely to be absent from work and to suffer poor mental health. For instance, a 2007 report noted that impaired work efficiency, as a result of mental disorders, costs the UK £15.1 billion a year, with mental-health-related absenteeism costing an additional £8.4 billion annually.

For some organisations, work related stress may result from exposure to traumatic events. The impact of traumatic events upon ‘at risk’ staff including emergency services personnel, military forces and security sector staff have been well documented in the scientific literature. For instance up to a third of some security contractors, between seven and 30% of combat troops and up to a quarter of war reporters are likely to suffer from Post-Traumatic Stress Disorder; many also frequently report significant trauma related guilt related to their work.”

Understanding what PTSD is and realising, quite obviously in fact, that ambulance personnel are an at risk group, it is comforting to learn that things certainly seem to have moved on, even in the few years since I have left. But the flip side to this is that there are clearly many staff who feel things need to go further. Let’s hope continued efforts and resources are put into keeping our ambulance staff mentally well and supported. offer a “Blue light programme, support for emergency workers.” Their website is worth a look.

If you are concerned about PTSD, here is a list of symptoms to be aware of:

  • Unwanted distressing memories of the trauma
  • Flashbacks
  • Nightmares
  • Feeling emotionally upset, tearful or irritable for example, when reminded of the trauma
  • Physical symptoms in response to reminders of the trauma, such as sweating, shaking or a racing heart beat
  • Avoiding talking about the trauma, thinking about it or feelings associated with it
  • Avoiding reminders of the trauma: people, places or activities
  • Feeling emotionally numb, difficulty experiencing feelings like love or happiness
  • Feeling detached and cut-off from other people, finding it difficult to be close to anyone
  • Loss of interest in activities that used to be enjoyable
  • Difficulty sleeping
  • Difficulty concentrating
  • Feeling overly alert or watchful
  • Feeling jumpy


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