Tom Goodfellow

Don’t ignore the risk of PTSD for clinicians involved in tragic events

It has truly been a horrific year so far with the Manchester bomb, the London terrorist attacks, and culminating in the dreadful Grenfell Tower fire.

In addition to the multiple tragic deaths many people have been deeply psychologically traumatised by the events. A term often used by psychologists is “shattered assumptions”.

Most of us believe the world to be a generally benign and benevolent place and, for example, going to a pop concert would be a safe occasion for happiness and fun.

But extreme unexpected trauma can shatter this world view leaving individuals in a desolate state.

Fortunately the human brain is very resilient, and after such experiences most people will recover in time, especially with the support of families, friends and general social networks. However a small but significant number will not recover and will go on to develop full blown post-traumatic stress disorder (PTSD).

This is characterised by a number of symptoms including nightmares, panic attacks, flash-backs, depression, hyperarousal and avoidance. Untreated this may become very debilitating.

NICE guidelines do not recommend intervention for at least four weeks after the incident, but evidence has shown that trauma-focussed cognitive behavioural therapy (TFCBT) is a very effective treatment when administered correctly, with significant reduction in symptoms.

This came to mind when I listened to a radio interview with Mr Naveed Yasin, a surgeon at the Salford Royal Hospital. He, with his colleagues, was involved in the management of some of those injured by the Manchester bomb.

He stated that he found it an “extremely profound and traumatising experience”. And, “as a father what I have witnessed is horrific”.

What made it worse for him was that, after two days of highly demanding surgery, he was racially abused on his way back to the hospital. During the radio interview the distress in his voice was obvious.

I hope that Mr Yasin has recovered, and we all would wish him well. But although PTSD is well recognised to occur in police, firemen and para-medics it is rarely spoken of in connection with medical and other clinical staff, and there seem to be relatively few studies on this.

But medical staff are human beings too, and are as likely to be affected by witnessing the effects of severe trauma as anyone. So called “secondary traumatisation” is well recognised and may occur in those not directly involved in the trauma, but who witness the effects of the trauma or who hear about the accounts of the trauma in others. The symptoms are the same as in PTSD.

All employers have a duty of care towards their employees, although in my view the NHS tends to be very poor at this.

In those hospitals where serious casualties have been admitted it is essential that staff are educated in the symptoms they might experience, and have clear referral routes for those in psychological trouble.

However given the current under-resourced state of mental health services in the NHS, perhaps this is a pipe dream!


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