Κυριακή, 26 Ιουνίου 2016

What do we know about traumatic stress in EMS?

By Elizabeth Donnelly

We are becoming more aware as an EMS community that there are significant costs to our physical and mental health associated with our work. We need to continue to talk about those costs in order to increase awareness and decrease the stigma associated with asking for help.

In addition to talking about traumatic stress, we need to better understand what places EMS providers at risk for developing a work-related stress reaction like post-traumatic stress.

The quick answer is there is no quick answer.

Whether or not you develop a post-traumatic stress reaction, depression or burnout as a result of working in EMS depends on a wide variety of personal, professional and situational factors. However, researchers have made some progress at understanding what might aggravate that risk.

Stress in EMS
Ever since Jeffrey Mitchell's seminal article in 1983, we have known that critical incidents can lead to stress reactions like post-traumatic stress.

Critical incidents have broadly been described as any situation faced by emergency services personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later. Multiple studies have identified a relationship between critical incidents and post-traumatic stress in EMS.

But is that the whole story? Are tragic, unexpected and chaotic scenes the only problem?

What about the more chronic stresses associated with EMS, the stress that is constant day in and day out, including shift work, conflict with administration, low pay and missing your family?

In 2010, I conducted a study to see if it were possible to capture a picture of what the biggest traumatic stress risk factors were for EMS personnel. Supported by the NREMT, 12,000 EMTs and paramedics were invited to complete a survey that asked about critical-incident stress, alcohol use and post-traumatic stress symptomatology (PTSS).

Nearly one-third (30.8 percent) of survey responses came from fire-based EMS personnel. Another quarter (25.3 percent) of the responses came from private for-profit departments. The remaining responses were third-service (7 percent), private non-profit (14.6 percent), volunteer (10.2 percent) and other types (12.1 percent) EMS personnel.

Service type, as well as some of the other collected data, was not included in the article published in Prehospital Emergency Care.

We also asked about two kinds of chronic stress — organizational stress (the stresses associated with working within a specific EMS agency) and operational stress (the stress of working in EMS regardless of the service).

We found that operational stress, organizational stress, critical incident stress, alcohol use and post-traumatic stress all correlated with one other in a statistically significant way.

Statistical significance means that the observed relationship between the three factors is not due to chance; as levels of chronic stress or critical incident stress increase, there also is an increase in levels of post-traumatic stress. Interestingly, chronic stress more strongly correlated with PTSS than critical incident stress did.

While previous research has been based on the premise that exposure to critical incidents is the culprit for PTSS in EMS personnel, these findings indicate that high levels of chronic stress may also be influential on levels of post-traumatic stress. So the picture is more complicated than just debriefing after a bad call.

Even more alarming, we found that high levels of chronic operational stress in combination with high levels of critical incident stress and high levels of chronic operational stress in combination with greater alcohol use was significantly associated with higher levels of post-traumatic stress.

What does this mean?
What this research indicates is that the relationship between work stress and post-traumatic stress in EMS go beyond the bad calls. Being stressed out because of your workplace or because of the structure of EMS work — changing shifts, being away from your family, fatigue — is also associated significantly associated with post-traumatic stress.

While we have a better picture of what might cause a stress reaction, we still lack a good body of evidence to let us know the best ways to increase resilience and mitigate stress reactions. We need to come together as a professional and academic community to do a better job of protecting EMS personnel from work-related stress.

This may come in the form of more education, increasing access to employee assistance programs and other support services, and continuing the important dialogue started by organizations like the Code Green Campaign and #IVEGOTYOURBACK911.

In terms of research, we need to develop and evaluate evidence-based interventions to increase resilience, including best practices for developing a peer support team and disseminating stress management curricula.

While it may not be possible to prevent everyone from developing a stress reaction, researchers need to focus attention on ways to support EMS personnel before they start suffering.

Study results are described in greater detail here: "Work-related stress and posttraumatic stress in the emergency medical services"
 

About the author: 
Elizabeth Donnelly is an associate professor at the University of Windsor. She has 17 years of experience working as an NREMT in Minnesota, Florida and Michigan. She would like to acknowledge the NREMT for their support of this research. Dr. Donnelly can be reached at donnelly@uwindsor.ca  or http://ift.tt/28Y6bDx.

Works referenced:
1. Mitchell, J.T. (1983). When disaster strikes…the critical incident stress debriefing process. JEMS. Jan; 8(1):36-39.

2. Donnelly, E. A. (2012). Work-related stress and posttraumatic stress in the emergency medical services. Prehospital Emergency Care, 16(1), 76-85. doi:10.3109/10903127.2011.621044

 



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What do we know about traumatic stress in EMS?

There is a significant correlation between operational stress, organizational stress, critical incident stress, alcohol use and post-traumatic stress

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Frequent Flyers: Who restocked the rig?

A comic for EMS drawing off the real experiences of EMS

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Frequent Flyers: Who restocked the rig?

See all of Lenwood Brown's comics.



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BREAKDOWN IN PERIPHERAL IMMUNE TOLERANCE IN EXPERIMENTAL DIABETES MELLITUS

2016-06-26T18-31-42Z
Source: Journal of Molecular Pathophysiology
Alex Kamyshny, Denis Putilin, Vita Kamyshna.
BREAKDOWN IN PERIPHERAL IMMUNE TOLERANCE IN EXPERIMENTAL DIABETES MELLITUS A.M.Kamyshnyi, D.A.Putilin, V.A.Kamyshna Zaporozhye State Medical University Abstract: We studied to determine the effect of the levels of Deaf1 mRNA expression on the nature of Foxp3+ Treg cells differentiation during experimental STZ-induced diabetes mellitus (EDM) in rats PLN. To determine the level of Deaf1 mRNA expression was performed RT-PCR in real-time by thermocycler CFX96 Real-Time PCR Detection Systems. The Foxp3+-immunopositive lymphocytes were determined using an indirect immunofluorescence technique with using a monoclonal rat antibody. We established that development of EDM was accompanied by decreased the expression levels of the transcriptional regulator Deaf1 4,2‐fold in rats PLN with 3-week EDM and 2,5‐fold in rats with 5-week EDM. Reduced Deaf1 mRNA expression during EDM associated with an decreased of total amount of Treg in the PLN, led to changes of distribution into individual classes of FoxP3+ lymphocytes and FoxP3 concentration in immunopositive cells. Key words: experimental diabetes mellitus; deformed autoregulatory factor 1 (Deaf1); Foxp3; Treg.


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Comparison of knowledge and practice of current infant feeding options among HIV-positive mothers in urban and rural communities in Anambra State, Nigeria

2016-06-26T17-51-26Z
Source: International Journal of Tropical Medicine and Public Health
Lawson Nwokedi Igbokwe, Elias Chikee Aniwada, Nwachinemere Uleanya, Benjamin Uzochukwu.
Objectives This was to compare the knowledge and practice of current infant feeding options among HIV-positive mothers in urban and rural communities in Anambra State, Nigeria Methods It was a comparative cross-sectional study involving HIV-positive mothers from rural and urban communities, whose babies were HIV- negative, and

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Barrett's esophagus detection: Multiple biopsies are useful, even better if you have an “X” on your map

Barrett's esophagus (BE), defined as the replacement of physiological squamous epithelium of the lower esophagus by metaplastic columnar epithelium containing goblet cells, is a premalignant condition that can lead to esophageal adenocarcinoma through dysplasia with an annual risk of about 0.5% [1–3]. The major determinant of BE is represented by gastro-esophageal reflux, which promotes chronic inflammation and progressively induces the metaplastic transformation in predisposed subjects [4,5]. Indeed, several pathophysiological studies carried out with the state-of-the-art technology clearly demonstrated that the severity of BE directly correlates with esophageal acid exposure and reflux occurrence of any type [6,7].

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Barrett's esophagus detection: Multiple biopsies are useful, even better if you have an “X” on your map

Barrett's esophagus (BE), defined as the replacement of physiological squamous epithelium of the lower esophagus by metaplastic columnar epithelium containing goblet cells, is a premalignant condition that can lead to esophageal adenocarcinoma through dysplasia with an annual risk of about 0.5% [1–3]. The major determinant of BE is represented by gastro-esophageal reflux, which promotes chronic inflammation and progressively induces the metaplastic transformation in predisposed subjects [4,5]. Indeed, several pathophysiological studies carried out with the state-of-the-art technology clearly demonstrated that the severity of BE directly correlates with esophageal acid exposure and reflux occurrence of any type [6,7].

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Analysis of the Substance Scanning Test Results of Non- Alcohol Substance Abusers Who Admitted an University Hospital

2016-06-26T08-00-57Z
Source: Bağımlılık Dergisi - Journal of Dependence
Aslıhan Okan, Abdullah Atli, Cafer Alhan, Süleyman Demir, Mehmet Cemal Kaya, Aytekin Sır.
Background: Urine toxicological analysis is one of the important procedures as rapidly investigate for the identifies substance use, including initial diagnosis, with treatment plan for substance abusers and compliance with treatment. Toxicological analysis for legal purposes primarily aims to detect illegal or banned drug and substance use in a variety of situations. Diyarbakir is is one of the largest cities in southeastern Turkey and also most of the population who living in Diyarbakir tended to be poor and middle socioeconomic levels.The aim of this study was to evaluate the results of toxicological analysis of patients who admitted to our department of psychiatry that prediagnosis of non-alcohol substance use. Method: A retrospective study including the 167 patients who voluntarily admitted to outpatient psychiatry department of Dicle Medicine Faculty, from January to December 2014. Files of each one participants were carefully analyzed by the experienced researchers. Results: Of 167 participants enrolled in the study who attempted for the prediagnosis of non-alcohol substance abuse. In all, 12.0 % (n=20) were female, and 88.0 % (n=147) were male. 44.9 % of patients (n=75) were urine positive whereas the 55.1% of patients (n=92) were urine negative for substance use on admission to hospital. The most common substance abuse was Marijuana (88%,n:66) followed by 3,4-methylenedioxymethamphetamine (MDMA) (18.6%,n=14), Methamphetamine (Meth) (16.0%,n=12), opioids (5.3%, n:4), Barbiturates (4.0%,n:3) and Phencyclidine (PCP) (2.7%, n:2), respectively. Two female were using to marihuana, and another one was using to MDMA-Meth. We showed here that 37.3% of patients were using together with great number of substance, whereas the 62.7% of patients were using only one substance. Also, the ranges of one substance abuse were found Marijuana 43.0%, Meth 2.0%, Barbiturates 1.0% and 1.0 % MDMA ,at the same time. Discussion and Conclusion: We found here the rates of not using of substance among the participants was 55.1%, according to toxicological analysis. In this case may be explained that a portion of patients were successfully treated or pay close attention of parents about to substance abuse. The most common substance abuse was Marijuana. On the other hand, other substances whit stimulant effect were among the commonly used substances, including the Meth, amphetamine, phencylidine, barbiturates, opioid and its derivatives. As clearly shown in our study that solely exclusively environmental factors, including the poor social and economic factors with adverse learning conditions can not explain the increases in Marijuana abuse and growing dependence prevalence numerous environmental factors, may have affected this growing rates. With regard to putative economic factors, there is a clear need for additional studies to ascertain how changes in alcoholic beverage prices, taxes, and availability affect the prevalence of alcohol use disorders among race-ethnic and other subgroups of the population. As a result, substance abuse is an important public health problem. Its should be remembered that increasing usage rates of substance may have be related to easy access to it. Unfortunately, our region is carries a significant risk in terms of the substance abuse. In light of these results, protective measures related to use of the substances should be increased in no time besides the emergency health care needs in Diyarbakir. On the other hand, Alcohol and Substance Abuse Treatment and Training Center (AMATEM) should be established in our region.


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RELATIONSHIP BETWEEN THE LEVEL OF LONELINESS AND INTERNET ADDICTION BASED ON THE PURPOSE OF USING SOCIAL NETWORKS BY UNIVERSITY STUDENTS

2016-06-26T08-00-57Z
Source: Bağımlılık Dergisi - Journal of Dependence
Özden Yalçınkaya Alkar, Furkan Bardak.
This study is aim to analyze the relation between the level of loneliness and the addiction of internet based on the purpose of using social networks by university students and the differences based on changes of gender. Totally, there are 348 university students in Ankara who play a part az samples in the study. In the study, the population of males is 144, of females is 204. The dates are collected from demographic information from, internet addiction scal, scale of the goals of social network using, UCLA loneliness scale. The dates are analyzed by using SPSS-20 programme whit the help of t-cross section and regression groups which are objective. The results showed that using social networks with the aims of communation and interaction, familiarisation and winnig fame, and aducation have on effect on internet addiction, with the aims of familiarisation and winning fame have on effect on loneliness. The results indicated that men's level of loneliness and internet addiction are higher than womens' and women we the internet for education with a higher level than men, while menuse it for familiarisation and winning fame.


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INVESTIGATION OF TREATMENT MOTIVATION IN ALCOHOL-DEPENDENT PERSONS FOLLOWED BY A RECOVERY MODEL: A CONTROLLED STUDY

2016-06-26T08-00-57Z
Source: Bağımlılık Dergisi - Journal of Dependence
Ayşegül Savaşan, Olcay Çam.
Objective:The aim of this study was to determine the effect of the psychiatric nursing approach based on the Tidal Model on motivation for treatment in alcohol-dependent persons. Method:The study was semi-experimental in design, with pre-test post-test evaluation and a control group, and was conducted on 36 individuals (18 experimental, 18 control). The Treatment Motivation Questionnaire(TMQ), The Addiction Profile Index(BAPI), Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) were applied before and three months after the application. Results:At the end of the three month follow up, alcohol use by individuals in the experimental group was found to be less than that of the control group. Individuals in the experimental group who was at the maintenance stage were found to be more than the control group.The BAPI craving subscale point decreased in the experimental group; increased in the control group. It was found that internalized and external motivation, interpersonal-help-seeking and total motivation of the experimental group decreased or remained the same and confidence-in-treatment of them increased at the end of three months; but the difference was not significant. Internalized motivation in the control group was a significant reduction; when compared with the experimental group, the difference in change between the two groups was found not to be significant. Conclusion:The psychiatric nursing approach based on the Tidal Model may have prevented a significant reduction in especially internalized motivation of the experimental group. It is recommended that follow-up studies did to prevent relapse and randomized controlled studies conducted with regard to the most frequently seen problems of alcohol-dependent persons.


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Editorial

2016-06-26T08-00-57Z
Source: Bağımlılık Dergisi - Journal of Dependence
Ayhan Kalyoncu.



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Study of analgesic effect of amiloride compared to aspirin in chemically induced pain models in rats and mice

2016-06-26T00-48-19Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Bhanu Prakash Kolasani, Raghunatha Rao Ponnaluri, Raghunandan Mudium.
Background: Acid-sensing ion channels (ASIC) contribute to acid-evoked pain in many painful inflammatory and ischemic conditions such as rheumatoid arthritis, cardiac ischemia, and exhausted skeletal muscles, which are accompanied by local tissue acidosis. Amiloride, a potassium-sparing diuretic was recently discovered to be a blocker of these ASIC. Aims and Objectives: The objective of present study is to evaluate the analgesic activity of amiloride in chemically induced pain models of rats and mice and compare it against the standard analgesic aspirin. Materials and Methods: A total of 24 mice and 24 rats were distributed into four groups of 6 each: Group A received distilled water as control, Group B received the test drug amiloride - low dose (20 mg/kg), Group C received amiloride-high dose (40 mg/kg), and Group D received standard drug aspirin (25 mg/kg); all drugs were given intraperitoneally. In formalin test, 0.025 ml of 1% formalin was injected under the plantar surface of hind paw and the mean time of paw licking (MTPL) was measured in both early (0-5 min) as well as late (20-40 min) phase. In acetic acidinduced writhing test, the animals were injected with 1 ml/100 g body weight of 0.6% acetic acid i.p. The number of writhings produced was recorded over a period of 20 min. Results: In the early phase of formalin test, the MTPL was significantly reduced (P

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