Why agencies need a buddy-care model for rapid PTSI response
It is time to work to remove the stigma for treatment of psychological injuries and push for early intervention
Around the 5th century B.C., Sophocles wrote a tragedy called Ajax. Ajax was a great warrior and thrived in battle — the kind of person we would all feel comfortable watching our back on the street today. Ajax returned home from war, feeling angry and betrayed by his country.
During one of his rages, Ajax become delusional and slaughtered a flock of sheep believing in his mind that they were the people who betrayed him. When Ajax's mind cleared again he recognized what he had done and committed suicide out of shame and embarrassment.
In the story, this hallucination is attributed to Athena, the goddess of war. The name has changed over the centuries but it appears that Ajax was dealing with PTSI.
From Ancient to Modern Times
While the Greeks believed the gods and goddesses controlled the fate of mankind and could affect the minds of man, our knowledge base has expanded dramatically today. A decade of war has brought with it a large number of psychiatric casualties, and in response the military has learned about causes, symptoms, early intervention, and long-term management.
We know today that traumatic incidents can result in post-traumatic stress injuries if not treated early on. The problem is we often don’t seek the treatment until things are at their worst. It is time to work to remove the stigma for treatment of psychological injuries and push for early intervention.
Consider the following scenario: Officer down, GSW to the leg, arterial bleed. The downed officer’s partner applies a tourniquet to prevent the immediate loss of life until EMS with advanced life support can arrive. EMS stabilizes the officer and provides an IV to replenish lost fluids and increase blood pressure and transports to definitive care. A trauma surgeon completes repair to the injury and the officer is sent off to recover.
The prognosis for an officer with a traumatic physical injury is greatly improved by early intervention by personnel who are increasingly more skilled in medicine at each point. I suspect that none of these steps come as a huge shock to anyone, because this is a standard response based on nationally accepted medical protocols for traumatic physical injuries.
An Immediate Medical Response
The issue is we do not commonly treat mental injuries with the same set of standards of care set forth for physical injuries. There is a need for immediate intervention at the scene, more advanced care to ensure stability and determine the next phase of appropriate assistance needed, and then possibly definitive care to put things back in order to manage the long-term effects of psychological injuries.
This initial intervention commonly falls to the first responding unit or supervisor to arrive and find an officer in need.
Nationwide, most law enforcement officers lack the understanding to provide traumatic field care for psychological injury. The goal of the immediate response is to limit the chances of a temporary injury becoming a longer lasting wound that is in need of more serious care. On-scene psychological intervention is consistent with the model used in our scenario when initially dealing with a gunshot wound in the field.
1. This one-on-one intervention should be short and result in the officer being assured that his/her physical and mental reactions are normal and that they are not alone. This initial intervention will be rudimentary in nature, but if handled properly, it sets the groundwork for all future interventions.
2. The second phase of treatment is commonly provided by peer support programs and critical incident stress debriefings. Peer support helps the injured officers learn what is likely to occur to them physically and mentally in the immediate future, what to do to mitigate the effects, and what to do if these effects do not begin to subside over the next coming week.
3. The final level of care is brought about through professional counseling from a psychologist or psychiatrist. This is long term care and in many cases will not be needed at all if early interventions are accomplished.
PTSI is nothing new, although it has changed names several times. The association between trauma and psychological injuries has been documented in soldiers, citizens, and first responders. Find out if your agency has a PTSI plan in place before you need it. Do you have trained peer support or access to a critical incident team? Just like using a tourniquet, if you don’t know how to apply it before it is needed, it will be too late to learn about it when the time comes.