LAUSR

If you ask health professionals about their experiences of resuscitation, they will sometimes tell you about a case that somehow bit deeper into them than they expected. It goes without saying that some events in medicine are more poignant, more disturbing, or more stressful than others. Sometimes, however, upsetting events can have effects that stray past the boundaries of work and into our personal lives. This begs the question: can we can spot those cases likely to affect us in this way? Or perhaps instead we could identify individuals most likely to be affected? In either case, can we do anything about it or is this just part and parcel of being a doctor or nurse? In this issue of Resuscitation, Spencer et al. have attempted to ask some of these questions in relation to advanced life support teams. Using the Trauma Screening Questionnaire (TSQ) to detect possible evidence of post-traumatic stress disorder (PTSD), they screened cardiac arrest responders for symptoms of psychological distress. PTSD has become part of common parlance and is regularly in the news. In the public mind it is probably most commonly associated with the mental trauma suffered by war veterans. This is due to a longstanding awareness that dysphoria and anxiety could be triggered by combat exposure. That awareness reaches a long way back into military history, but the specific term PTSD was only included into the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. However, the events of war are not the only precursors of PTSD, and the International Statistical Classification of Diseases (ICD 11) specifies only that the trauma should be an “extremely threatening or horrific event or series of events”. It is recognized that other grossly traumatic events such as sexual assaults or civilian disasters, can act as trigger events for PTSD, and as Spencer et al. point out in their discussion, emergency response workers are at increased risk of developing PTSD. It seems very reasonable to assume that a paramedic or fireman might be traumatized by horrific incidents, but it becomes less easy to imagine that healthcare professionals might be at risk of PTSD in the controlled, “sterile” hospital setting. Surely events inside a hospital cannot compare with those encountered in a war or catastrophe? Are we in danger of pathologising something normal; distress may be the appropriate reaction to horrible events?