Identifying and Managing Post Traumatic Stress Disorder in Frontline Workers

Let us think about post traumatic stress disorder on its own and then we will consider the possibility, prevalence and ways of managing this in frontline workers.

PTSD(Post traumatic stress disorder) is a term we use for a constellation of symptoms which develop following a life threatening trauma like accidents, assault of violent nature, wars, natural calamities, rape etc.it is very important to emphasise that the nature of the trauma has to severe and life threatening.

The symptoms mainly include -

1. Reliving the trauma in the form of memories, visions, dreams etc.
2. Hyperarousal where in one is vigilant and in a aroused mode like one would be when faced with a threatening situation i.e.in a fight or flight mode.
3. Avoidance behaviour of cues to the original trauma for instance one avoiding watching news to stay away from visuals that are remiscent of the original trauma, this leads to increasing social withdrawal and isolation.

Unchecked and untreated these symptoms can lead to severe depression and decline in all aspects of functioning. One can fall in the trap of substances like alcohol in an attempt to self-medicate.

In reality, majority of the frontline workers would qualify for a formal diagnosis of PTSD,but that does not diminish the suffering they go through.

There are various studies that have demonstrated time and again that frontline workers in pandemic situation are very vulnerable to psychological difficulties including anxiety, insomnia, depression and what is collectively referred to as moral injury. Moral injury happens when one “perpetrates, fails to prevent, bears witness to, or learns about acts that transgress deeply held moral beliefs and expectations”. For instance a intensive care physician having to take a call who should get the only available ventilator, by default allowing somebody else to die.

Front line workers be it medical, nursing, paramedical staff and police personnel have to endure war like situations on an everyday basis.

Factors which make matters worse are a lack of leadership and organisational clarity on ones roles and responsibilities, lack of resources and systemic planning around the same. Uncertain and unpredictable nature of pandemics leading to threats to ones own safety and wellbeing. Couple the above factors with a limited acknowledgement and support provided to staff from the government and other relevant authorities and it is a recipe for very toxic emotional environment.

The potential solution is effective leadership, accurate job profiles relevant to required tasks, clarity in chain of command, effective supplies of equipment, timely, proactive communication, accurate information and a non-judgmental culture.Unfortunately,we are far from the requirement of the hour in acountry of our size and complexity.

The clearest message from studies is that key to prevention and recovery is support: social support from peers; advice and feedback from supervisors; emotional support from families; being valued by communities. We can all bear this mind and provide whatever emotional support we can provide to our real heroes.

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