Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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A Case Study of the Effects of Posttraumatic Stress Disorder on Operational Fire Service Personnel Within the Lancashire Fire and Rescue Service

  • Khan, Khalid (School of Engineering, University of Central Lancashire) ;
  • Charters, Jonathan (School of Engineering, University of Central Lancashire) ;
  • Graham, Tony L. (School of Engineering, University of Central Lancashire) ;
  • Nasriani, Hamid R. (School of Engineering, University of Central Lancashire) ;
  • Ndlovu, Shephard (School of Engineering, University of Central Lancashire) ;
  • Mai, Jianqiang (School of Engineering, University of Central Lancashire)
  • Received : 2017.06.02
  • Accepted : 2017.11.13
  • Published : 2018.09.30
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Abstract

Background: Lancashire Fire and Rescue Service (LFRS), the subject of this evaluative research document employs 1400 people. 80% of employees are operational firefighters and officers whom operate across a range of duty systems and support functions, providing prevention, protection and emergency response to the communities of Lancashire. Methods: The overarching purpose of this epidemiological study is to assess the prevalence of posttraumatic stress disorder (PTSD) amongst operational LFRS personnel and to analyse the effects upon those who may be suffering from it, whether brought about by a single traumatic event or by repeated exposure to traumatic occurrences over a period of time. A combination of primary and secondary research was carried out. Primary data was collated using two recognised clinical questionnaires and statistical analysis was conducted with the aid of the software package SPSS. Results: The findings and statistical analysis showed that out of the 100 people surveyed, 30% of respondents had signs of probable distress. Of this quota, 4% showed symptoms of PTSD. The study considers how an organisation can recognise and manage PTSD and provides recommendations to assist in better recognising and managing the associated risks. Conclusion: Based upon the findings, the authors conclude that the level of PTSD within LFRS is slightly lower than those found in other studies undertaken within the Fire and Rescue Service sector. The paper provides recommendations for future studies and a series of actions for consideration by LFRS senior management to improve PTSD support services for employees.

Keywords

References

  1. Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993;6(4):459-73. https://doi.org/10.1002/jts.2490060405
  2. Lusa S, Hakkanen M, Luukkonen R, Viikari-Juntura E. Perceived physical work capacity, stress, sleep disturbance and occupational accidents among firefighters working during a strike. Work Stress 2002;16(3):264-74. https://doi.org/10.1080/02678370210163301
  3. Del Ben KS, Scotti JR, Chen Y-C, Fortson BL. Prevalence of posttraumatic stress disorder symptoms in firefighters. Work Stress 2006;20(1):37-48. https://doi.org/10.1080/02678370600679512
  4. Beaton RD, Murphy SA. Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes. Prehosp Disaster Med 1993;8(2):140-50. https://doi.org/10.1017/S1049023X00040218
  5. Dahlan A, Malek M, Mearns K, Flin R. Stress and psychological well-being in UK and Malaysian fire fighters. Cross Cult Manag An Int J 2010;17(1):50-61. https://doi.org/10.1108/13527601011016907
  6. Regel S, Joseph S. Post-traumatic stress. Oxford University Press; 2010.
  7. Duckworth DH. Psychological problems arising from disaster work. Stress Health 1986;2(4):315-23.
  8. Raphael B, Lundin T, McFarlane C. A research method for the study of psychological and psychiatric aspects of disaster. Acta Psychiatr Scand 1989;80(S353):1-75.
  9. Fullerton CS, McCarroll JE, Ursano RJ, Wright K. Psychological responses of emergency workers: firefighters and trauma. Am J Orthopsychiatry 1992;62:371-7. https://doi.org/10.1037/h0079363
  10. Carlier I, Gersons B. Trauma at work: post-traumatic stress disorder-an occupational health hazard. J Occup Heal Saf Aust New Zeal 1994;10:264.
  11. Marmar CR, Weiss DS, Metzler TJ, Ronfeldt HM, Foreman C. Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents. J Trauma Stress 1996;9(1):63-85. https://doi.org/10.1002/jts.2490090107
  12. Beaton R, Murphy S, Johnson C, Pike K, Corneil W. Coping responses and posttraumatic stress symptomatology in urban fire service personnel. J Trauma Stress 1999;12(2):293-308. https://doi.org/10.1023/A:1024776509667
  13. Association AP. Diagnostic and statistical manual of mental disorders (DSM-$4{(R)}$). Am Psychiatr Pub; 1994.
  14. National Fire Protection Association. Trouble in mind [Internet]. 2014. Available from: http://www.nfpa.org/newsandpublications/nfpa-journal/2014/may-june-2014/features/special-report-firefighter-behavioral-health. [Accessed 27 September 2014].
  15. Haslam C, Mallon K. A preliminary investigation of post-traumatic stress symptoms among firefighters. Work Stress 2003;17(3):277-85. https://doi.org/10.1080/02678370310001625649
  16. Bryant RA, Harvey AG. Posttraumatic stress in volunteer firefighters: predictors of distress. J Nerv Ment Dis 1995;183(4):267-71. https://doi.org/10.1097/00005053-199504000-00014
  17. Baker SR, Williams K. Relation between social problem-solving appraisals, work stress and psychological distress in male firefighters. Stress Health 2001;17(4):219-29. https://doi.org/10.1002/smi.901
  18. Wilmoth JA. Trouble in mind [Internet]. 2014. Available from: http://www.nfpa.org/newsandpublications/nfpa-journal/2014/may-june-2014/features/ special-report-firefighter-behavioral-health. [Accessed 15 September 2014].
  19. National Volunteer Fire Council. Suicide in the fire and emergency services: adopting a proactive approach to behavioural health awareness and suicide prevention [Internet]. National Volunteer Fire Council. 2012. Available from: http://www.nvfc.org/health-and-safety-news/nvfc-releases-report-and-webinar-onsuicide-in-the-fire-and-emergency-services. [Accessed 15 September 2014].
  20. Senn R. Post traumatic stress disorder: one firefighters story [Internet]. 2010. Available from: http://www.fireengineering.com/articles/print/volume-163/issue-12/features/post-traumatic-stress-disorder-one-firefighters-story.html. [Accessed 26 September 2014].
  21. Meroney B. Dealing with PTSD in the fire service [Internet]. 2013. Available from: http://www.firefighternation.com/article/management-and-leadership/dealing-ptsd-fire-service. [Accessed 15 September 2014].
  22. National Health Service. Post traumatic stress disorder (PTSD) - Andy's story [Internet]. 2013. Available from: http://www.nhs.uk/Conditions/Posttraumatic-stress-disorder/Pages/realstoriespage.aspx. [Accessed 2 March 2015].
  23. Ministry of Defence. Trauma awareness in firefighter leadership training [Internet]. 2011. Available from: http://www.ptsdresolution.org/pdf/P.27-31Trauma Awareness.pdf. [Accessed 10 September 2014].
  24. Clohessy S, Ehlers A. PTSD symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol 1999;38(3):251-65. https://doi.org/10.1348/014466599162836
  25. National Institute for Health and Care Excellence. Post traumatic stress disorder (PTSD) - support for education and learning [Internet]. 2012. Available from: http://www.nice.org.uk/guidance/cg26/resources. [Accessed 21 September 2014].
  26. Association AP. Diagnostic and statistical manual of mental disorders (DSM-$5{(R)}$). American Psychiatric Pub; 2013.
  27. World Health Organisation. Guidelines for the management of conditions specifically related to stress [Internet]. 2013. Available from: http://www.who.int/mental_health/emergencies/stress_guidelines/en/. [Accessed 25 February 2015].
  28. Briere J. Psychological assessment of adult posttraumatic states. Washington, DC: Am Psychol Assoc; 1997. p. 26-9.
  29. Lancashire County Council. District population [Internet]. 2014. Available from: http://www3.lancashire.gov.uk/corporate/web/?siteid=6120&pageid=39945. [Accessed 2 January 2015].
  30. Boxer PA, Wild D. Psychological distress and alcohol use among fire fighters. Scand J Work Environ Health 1993:121-5.
  31. Aguilera DC. Crisis intervention: theory and methodology [Internet]. Mosby. 1998 (Crisis Intervention). Available from: https://books.google.co.uk/books?id=c6pHAAAAMAAJ. Accessed April 2015.
  32. Moran C, Colless E. Positive reactions following emergency and disaster responses. Disaster Prev Manag An Int J 1995;4(1):55-60. https://doi.org/10.1108/09653569510079050
  33. Moran C, Britton NR. Emergency work experience and reactions to traumatic incidents. J Trauma Stress 1994;7(4):575-85. https://doi.org/10.1002/jts.2490070406
  34. Kessler RC, Price RH, Wortman CB. Social factors in psychopathology: stress, social support, and coping processes. Annu Rev Psychol 1985;36(1):531-72. https://doi.org/10.1146/annurev.ps.36.020185.002531
  35. Moran CC. Personal predictions of stress and stress reactions in firefighter recruits. Disaster Prev Manag An Int J 2001;10(5):356-65. https://doi.org/10.1108/09653560110411611
  36. Lindy JD. The trauma membrane and other clinical concepts derived from psychotherapeutic work with survivors of natural disasters. Psychiatr Ann 1985;15(3):153-60. https://doi.org/10.3928/0048-5713-19850301-06
  37. Lou L. Work motivation, job stress and employee well-being. J Appl Manag Stud 1999;8(1):61-72.
  38. Palmer CE. A note about paramedics' strategies for dealing with death and dying. J Occup Psychol 1983;56(1):83-6. https://doi.org/10.1111/j.2044-8325.1983.tb00114.x
  39. Rosenberg L. A qualitative investigation of the use of humor by emergency personnel as a strategy for coping with stress. J Emerg Nurs JEN Off Publ Emerg Dep Nurses Assoc 1991;17(4):197-202.
  40. Corneil DW. Prevalence of post traumatic stress disorders in a metropolitan fire department; 1993.
  41. Mitani S, Masatoshi F, Nakata K, Shirakawa T. Impact of post-traumatic stress disorder and job-related stress on burnout: a study of fire service workers. J Emerg Med 2006;31(1):7-11. https://doi.org/10.1016/j.jemermed.2005.08.008
  42. Prag PW. Stress, burnout, and social support: a review and call for research. Air Med J 2003;22(5):18-22. https://doi.org/10.1016/S1067-991X(03)00021-X
  43. Boscarino JA, Figley CR, Adams RE. Compassion fatigue following the September 11 terrorist attacks: a study of secondary trauma among New York City social workers. Int J Emerg Ment Health 2004;6(2):57.
  44. Jonsson A, Segesten K. Guilt, shame and need for a container: a study of posttraumatic stress among ambulance personnel. Accid Emerg Nurs 2004;12(4):215-23. https://doi.org/10.1016/j.aaen.2004.05.001
  45. Harris MB, Baloglu M, Stacks JR. Mental health of trauma-exposed firefighters and critical incident stress debriefing. J Loss Trauma 2002;7(3):223-38. https://doi.org/10.1080/10811440290057639
  46. Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population. N Engl J Med 1987;317(26):1630-4. https://doi.org/10.1056/NEJM198712243172604
  47. Williams RM, Joseph S, Yule W. The role of avoidance in coping with disasters: a study of survivors of the capsize of the "Herald of Free Enterprise. Clin Psychol Psychother 1994;1(2):87-94. https://doi.org/10.1002/cpp.5640010205
  48. Ingledew DK, Cooper CL. Coping research in the UK: do we know enough to apply it?. In: International Journal of Psychology. 27 Church Rd, Hove, East Sussex, England BN3 2Fa: Psychology Press; 1996. 2011 p.
  49. Hytten K, Hasle A. Fire fighters: a study of stress and coping. Acta Psychiatr Scand 1989;80(s355):50-5.
  50. Corneil W. Traumatic stress and organizational strain in the fire service; 1995.
  51. Mitchell J, Bray G. Emergency services stress: guidelines for preserving the health and careers of emergency services personnel. PO Box 15, Ellicott City, MD: Chevron Publ Corp; 1990.
  52. Harris MB, Stacks J. A three year five state study on the relationships between critical incident stress debriefings, firefighters disposition, and stress reactions. Commerce 1998.
  53. World Health Organisation. Guidelines substance abuse [Internet]. 2015. Available from: http://www.who.int/topics/substance_abuse/en/. [Accessed 25 February 2015].
  54. Mitchell JT. When disaster strikes: the critical incident stress debriefing process. In: Journal of emergency medical services 1983. p. 36-9.
  55. Dyregrov A. Caring for helpers in disaster situations: psychological debriefing. Disaster Manag 1989;2(1):25-30.
  56. Bolwig TG. Debriefing after psychological trauma. Acta Psychiatr Scand 1998;98(3):169-70. https://doi.org/10.1111/j.1600-0447.1998.tb10062.x
  57. Mitchell JT, Everly GS. Critical incident stress debriefing-CISD: an operations manual for the prevention of traumatic stress among emergency service and disaster workers. Chevron Pub; 1996.
  58. Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Libr 2002;2:1-34.
  59. Bisson JI, Deahl MP. Psychological debriefing and prevention of post-traumatic stress. Br J Psychiatry 1994;165:717-20. https://doi.org/10.1192/bjp.165.6.717
  60. Foa EB, Meadows EA. Psychosocial treatments for posttraumatic stress disorder: a critical review. Annu Rev Psychol 1997;48(1):449-80. https://doi.org/10.1146/annurev.psych.48.1.449
  61. Stephens C. Testing a multi-dimensional model of organisational traumatic stress [Internet]. 1997. Available from: http://www.massey.ac.nz/-trauma/issues/1997-1/cvs1.htm. [Accessed 6 February 2015].
  62. Shalev AY. Debriefing following traumatic exposure. In: Individ Community Responses to Trauma Disaster Struct Hum Chaos 1994. p. 201-19.
  63. Raphael B, Meldrum L, McFarlane AC. Does debriefing after psychological trauma work? Time for randomised controlled trials. Accid Emerg Nurs 1996;4(2):65-7. https://doi.org/10.1016/S0965-2302(96)90003-X
  64. Litz BT, Gray MJ, Bryant RA, Adler AB. Early intervention for trauma: current status and future directions. Clin Psychol Sci Pract 2002;9(2):112-34. https://doi.org/10.1093/clipsy.9.2.112
  65. Kienzler H, Pedersen D. Using qualitative and quantitative research methods in the study of mental and trauma-related disorders. Fr Mcgill Ca; 2007.
  66. Solomon SD, Keane TM, Newman E, Kaloupek DG. Choosing self-report measures and structured interviews. Trauma Res Methodol 1996:56-81.
  67. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis 1992;180(2):111-6. https://doi.org/10.1097/00005053-199202000-00008
  68. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9(1):139-45. https://doi.org/10.1017/S0033291700021644
  69. Ali D. General Health Questionnaire-28 [Internet]. 2010. Available from: www.rehabmeasures.org/Lists/RehabMeasures/DispForms.aspx?ID=909. [Accessed 12 March 2015].
  70. Young KM, Cooper CL. Occupational stress in the ambulance service: a diagnostic study. Health Manpow Manage 1997;23(4):140-7. https://doi.org/10.1108/09552069710184418
  71. Psych Central. PTSD and relationships [Internet]. Psych Central. 2015. Available from: http://psychcentral.com/lib/ptsd-and-relationships/000664. [Accessed 30 March 2015].
  72. Brown J, Mulhern G, Joseph S. Incident-related stressors, locus of control, coping, and psychological distress among firefighters in Northern Ireland. J Trauma Stress 2002;15(2):161-8. https://doi.org/10.1023/A:1014816309959
  73. Sterling M. General Health Questionnaire-28 (GHQ-28). J Physiother 2011;57(4):259. https://doi.org/10.1016/S1836-9553(11)70060-1
  74. White SH. Show me the proof!: tools and strategies to make data work for you. Lead+ Learn Press; 2005

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