Helping heal the psychological trauma... of trauma
May 2, 2013 12:58 PM Subscribe
I'm a career Firefighter/Paramedic. Recently, I've been thinking more about the long-term psychological trauma that results from a serious injury/illness, and how my actions during emergencies may help or hinder patients' healing. Help me help my patients.
I have over 15 years experience in EMS, and I pride myself on being a compassionate practitioner. I've been reading about the importance of psychological factors in patient recovery - for example, the study that found post-operative patients whose rooms looked out on trees had shorter hospital stays and used less narcotic pain meds than ones whose rooms faced a wall. This has started me thinking about how EMS care might more effectively contribute to patients' psychological well-being.
First, can you refer me to any research that addresses this in a pre-hospital environment? The closest I've found is research on how family members often benefit from witnessing resuscitation efforts after cardiac arrest. We're aware of this in my department, and we try to assign someone to be with family members as we work a full arrest, to explain what we're doing and help them sort out what to do next. I'm focusing on direct patient care right now.
Second, if you've had contact with EMS, can you specify anything that the provider said or did that had a long-term impact on your recovery? Anecdotal evidence is still of interest to me because I so rarely get long-term follow-up with patients.
I have over 15 years experience in EMS, and I pride myself on being a compassionate practitioner. I've been reading about the importance of psychological factors in patient recovery - for example, the study that found post-operative patients whose rooms looked out on trees had shorter hospital stays and used less narcotic pain meds than ones whose rooms faced a wall. This has started me thinking about how EMS care might more effectively contribute to patients' psychological well-being.
First, can you refer me to any research that addresses this in a pre-hospital environment? The closest I've found is research on how family members often benefit from witnessing resuscitation efforts after cardiac arrest. We're aware of this in my department, and we try to assign someone to be with family members as we work a full arrest, to explain what we're doing and help them sort out what to do next. I'm focusing on direct patient care right now.
Second, if you've had contact with EMS, can you specify anything that the provider said or did that had a long-term impact on your recovery? Anecdotal evidence is still of interest to me because I so rarely get long-term follow-up with patients.
I was in a serious accident where I lost short-term memory for several hours during which I was without medical care. My memory started spooling again the moment I saw medical staff rushing towards me, taking charge of the situation and bringing me to the hospital. I don't remember anything specific they said or did, it was simply the act of having caring, confident people taking charge of me and addressing the situation. Simple yet powerful.
Despite lots of injuries, I experienced absolutely no pain in the weeks afterwards, just a sense of peace and a feeling of gratitude at the kindness of strangers. It was one of the best experiences of my life in terms of growing and maturing as an adult.
posted by nanook at 1:37 PM on May 2, 2013
Despite lots of injuries, I experienced absolutely no pain in the weeks afterwards, just a sense of peace and a feeling of gratitude at the kindness of strangers. It was one of the best experiences of my life in terms of growing and maturing as an adult.
posted by nanook at 1:37 PM on May 2, 2013
Read Waking the Tiger, it talks about how the body processes trauma (or stays stuck in trauma) and has a whole chapter on "psychological first aid". Here is a pdf by the same author. There's also this link.
posted by St. Peepsburg at 1:38 PM on May 2, 2013 [3 favorites]
posted by St. Peepsburg at 1:38 PM on May 2, 2013 [3 favorites]
I got stabbed at a party when I was a kid, some guys trying to rob me just stabbed me in the chest when I wouldn't do what they wanted. The thing that really stuck with me though was the snide remarks that nurses and the ambulance guy made. All along the lines of "you must have done something pretty bad to deserve this". I was already feeling pretty full of despair and that just made it a lot worse.
I'm sure you don't do that. But I guess I just wish that medical people remembered that being a drunk 18 year old doesn't mean you deserve to get stabbed. So, being non judgemental and caring is probably the most impactful thing you can do.
posted by aychedee at 1:41 PM on May 2, 2013 [12 favorites]
I'm sure you don't do that. But I guess I just wish that medical people remembered that being a drunk 18 year old doesn't mean you deserve to get stabbed. So, being non judgemental and caring is probably the most impactful thing you can do.
posted by aychedee at 1:41 PM on May 2, 2013 [12 favorites]
The first thing I flashed on when I read your question was Carl Rogers on "look for the helpers." . Honestly, what you're already doing may be the most 'healing' thing possible--in both senses of the word. I can't imagine how things like looking at trees could hold a candle to the knowledge that there human beings like you who are ready to help people in desperate need.
I do have one anecdote. My mother was in a house fire. She was not breathing when she was rescued and was intubated on the site by a fireman who punctured her stomach in the process (?my memory is fuzzy on the medical details). In any event, she had to have emergency surgery, on top of everything else, and to make a long story short, it was the intubation that instigated the cascade of medical complications that led to her death after a month in intensive care. There's good reason to believe she would have otherwise survived (although there probably would have been long-term complications as a result of smoke inhalation).
My feelings about this were contradictory: first, I was grateful for the rescue, and I know that our mother was seconds from death when she was found and that the necessary haste may have made the risk of an accident unavoidable. Second, I was bitter that I lost my mother and, especially, that my young kids lost a grandmother they adored. There's something particularly agonizing about the thought that you could have lost somebody from a single mistake*, since it could so easily have been otherwise.
(*Actually, there were TWO mistakes: the first was my mother's: we're sure the fire started because she was careless with a cigarette. So, it was really her action that started the catastrophic cascade... I so often wished she was alive so that I could tell her how angry I was with her that she'd gone and done something so sheerly STUPID that she'd died!)
I do know that, psychologically, the one thing that could have removed any feelings of bitterness (which were far from overwhelming, btw) and that was the knowledge that some 'good' could come from her death, such as improved training for first responders. The knowledge that lives might be saved as a result of my mother's loss would have removed whatever bitterness I had.
I could never follow-up on this because I didn't live in the same city. And I could never bring it up with my father, because we (or maybe it was just me) couldn't bear to talk about the fact that my mom could be alive, if only... The wounds caused by her death were very raw. But it occurred to me later that we should have talked about it. Maybe he felt the same way I did.
Alternatively, the fire department could have followed up with US. It would be nice if, in the case of any emergency responses where there are any mishaps caused by a responder to know that the department does a thorough post-mortem (so to speak), and analyzes what went wrong and how they might be able to improve things in the future (although, realistically, there is an irreducible risk of error in such situations). This is relevant to your question because it would be all that much better (psychologically) for the people involved if they reported the results to them. After all, just as emergency departments care for everybody, so, in a way, do the people who are cared for.
(To aychedee: what the hell? Your answer points out that rooting out people who cause psychological trauma might be as important as doing things to prevent it.)
posted by Transl3y at 3:18 PM on May 2, 2013
I do have one anecdote. My mother was in a house fire. She was not breathing when she was rescued and was intubated on the site by a fireman who punctured her stomach in the process (?my memory is fuzzy on the medical details). In any event, she had to have emergency surgery, on top of everything else, and to make a long story short, it was the intubation that instigated the cascade of medical complications that led to her death after a month in intensive care. There's good reason to believe she would have otherwise survived (although there probably would have been long-term complications as a result of smoke inhalation).
My feelings about this were contradictory: first, I was grateful for the rescue, and I know that our mother was seconds from death when she was found and that the necessary haste may have made the risk of an accident unavoidable. Second, I was bitter that I lost my mother and, especially, that my young kids lost a grandmother they adored. There's something particularly agonizing about the thought that you could have lost somebody from a single mistake*, since it could so easily have been otherwise.
(*Actually, there were TWO mistakes: the first was my mother's: we're sure the fire started because she was careless with a cigarette. So, it was really her action that started the catastrophic cascade... I so often wished she was alive so that I could tell her how angry I was with her that she'd gone and done something so sheerly STUPID that she'd died!)
I do know that, psychologically, the one thing that could have removed any feelings of bitterness (which were far from overwhelming, btw) and that was the knowledge that some 'good' could come from her death, such as improved training for first responders. The knowledge that lives might be saved as a result of my mother's loss would have removed whatever bitterness I had.
I could never follow-up on this because I didn't live in the same city. And I could never bring it up with my father, because we (or maybe it was just me) couldn't bear to talk about the fact that my mom could be alive, if only... The wounds caused by her death were very raw. But it occurred to me later that we should have talked about it. Maybe he felt the same way I did.
Alternatively, the fire department could have followed up with US. It would be nice if, in the case of any emergency responses where there are any mishaps caused by a responder to know that the department does a thorough post-mortem (so to speak), and analyzes what went wrong and how they might be able to improve things in the future (although, realistically, there is an irreducible risk of error in such situations). This is relevant to your question because it would be all that much better (psychologically) for the people involved if they reported the results to them. After all, just as emergency departments care for everybody, so, in a way, do the people who are cared for.
(To aychedee: what the hell? Your answer points out that rooting out people who cause psychological trauma might be as important as doing things to prevent it.)
posted by Transl3y at 3:18 PM on May 2, 2013
Sorry, hit the wrong button on the iphone. I meant to link to the main SE Trauma Institute page above, and to mention that they run training programs for health professionals.
There are some books and articles there by Dr Robert Scaer that should also interest you.
posted by goshling at 3:29 PM on May 2, 2013
There are some books and articles there by Dr Robert Scaer that should also interest you.
posted by goshling at 3:29 PM on May 2, 2013
Here's a series of teleseminars from a few years ago that includes one by Peter Levine.
posted by goshling at 3:39 PM on May 2, 2013
posted by goshling at 3:39 PM on May 2, 2013
I was in a serious car accident when I was 19. I was not able to move after the crash and couldn't tell how bad my injuries were. I just knew there was a lot of blood all over. I was panicked. Ill never forget the paramedics that got me out of the car as long as I live. They were calm and caring and they even made some little jokes with me. The jokes helped me calm down and reassired me better than anything else. I was able to focus on doing what I needed to do to help them help me.
I had head injuries that required surgery but everything turned out fine and today what I most remember instead of the pain and panic, are the feelings of relief and gratitude to the people that came to my aid.
posted by WalkerWestridge at 4:11 PM on May 2, 2013 [4 favorites]
I had head injuries that required surgery but everything turned out fine and today what I most remember instead of the pain and panic, are the feelings of relief and gratitude to the people that came to my aid.
posted by WalkerWestridge at 4:11 PM on May 2, 2013 [4 favorites]
This is only anecdote (I'm a critical care float nurse) but I often get patients after traumas from the ED and I only ever really hear wonderful things about EMS and paramedics. Indeed, when someone is caring and calm and level headed, even in the midst of true psychological stress, most of my patients seem to have at least some vague recollection of being helped and being reassured by the helpers.
For my intubated and sedated patients, I do often wonder (and have read many studies on) how patients process all the difficult stuff we do to them. There is definitely a lot of evidence that patients in the ICU, for instance, often have a PTSD response to their stay, even when sedated and vented with very low level measured brain activity. So we know it happens. I try to take the approach that I never, ever make light of a patient's experience. I think with a certain amount of experience, the sphere of things and procedures that seem "routine" to us widens as HC providers and yet they are always scary, even the little things, to the patient who hasn't experienced it. So keeping measured and calm, with explanations of what I'm doing even for people who I'm not sure will hear or understand me, is something I really try to make a priority.
Wish I had more studies on EMS - went looking and didn't find a ton, but I think that a lot f the same things apply as in the hospital, at least in the sense that a caregiver is a caregiver. I always feel as if I have to detach a little from the nightmarish things that I might have to do to keep someone alive (tubes in every orifice, dressing changes, chest tubes, pacing, even just IV placement! uggghh) so that I can calmly do my job and do justice to their care, but at the same time it's definitely important to realize that these things are traumatic and that people deserve explanations of what's going on and the most compassionate attitude and care we can give them. It's a tough balance.
posted by takoukla at 7:00 AM on May 3, 2013 [5 favorites]
For my intubated and sedated patients, I do often wonder (and have read many studies on) how patients process all the difficult stuff we do to them. There is definitely a lot of evidence that patients in the ICU, for instance, often have a PTSD response to their stay, even when sedated and vented with very low level measured brain activity. So we know it happens. I try to take the approach that I never, ever make light of a patient's experience. I think with a certain amount of experience, the sphere of things and procedures that seem "routine" to us widens as HC providers and yet they are always scary, even the little things, to the patient who hasn't experienced it. So keeping measured and calm, with explanations of what I'm doing even for people who I'm not sure will hear or understand me, is something I really try to make a priority.
Wish I had more studies on EMS - went looking and didn't find a ton, but I think that a lot f the same things apply as in the hospital, at least in the sense that a caregiver is a caregiver. I always feel as if I have to detach a little from the nightmarish things that I might have to do to keep someone alive (tubes in every orifice, dressing changes, chest tubes, pacing, even just IV placement! uggghh) so that I can calmly do my job and do justice to their care, but at the same time it's definitely important to realize that these things are traumatic and that people deserve explanations of what's going on and the most compassionate attitude and care we can give them. It's a tough balance.
posted by takoukla at 7:00 AM on May 3, 2013 [5 favorites]
I broke my ankle when I was roller skating once, and I was alone and didn't have medical coverage. I was mostly thinking "this is going to be insanely expensive and life-ruining, and this hurts really bad too". The paramedics completely ignored me and were basically jerks, and I didn't stop crying for HOURS. When I got to the hospital, I wanted nothing more than to see someone I knew. Apparently my dad did come, but they didn't let him see me, because I was "hysterical." Please don't do that, if you can help it.
posted by masquesoporfavor at 3:14 PM on May 9, 2013 [1 favorite]
posted by masquesoporfavor at 3:14 PM on May 9, 2013 [1 favorite]
When a childhood accident left me with broken bones, cuts, and abrasions the nurses in the ER used what felt like steel wool and Betadine to clean my wounds. Naturally this was pretty painful, and I still recall the kindness in the voice of the nurse who explained to me why it had to be done. As a young girl on the verge of social awareness I would have endured anything to avoid scarring. Yet the simple act of her noticing and taking the time to connect was very soothing somehow.
posted by R2WeTwo at 8:30 PM on May 12, 2013
posted by R2WeTwo at 8:30 PM on May 12, 2013
Sorry for the late response, but I just registered. I felt compelled to come back to answer this post, since I'm sadly overqualified, and I so appreciated the question.
The most healing interactions I've had were when a first responder really honed in on me as a person, and what I needed right then, even if I wasn't able to verbalize it yet. I still remember the fireman from 11 years ago who made sure I was OK to drive 5 hours home after being peripherally involved in a fatal accident; I can't describe exactly how, but he made it very clear that he was intensely and sincerely interested in my emotional state and that he wasn't going to let me go until he was convinced I was ok (enough). In other cases it was just quietly but steadily holding my hand, and saying "I'm going to stay with you". The common element is that often I'm in emotional shock -- I'm slow to realize my own trauma. But these folks, the fireman, the nurses, recognized it, looked into me, and calmed me for me. That was healing.
In contrast, the docs who came and described the emergency surgery I'd be having, but talked to my abdomen instead of my face ... not so healing.
posted by Dashy at 8:50 AM on June 4, 2013 [2 favorites]
The most healing interactions I've had were when a first responder really honed in on me as a person, and what I needed right then, even if I wasn't able to verbalize it yet. I still remember the fireman from 11 years ago who made sure I was OK to drive 5 hours home after being peripherally involved in a fatal accident; I can't describe exactly how, but he made it very clear that he was intensely and sincerely interested in my emotional state and that he wasn't going to let me go until he was convinced I was ok (enough). In other cases it was just quietly but steadily holding my hand, and saying "I'm going to stay with you". The common element is that often I'm in emotional shock -- I'm slow to realize my own trauma. But these folks, the fireman, the nurses, recognized it, looked into me, and calmed me for me. That was healing.
In contrast, the docs who came and described the emergency surgery I'd be having, but talked to my abdomen instead of my face ... not so healing.
posted by Dashy at 8:50 AM on June 4, 2013 [2 favorites]
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posted by brilliantine at 1:14 PM on May 2, 2013