Frontline Workers and Post Traumatic Stress Disorder

For decades it has been evident that frontline workers (medical personnel, healthcare workers, nursing, police personnel and paramedical staff) are at the highest risk for being diagnosed with post-traumatic stress disorder (PTSD) and other psychological imbalance/difficulties due to the nature of their work. 

As the pandemic grapples us and we are asked not to flout the restriction rules, remember that our actions have a long term impact. Our healthcare workers are fighting a tough battle to protect and save all of us. We aren’t alien to ample amounts of videos of doctors/frontline workers flooding our social media, showing us the stark realities of the impact of the pandemic, them being pushed to exhaustion and breaking down at the apathy of the situation.

An understanding of what is PTSD and how we can aid our healthcare heroes will help us all support those who are selflessly striving to save our lives!

What is Post-traumatic Stress Disorder (PTSD)?

When one is constantly at risk of contracting a life-threatening illness, surrounded by potentially traumatic events and dismay,  being prone to psychological issues is inevitable. PTSD is one such common disorder found amongst frontline workers. The common symptoms include: 

• It is a cluster or group of symptoms that usually develop after one experience’s a life-threatening situation or event like war, a pandemic, sexual abuse, violence, natural calamity, etc.
• The emphasis is on the fact that these events or situations are supposed to be severe and life-threatening.

What are the evident symptoms we can witness and signpost? 

In terms of mental health, being aware of the symptoms can help not only signpost the one suffering but also help seek help at the earliest. Training healthcare workers to identify them among their colleagues and sometimes among themself, can be beneficial. 

PTSD comes with quite evident symptoms, so whenever you notice them it would be useful to signpost (guide) them towards professional services. The behavioral or emotional symptoms may include:  

• Suffering and reliving the trauma through nightmares, visions, memories, and flashbacks.
• Social isolation and withdrawal to avoid any cues or reminders of the trauma.  
• Being extremely vigilant to protect oneself from the reoccurrence or supposed danger of the trauma and being in constant “fight or flight mode”.
• Suffering physical symptoms like loss of sleep, appetite issues, inability to concentrate
• An exhausting emotional reaction like irritability, anger outburst, overwhelming guilt, or shame.

Why is it essential to have awareness about PTSD?

PTSD has shown to lead to a number of issues at both personal and professional level. It is therefore necessary we spread awareness about the same. Awareness will help to reduce the stigma associated with seeking help, help people who are suffering supported and most importantly helps recognize early signs/risks. Some of the common impacts of PTSD include:

• Self-destructive behaviour like alcohol or substance abuse
• Insomnia
• Depression or other mood/psychological disorder
• Suicidal thoughts
• Medication errors and a lower standard of care due to psychological issues (professional/ organizational level impact)

Frontline workers and the dilemma of ‘Moral Injury’

The current pandemic is adding to the already overburdened and struggling health system in our country. Frontline workers are subjected to and extremely vulnerable especially during a pandemic. They are highly disposed to psychological issues like anxiety, depression, and moral injury. 

‘Moral injury’ is an interesting concept and we should know about the same. It will help us understand the graveness of the situation. These frontline workers are constantly battling between ethics, duty and morals.  

‘Moral injury’ happens in the situation where frontline workers may perpetuate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations. On a regular basis, physicians or other frontline workers may have to choose and pick on who is medically suitable to continue receiving treatment. We have witnessed how during the pandemic, age and pre-existing medical conditions have become a reason for allowing admission to the hospital or being offered the ventilator. These situations can cause gravely negative thoughts, guilt, and depressive feelings.

We as commoners could only imagine how they are dealing with such decisions! While frontline workers have to actually implement them. Their actions follow consequences and many times a risk to their lives too.  We are well aware of how doctors and staff are beaten up by the family. However, the physical hurt could be fixed, but the psychological guilt and scaring required constant therapy. These situations may become a major risk factor for PTSD too. 

Is there a solution? How can we support our frontline workers? 

PTSD and its impact on frontline workers are inevitable. The nature of their job coupled with the scarcity and population demands can be overwhelming. Research has shown that social support is the leading factor that can help cope with and promote wellbeing among our frontline warriors.

There are a few actions that can help those who are helping save our lives:

1. Support and leadership with clarity of commands can help create a proper chain of work expectations.
2. Organizations can set up mental health and emergency support with a successive mandatory check-up to help frontline workers monitor and cope with their mental health issues.
3. There need to be protective laws, especially during such an unpredictable and unprecedented time of pandemic to protect the health and wellbeing of all involved.
4. Introducing and training at all levels in an organization for identifying, flag posting and self-care in terms of mental health
5. Promoting and celebrating our real heroes can go a long way to help them keep encouraged, valued and committed to the services they offer.
6. Finally, emotional support from families, friends coupled with self-care techniques like yoga, relaxation techniques, etc can be quite helpful.

Taking a comprehensive screening can help to understand what is the level of functioning and what are the further steps. Becoming aware can help you better manage your self. Accessing articles, podcasts and videos at will can help to improve mental wellbeing.  In the end, we all need to work together and play our part to promote, support and spread awareness about the psychological wellbeing of our frontline heroes.