Recently, NBC New York and NBC Bay Area in partnership with the International Association of Fire Fighters (IAFF) sent a confidential online survey to thousands of firefighters to hear directly from them about the impact of post-traumatic stress on their lives. 7,000 firefighters responded from across North America. 19% have had thoughts of suicide! 27% have struggled with substance abuse! 59% have experienced family and relationship problems! And 65% are haunted by memories of bad calls! The IAFF stated “fire fighters are suffering from PTSD and other behavioral health disorders and, more importantly, there’s a stigma attached to seeking help.”
Sadly, PTSD is extremely common and, of course, is very damaging to the lives and hopes of our patients who suffer from it as well as their families and friends.
A few years ago I was asked to write an article to help physicians and nurses know what to do to help these patients when they first show up in our offices, clinics, and emergency rooms after an acute trauma or an exposure to acute trauma like our heroic fire fighters. I coined the acronym FRESH to help us recall what to do. F stands for Family and Friends. Educate them about PTSD so they are able to understand and support the patient and know what to do should deterioration occur. R stands for Reassurance that they are not weak and character flawed and for Retelling as the patient benefits from repeatedly sharing their experience as they struggle to gain mastery over it. E is for Education. Help your patient understand the nature of PTSD, it’s biopsychosocial etiology, and the effective treatments that are available. S is for Substance Abuse and for Sleep. The most common “treatment” for anxiety in the face of stress is alcohol and drugs in an attempt to self medicate. These must be avoided as they intensify the severity of the disorder and interfere with treatment success. Some research suggests that sleep deprivation for the first night may actually decrease the consolidation of memories of the trauma. But patients do eventually need to sleep. Prescribe BZRAs carefully but use them when necessary. H stands for History. Know the risk factors that increase the likelihood that your patient will develop PTSD including a previous history of PTSD or other anxiety/depressive disorders, lack of a good support system, comorbid medical problems, and significant other stressors among others.
Successful treatment of PTSD includes a combination of appropriate forms of psychotherapy geared toward the treatment of PTSD. Medications are often a crucial part of successful treatment. Two medications have received FDA approval for PTSD treatment – Zoloft and Paxil. Neither is a panacea but both, and other Serotonin Reuptake Inhibitors like them, can be very effective. More recently, Prazosin has been studied and clinically used to treat PTSD. The idea is that the symptoms of PTSD are similar to those caused by an upregulated noradrenergic system. Consequently, it is thought, can medications that decrease the activity of norepinephrine such as Prazosin, an alpha 1 adrenergic antagonist, help decrease PTSD symptoms? The answer, though somewhat controversial as not all of the studies showed benefit, appears clinically to be yes it does help significantly with symptoms generally and, especially, with decreasing nightmares.
We can and must do a better job of successfully treating Post Traumatic Stress Disorder to remission. We see it in our offices, our clinics, our ERs, and our hospitals every day. Do you have the knowledge and training that you need to do so?