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Emergency Care and Services
Emergency service workers, such as police officers, firefighters, and ambulance workers, are regularly exposed to trauma as part of their job. They are called upon to rescue people, many of whom are dying or are already deceased, regularly witness the aftermath of trauma, and often face life-threatening situations in their rescue roles. This puts emergency service workers at increased risk of developing post-traumatic stress disorder (PTSD). Research has identified that emergency service workers seek help for emotional problems at up to four times the rate of nonemergency workers. Prevalence of PTSD in emergency service workers, also known as first responders, is much higher than in the general population, with research suggesting rates of PTSD that range from between 5% and 40%. This dramatic variability in reported rates of PTSD appears to be due to how and when the disorder is measured.
The impact of PTSD in the emergency services is far-reaching and can include memory problems, alcohol dependence, relationship problems, and poor work performance, all of which can impact the working lives of the staff and potentially their job performance. The aim of this entry is to outline stressors linked to emergency service work, as well as the prevalence of PTSD in these groups, to discuss risk factors and methodological issues of research in this field, and finally to focus on prospective research and interventions. In the entry, the term emergency service workers will refer to firefighters, ambulance workers, and police officers.
Stressors Linked to the Job
Management Issues
Organizational issues are consistently identified as causing stress to emergency service workers, for example, not receiving enough downtime or support in the immediate aftermath of a critical incident, shift work, low pay, time pressures, and lack of control over decision-making processes. This can create a difficult working environment, as well as resulting in burnout, which may impact the workers’ psychological and physical health. Physical complaints from burnout can include fatigue, insomnia, and headaches, while psychological correlates include depression and anxiety. Research, such as that carried out by Eleonore van der Ploeg and colleagues, has identified associations between burnout and PTSD in emergency service workers, suggesting that PTSD-related stress is a risk factor for developing burnout. Trauma-related stress and difficulties, such as burnout, that develop in emergency service workers are extremely costly to organizations.
Sleep
Disturbed sleep is one of the most commonly reported symptoms after a trauma in those who develop PTSD; however, it is unclear whether it is a consequence of the disorder or whether it precedes and therefore contributes to its development. People can have trouble sleeping after a trauma because of intrusive memories of the event or from recurrent nightmares, or because they dwell on the implications of what they have suffered, drastically delaying sleep onset. Insufficient sleep may increase sensitivity, reactivity, and avoidance of trauma memories, heightening anxiety and feelings of being unable to cope. Furthermore, sleep disturbances may impair the emotional processing of the trauma memory. A poorly consolidated trauma memory is more likely to be linked to intrusive memories. In these ways, sleep problems may contribute to the development of traumatic stress symptoms and maintain them once they are established. Given the nature of emergency service work and the long shifts it often entails, these findings have important implications. Sleep problems in this group may increase their risk for developing PTSD and may make it difficult for them to recover once they experience such symptoms. Only prospective research can determine the role of sleep problems in the development and maintenance of PTSD in at-risk individuals.
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- Anthropology and Archaeology
- Anthropology and Trauma
- Anthropology and War
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Arts and Humanities
- Business and Economics
- Children and Families
- Abduction/Kidnapping
- African Women and Girls' Trauma
- Campus Violence
- Childhood and Adolescent Trauma: An Overview
- Childhood and Adolescent Trauma: Assessment and Treatment
- Childhood Trauma and the Juvenile Justice System
- Childhood Traumatic Stress
- Children of War
- Critical Illness in Children
- Dissociative Identity Disorder and Trauma
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Genetic Epidemiology
- Incest
- Marital Rape
- Marriage and the Marital Relationship
- Military Families, Effects of Combat and Deployment on
- Parenting During and After Traumatic Events
- Perinatal Trauma
- Perinatal Trauma, Long-Term Consequences of
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Resilient Posttraumatic Adjustment in Childhood and Beyond
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- School Shootings
- Systemic Trauma Research
- Transgenerational Transmission of Trauma
- Crime and Law
- Abduction/Kidnapping
- Battered Women
- Blaming the Victim
- Campus Violence
- Childhood Trauma and the Juvenile Justice System
- Clergy, Sexual Abuse by
- Community Violence
- Comstock Act
- Correctional Officers and Trauma
- Crime Scene Investigation
- Criminal Behavior Consequent to War
- Date Rape/Acquaintance Rape
- Genocide
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- Genocide, Cambodia's Mass Casualty Trauma
- Hate Crimes
- Homicide and Trauma
- Human Trafficking
- Incarceration and Trauma
- Incest
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- Male Rape
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- Mass Violence
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- Murder
- Perpetrators of Trauma
- Psychological Injury and Law
- Rapist Profiles
- School Shootings
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
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- Sexual Assault, Drug Facilitated
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- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
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- Social Learning Theory and Sexual Aggression
- Survival and Coping After Rape
- Terrorism, History of
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- Wartime Rape
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- Emergency Care and Services
- First Responders and Trauma
- Humanitarian Missions
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- Psychological First Aid
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- Role of Media in Managing Disasters
- Culture and Ethnicity
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- African Women and Girls' Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Cultural Beliefs
- Culture and Trauma
- Ethnicity, Culture, and Disaster Response
- Genocide
- Genocide in Non-Western Nations
- Genocide, Cambodia's Mass Casualty Trauma
- Nongovernmental Organizations, Governments, and Humanitarian Aid
- Race-Based Traumatic Stress
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Racism-Induced Trauma
- Refugees
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- Slavery and Forced Servitude
- Traumatization in the Name of Religion
- Death and Dying
- Ethics and Philosophy
- Assisted Suicide
- Boundaries and Boundary Violations
- Boundary Issues for Traumatologists
- Counterbalancing Stress
- Countertransference
- Ethical Dilemmas in Treatment of Trauma
- Ethics
- Humor and Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Philosophy of Trauma Nursing
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Trauma Among Chaplains
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
- Secondary Trauma Among Medical Professionals
- Secondary Trauma Among Medics and Corpsmen
- Secondary Traumatic Stress
- Shame
- Trauma Caregivers
- Trauma Memories: Research and Ethics
- First Responders
- History
- Humanitarian Aid
- Internet, the Media, and Entertainment
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- Alcohol and Trauma
- Assisted Suicide
- Brain and Trauma
- Combat Medics and Corpsmen
- Critical Illness in Children
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- Pain
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- Perinatal Trauma, Long-Term Consequences of
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- Philosophy of Trauma Nursing
- Primary Care
- Psychopharmacology, Psychiatry, and Trauma
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- Retraumatization
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- Sexual Assault, Drug Facilitated
- Somatic Complaints
- Trauma-Related Physical Symptoms and Illnesses
- Traumatized Nurses
- Traumatized Physicians
- Natural Sciences
- Biological Effects of Physical and Psychological Trauma
- Biological Mechanism of Traumatic Stress Response
- Biology and Posttraumatic Stress Disorder
- Brain and Memory
- Brain and Trauma
- Encoding Trauma, Neurobiology of
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- Hippocampus
- Limbic System
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Psychobiology of Crisis
- Trauma and Metabolic Syndrome
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- Traumatized Scientists
- Psychology and Psychiatry
- Acute Stress Disorder
- Biological Mechanism of Traumatic Stress Response
- Brain and Memory
- Burnout
- Clinical Trauma Psychology
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Cognitive Restructuring and Trauma
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Compassion Fatigue
- Complex Trauma
- Conservation of Resources Theory
- Counseling and Education About Trauma
- Counterbalancing Stress
- Countertransference
- Dissociation
- Dissociative Identity Disorder and Trauma
- Evidence-Based Practice
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Fragility, Posttraumatic
- Iatrogenic Effects
- Lawsuits Against Behavioral Health Professionals
- Limbic System
- Marriage and the Marital Relationship
- Meditation
- Memory Work
- Military Psychology and Combat Stress Injuries
- Mowrer's Two-Factor Theory
- Pain
- Personality Disorders
- Pharmacotherapy
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Primary Care
- Promoting Resilience in the Traumatized
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Psychological Injury and Law
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychopharmacology, Psychiatry, and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
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- Resilience, Growth, and Thriving
- Retraumatization
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Traumatic Stress
- Shame
- Social Learning Theory and Sexual Aggression
- Social Support and Trauma
- Somatic Complaints
- Stigma
- Stress Inoculation Training
- Suicide
- Survival and Coping After Rape
- Systemic Trauma Research
- Theories of Psychological Stress
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma Assessment
- Trauma Education
- Trauma Prevention
- Trauma Psychology Research
- Trauma Triggers
- Trauma-Related Happiness and Pleasure
- Trauma-Related Physical Symptoms and Illnesses
- Trauma, Causes of
- Trauma, Identity, and the Workplace
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Practitioners, Supervisors of
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- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- Public Health
- Religion and Spirituality
- Clergy, Counseling by
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- Combat Chaplains
- Cults and Sects
- Growth, Posttraumatic
- Meditation
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Psychospiritual Impact of Disaster
- Religious and Pastoral Responses to Trauma
- Religious Fundamentalism
- Secondary Trauma Among Chaplains
- Spiritual and Religious Growth
- Spiritual Intelligence and Posttraumatic Growth
- Traumatization in the Name of Religion
- Social Work
- Battered Women
- Bereavement
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Comstock Act
- Ethics
- Evidence-Based Practice
- Military Social Work and Combat Stress Management
- Social Support and Trauma
- Social Work With the Traumatized Homeless
- Theories of Psychological Stress
- Trauma and Domestic Violence
- Trauma and Homelessness
- Trauma and Social Work Practice
- Trauma Research, Social Work Contributions to
- Traumatized Practitioners, Supervisors of
- Sociology
- Traumatology and Trauma Recovery
- Acute Stress Disorder
- Additive Trauma
- Alcohol and Trauma
- Bearing Witness to Trauma
- Biology and Posttraumatic Stress Disorder
- Clergy, Counseling by
- Clinical Trauma Psychology
- Cognitive Restructuring and Trauma
- Compassion Fatigue
- Complex Trauma
- Conspiracy of Silence
- Counseling and Education About Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Trauma
- Cumulative Trauma
- Dance and Trauma
- Despair, Posttraumatic
- Disaster-Related Trauma
- Early Interventions
- Encoding Trauma, Neurobiology of
- Ethical Dilemmas in Treatment of Trauma
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Fear, Posttraumatic
- Fragility, Posttraumatic
- Grief and Mourning
- Grief, Complicated
- Growth, Posttraumatic
- Hippocampus
- Homicide and Trauma
- Humor and Trauma
- Hypnosis in the Treatment of Posttraumatic Stress Disorder
- Iatrogenic Effects
- Incarceration and Trauma
- Literary Expressions of Trauma
- Managing Trauma Symptoms
- Medical Marijuana and Posttraumatic Stress Disorder
- Medical Trauma Research
- Military Trauma
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Perpetrators of Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Poetry and Trauma
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Posttraumatic Stress Disorder, History of
- Prolonged Exposure
- Promoting Resilience in the Traumatized
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Rapist Profiles
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
- Resilience and Hurricane Katrina
- Resilience Bolstering
- Resilience, Growth, and Thriving
- Sanctuary Model
- Self-Regulation
- Sexual Compulsion and Trauma
- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
- Shared Trauma
- Silencing Response
- Stigma
- Suicide
- Transgenerational Transmission of Trauma
- Trauma and Autobiography
- Trauma and Homelessness
- Trauma and Metabolic Syndrome
- Trauma and Metaphor
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma and Social Work Practice
- Trauma as Entertainment
- Trauma Assessment
- Trauma Caregivers
- Trauma Education
- Trauma Memories: Research and Ethics
- Trauma Prevention
- Trauma Psychology Research
- Trauma Survival Strategies
- Trauma Triggers
- Trauma-Organized Systems
- Trauma-Related Happiness and Pleasure
- Trauma, Causes of
- Trauma, Definitions of
- Traumatic Bereavement
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Scientists
- Traumatology
- Vicarious Trauma
- Victim, Survivor, Thriver
- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- War Crimes
- War and Combat
- Anthropology and War
- Children of War
- Combat Chaplains
- Combat Medics and Corpsmen
- Combat Mortuary Services
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Combat-Related Stress Injury: Theory, Research, and Management
- Criminal Behavior Consequent to War
- Death Notification in War
- Military Families, Effects of Combat and Deployment on
- Military Psychology and Combat Stress Injuries
- Military Sexual Abuse
- Military Social Work and Combat Stress Management
- Military Trauma
- Secondary Trauma Among Medics and Corpsmen
- War Crimes
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Wartime Rape
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