Page 57 - JSOM Spring 2021

Secondary Traumatic Stress in
Emergency Services Systems (STRESS) Project

Quantifying Personal Trauma Profiles for Secondary Stress Syndromes in

Emergency Medical Services Personnel With Prior Military Service

1
Ginny K. Renkiewicz, PhD, MHS, Paramedic, FAEMS *; Michael W. Hubble, PhD, MBA, NRP 2

ABSTRACT
Background: EMS personnel are often exposed to traumatic Previous reports have identified that clinicians in direct pa-
material during their duties. It is unknown how prior military tient care roles are at a higher risk for developing secondary
1,2
experience affects the presence of stress in EMS personnel. traumatic stress syndromes. Concomitantly, previous studies
Methods: This was a prospective cross-sectional study. Nine on traumatic stress show a relationship between a clinician’s
EMS agencies provided data on call mix, while individuals personal history of trauma acting as a psychopathological co-
were recruited during training evolutions. The survey evaluated morbidity and the development of stress syndromes, such as
sociodemographic factors and the relationship between child- vicarious trauma (VT). 3–6
hood trauma and previous military service using the Adverse
Childhood Experiences questionnaire, Life Events Checklist VT, like posttraumatic stress disorder (PTSD), is a primary
DSM-5, and Military History Questionnaire. Descriptive sta- stress syndrome characterized by exposure to intensely trau-
tistics calculated personal trauma profiles, comparing civilian matic material that causes a maladaptation in clinician coping
EMS personnel to those with prior service. Hierarchical linear structures. 7–10 VT can be best described as emotional counter-
regression assessed the predictive utility of military history to transference between a care provider and their patient and can
scores on the Impact of Events Scale-Revised. Results: A total often lead to a transformation of the clinician’s worldview. 11,12
of 765 EMS personnel participated in the study; 52.8% were Symptomatology can range from nonspecific dissatisfac-
male, 11.4% were minorities, and 11.6% had prior military tion and irritability to the loss of a sense of purpose, emo-
service. A total of 64.4% of civilian EMS providers had any tional withdrawal, hopelessness, or a general feeling of being
stress syndrome, while that number was 71.8% in those with unsafe. 7–10,13,14
prior military service. Hierarchical linear regression identified
that years of service and the performance of combat patrols or Similar to other types of stress syndromes, VT is based on
other dangerous duty accounted for a unique criterion variance the amalgamation of constructionist self-development theory
in the regression model. Conclusions: Prior military service or (CSDT) and oppression theory. 8,15–17 After the occurrence of a
combat deployments alone do not contribute to the presence traumatic event, a clinician may not be able to rationalize that
of stress syndromes. However, performance of combat patrols to which they have been exposed, which results in maladaptive
or other dangerous duties while deployed was a contributing coping. This can be a dramatic interruption to coping mecha-
factor. These results must be interpreted holistically, as other nisms that have evolved over the clinician’s lifetime. As this ex-
factors contribute to the presence of vicarious trauma (VT) in posure continues, the clinician’s belief system may also become
EMS personnel who are also veterans. altered. Faced with a tenuous hold on a previously understood
reality, individuals may model their values on others who have
Keywords: paramedic; EMS; military; compassion fatigue; vi- been determined to be “right.” 8,15–17 These individuals may
carious trauma; burnout; secondary traumatic stress then cope with the frustration of ill-fitting values by engaging
in lateral violence with peers and superiors. 8,15–17 This series
of events repeats with the exposure to additional traumatic
material and can be cumulative in nature.
Introduction
This report is part of the Secondary Trauma Response in Anecdotally, it is known that EMS personnel are sometimes
Emergency Services Systems (STRESS) project. The focus of exposed to intensely traumatic material. However, the rates
this arm was to create a personal trauma profile of emergency and types of exposure in this unique population have yet to be
medical services (EMS) personnel with prior military service, comprehensively quantified, particularly in those with prior
while evaluating the impact of military service on the presence military service. Collaterally, many studies have identified that
of stress syndromes in this population. combat veterans have also been exposed to highly stressful
matter, albeit in a different setting. The effects of such stress
The depth and breadth of the patient care experience provided could be compounded by continued service in the EMS profes-
by EMS personnel in the prehospital environment is consid- sion on military discharge. 18–20 It is important to understand
erable. However, these clinicians have little control over the the interplay between military and EMS service, particularly
events and circumstances to which they are often exposed. as those experiences relate to traumatic stress syndromes. As
*Correspondence to Health Sciences Program, Rush University, Chicago; or gkrenkiewicz@waketech.edu
1 Dr Renkiewicz is the department head of the Emergency Medical Science and Healthcare Simulation at Wake Technical Community College,
2
Raleigh, NC, and Dr Hubble is an instructor at Wake Technical Community College, Raleigh, NC.
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