Page 65 - JSOM Spring 2021

The potential for anosognosia was an additional concern, which wrote the first draft. MWH assisted with the statistical analy-
presented as a modified Hawthorne effect. Anosognosia has sis and subsequent edits of the manuscript.
been associated with stress syndromes and presents as the lim-
ited self-awareness of one’s condition; in this context, a person References
with a disability does not recognize that they are ill or minimizes 1. Figley CR. Compassion fatigue: psychotherapists’ chronic lack of
self care. J Clin Psychol. 2002;58(11):1433–1441.
the associated difficulties. 56–60 Anosognosia is a biological pro- 2. Sabin-Farrell R, Turpin G. Vicarious traumatization: implica-
cess characterized by the aforementioned symptomatology and tions for the mental health of health workers? Clin Psychol Rev.
damage to the right hemisphere of the brain. It has been linked 2003;23(3):449–480.
with PTSD and traumatic brain injury in multiple studies. 48–52 3. Creamer M, Bell R, Failla S. Psychometric properties of the Im-
This effect manifested itself as inappropriate affect (e.g., overly pact of Event Scale – Revised. Behav Res Ther. 2003;41(12):
aggressive refusal to participate without provocation), which is 1489–1496.
a symptom of stress syndromes. However, this effect was small 4. Weiss DS, Marmar CR. The Impact of Event Scale–Revised. In:
Wilson JP, Keane TM, eds. Assessing psychological trauma and
given that the overall survey completion rate was 98.3%. PTSD. New York, NY: Guilford Press; 1997.
5. Asukai N, Kato H, Kawamura N, et al. Reliability and validity
Because this study was cross-sectional, causal relationships of the Japanese-language version of the Impact of Event Scale-
could not be observed and only a personal trauma profile and Revised (IES-R-J): four studies of different traumatic events. J
the history of prior military service could be described at a Nerv Ment Dis. 2002;190(3):175–182.
singular point in time. 6. Beck JG, Grant DM, Read JP, et al. The Impact of Event Scale-
Revised: psychometric properties in a sample of motor vehicle
accident survivors. J Anxiety Disord. 2008;22(2):187–198.
As a final point, this study did not account for EMS personnel 7. Newland C, Barber E, Rose M, Young A. CRITICAL STRESS.
who may have had experience as defense contractors, and as Survey reveals alarming rates of EMS provider stress & thoughts
such, may have had similar exposures to those in military ser- of suicide. JEMS. 2015;40(10):30–34.
vice deployed overseas to a combat theater. 8. McCann IL, Pearlman LA. Vicarious traumatization: a frame-
work for understanding the psychological effects of working with
victims. J Trauma Stress. 1990;3:131–149.
Conclusion 9. Kadambi MA, Truscott, D. Vicarious trauma among therapists
working with sexual violence, cancer, and general practice. Can J
In this study, EMS personnel with prior military service who Counsel. 2004;38(4):260–276.
identified as having a stress syndrome had experienced PTEs 10. Pearlman LA, Saakvitne KW. Trauma and the therapist: counter-
at a rate 2–4 times higher than in respondents without stress transference and vicarious traumatization in psychotherapy with
syndromes, regardless of how that event was experienced. The incest survivors. New York, NY: W.W. Norton & Co; 1995.
exposure to combat patrols or other dangerous duties while 11. Pearlman LA & Mac Ian PS. Vicarious traumatization: an em-
pirical study of the effects of trauma work on trauma therapists.
deployed, as well as lower total years of military service were Professional Psychol Res Pract. 1995;26(6):558–565.
significant and unique predictors of VT in this population. Ad- 12. Baird S, Jenkins SR. Vicarious traumatization, secondary trau-
ditional research should focus on the panoptic experience of matic stress, and burnout in sexual assault and domestic violence
EMS personnel who are exposed to stressful material, partic- agency staff. Violence Vict. 2003;18(1):71–86.
ularly in those with prior military service. Studies that focus 13. Busch J. (2014, February, 28). Preventing Provider Suicide.
on causality for critical incident stress are needed, particularly 14. http://www.emsworld.com/article/11320416/firefighter-
behavioral-health-alliance-ffbha-seeks-to-prevent-suicides-with-
those related to the intricate association between the circum- data-on-ems-fire-service. Accessed September 7, 2017.
stances in an individual’s life, such as childhood trauma, oc- 15. Helm H. Managing vicarious trauma and compassion fatigue
cupational impact, sociodemographic factors, military service defining vicarious trauma and compassion fatigue. https://www
history, and life experiences, and the development of stress .lianalowenstein.com/artcile_helm.pdf. Accessed 21 October 2020.
syndromes that have been shown to impact overall health. 16. Abberley P. The concept of oppression and the development of a
Equally important is the potential for the study of individuals social theory of disability. Disability Handicap Society. 1987;2
(1):5–19.
in high-stress occupations, such as the military or public safety 17. Sidanius J, Pratto F. Social dominance: an intergroup theory of
officials, who seem to be immune from traumatic stress. Such social hierarchy and oppression. New York, NY: Cambridge Uni-
elucidations would contribute to the scopious understanding versity Press; 1999.
of how traumatic stress affects both the public safety and mil- 18. Lee J, Possemato K, Ouimette PC. Longitudinal changes in
itary communities. This study may induce the development of combat-related Posttraumatic Stress Disorder among Operation
abatement measures, and awareness or outreach strategies for Enduring Freedom/Operation Iraqi Freedom/Operation New
critical incident stress in EMS systems. Dawn veterans with hazardous alcohol use: the role of avoidance
coping. J Nerv Ment Dis. 2017;205(10):805–808.
19. Stovall-McClough KC, Cloitre M. Unresolved attachment, PTSD,
Acknowledgments and dissociation in women with childhood abuse histories. J Con-
The authors would like to acknowledge participating EMS sult Clin Psychol. 2006;74(2):219–228.
agencies for their contribution to this project. 20. Cai WP, Pan Y, Zhang SM, et al. Relationship between cognitive
emotion regulation, social support, resilience and acute stress re-
Funding sponses in Chinese soldiers: exploring multiple mediation model.
This project received no external funding. Psychiatry Res. 2017;256:71–78.
21. United States Census Bureau. 2010 Census Urban Area Delinea-
Disclosure tion Program. https://www2.census.gov/about/partners/sdc/events
The authors report no conflicts of interest relevant to this ar- /steering-committee/2013-04/2013-ratcliffe.pdf. Accessed 21 Oc-
ticle to disclose. tober 2020.
22. North Carolina Department of Commerce. Where the jobs are:
supply and demand for labor in North Carolina’s regions. 1 De-
Author Contributions cember 2016. https://www.nccommerce.com/blog/2016/12/13
GKR conceived the study concept, recruited participants, /where-jobs-are-supply-and-demand-labor-north-carolina
collected and coded the data, ran the statistical analysis, and %E2%80%99s-regions. Accessed 21 October 2020.

Trauma Profiles for Secondary Stress Syndromes in EMS Personnel | 63