When we manage these continually emerging trauma cases, such as mass killings, be aware not only of these significant large trauma but of the single individual trauma that occurs in work-related assaults, horrific motor vehicle accidents, falls from height, amputations, severe burn injuries and other extreme injuries. There is a tendency to be immediately responsive to the large volume events where many have been injured and to pay inadequate attention to one event and one employee trauma.
The most severe trauma are those that are deliberate, extreme and prolonged. Such is the case with individuals who have been tortured, but we also see work-injury cases in which an worker has, for example, sustained severe burns which, in themselves, require extensive time even for partial recovery.
Posttraumatic Stress Disorder is a stress-related disorder and emerges when the injuring event involves serious injury to oneself. While workers’ compensation does not cover PTSD resulting from watching or learning of death of a coworker, PTSD does, in fact, arise from observing serious injury or death of others or even from hearing of the occurrence of such events. The events that will produce PTSD are those that create intense fear, helplessness and horror.
This event is then relived through flashbacks or nightmares, symptoms are triggered by exposure to environmental cues the remind the victim of what had occurred. The traumatized individual then begins to restrict activities in a vain attempt to stop the symptoms, and he/she becomes hyper-alert, startles easily, cannot concentrate nor sleep.
The first month of these symptoms are referred to as Acute Stress Disorder. When the symptoms have persisted for more than 30 days, it is referred to as Posttraumatic Stress Disorder. In some cases, however, the symptoms do not begin until months or more after the trauma. This is called Delayed Onset PTSD.
Why does PTSD occur? There are several emotional and several physical reasons:
a. The mind is unable to process the information and feelings about the event in a normal way. The reaction of others after the trauma, and/or low self-esteem before the trauma, can influence whether PTSD emerges.
b. Neurochemical changes in the brain may result in damage to an area of the brain that has to do with emotional memory. This damage makes the event take on a life of its own with a sense that it is all happening again and again.
c. Another area of the brain is involved with how we learn about fear. That area may become hyperactive as a result of trauma, and the individual begins to “learn” unhealthy responses to his/her world.
Clearly, access to care immediately following a trauma is important. At the same time, there are research data to indicate that care should be under the control of the individual and not forced en masse for an entire workforce as has become common practice.