Ashley Atkins BSN RN Melissa Bowen BSN RN
Ashley Atkins, BSN, RN Melissa Bowen, BSN, RN Tammy Lynn, BSN, RN Ami Pearse, BSN, RN
TRAUMA IS CLASSIFIED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS AS EXPOSURE TO ACTUAL OR THE THREAT OF DEATH, SERIOUS INJURY, OR SEXUAL VIOLENCE THAT CAN OCCUR IN THE FOLLOWING WAYS: a) Witnessing the event occurring to others b) Experiencing the event directly c) Learning that the event happened to someone that we feel close to, as in a family member or friend d) Repeated exposure to such events, as with first responders (Wilkins, Owen, & Kilpatrick, 2017).
First Responders are on the frontlines of distressing situations everyday. They provide help and assist with the safety, health, and well-being of the population. Witnessing stressful and traumatic events places them at risk for mental health disorders. The high pace of the work environment, and not enough time to recover between traumatic events can lead to depression, suicidal ideation, substance abuse, and PTSD (Wilkins, Owen, & Kilpatrick, 2017).
First Responders such as firefighters, police officers, and paramedics have a high rate of suicide. PTSD was a common component in first responders suffering from mental health concerns. Some employers terminate first responders who suffer from PTSD. The fear of losing a job hinders a call for help. Legislation is being pushed to make PTSD a job-related injury (Bigham, 2016)
The first responder population is not forthcoming of those issues related to mental health. It is a culture of being self reliant that keeps many from getting the help they need (Jones, Nagel, Mc. Sweeney, & Curran, 2018)
• Healthcare providers need to be aware of the prevalence of the trauma and mental health concerns with first responders. • Proper screening and education for the provider and the patient is imperative. • First responder organizations have been seeking legislation to support their efforts for resources and funding in mental health for this population (Jones, Nagel, Mc. Sweeney, & Curran, 2018)
• In 2017, the Firefighter Behavioral Health Alliance says at least 98 firefighters killed themselves and a similar group Blue Help says the same is true of 159 police officers (Foster, 2019). • Nurses are four times more likely to commit suicide than people working outside of medicine (Yazdi, 2017).
To support healthy, growing communities, Carolinas Health. Care System offers a free Mental Health First Aid (MHFA) course that empowers people to respond to signs of mental illnesses and substance use disorders. Mental Health First Aid is an 8 -hour course that teaches you how to identify, understand respond to signs of mental illnesses and substance use disorders. The training gives individuals the skills needed to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. With more than 10, 000 individuals trained across the Carolinas, we asked the Behavioral Health team at Carolinas Health. Care System about the programs impact and its importance for North Carolina and beyond (Atrium Health, 2019).
The North Carolina First Responder Peer Support organization is a non-profit organization comprised of first-responders, medical professionals, and caring members of the community(North Carolina First Responder Peer Support, 2017). Assistance provided by a trained individual or group of trained firefighters and emergency responders who answer the call to their brothers and sisters in need, regardless of the need. Trained firefighters and emergency responders are educated on referrals for individuals seeking help regarding treatment facilities, drug abuse, anxiety, depression, problematic drinking, insomnia, and therapists.
• Distributed over 150, 000 mental health resource cards to providers. • Collected over 700 stories to raise awareness and remind providers that no one is suffering alone. • Educated tens of thousands first responders about mental health, resilience, and what mental health resources are available. • We have a semi-regular column on EMS 1, the largest EMS related news website. • Increased reporting of public safety suicides by 100%, leading to a better understanding of the core issue. • Created a first-of-its-kind database of first responder oriented mental health resources. • Provide peer support and crisis referral for hundreds of providers. • Provide financial assistance to first responders who need help paying for mental health care. • Presented mental health education at numerous conferences, education events, and agencies.
Objective: Address the mental health disorders and sequalae of First Responders, as secondary victims, when traumatized during or after interventions in densely populated areas. North Carolina Peer Support Carolinas Health. Care System offers a free Mental Health First Aid (MHFA) The Code Green Campaign
ACTION PLAN AND IMPLEMENTA TION § Mental Health First Aid added to yearly competencies for all first responders. § Mental Health Screenings complete with onboarding. Follow-up screenings should be implemented at 4 months and yearly to identify at risk individuals. § Leaders/Chiefs/Sergeants/Managers of the organization should be required to complete the Certification in Critical Incident Stress Management (CCISM) to provide beneficial debriefing for all first responders.
§ It is evident that first responders are a vulnerable population at risk for developing post-traumatic stress disorder depression. Not only do these individuals put themselves at risk daily, but they are also the initial response to accidents, injuries, and shocking events. First responders put the needs of others above their own daily. § Mental Health First Aid introduced the Fire/EMS module, which provides a fundamental understanding of the common mental health challenges experienced by first responders and the skills to identify and respond to someone who may be in crisis. The program teaches post -crisis strategies for first responders to better assess and access support for themselves, their colleagues and community members (Wells, 2019). Mental Health First Aid should be added as an adjunct to yearly competencies for first responders.
§ Initiate a mental health screen as part of the orientation/onboarding of newly hired first responders. Follow up after 4 months on the job then include with yearly evaluations. § Early assessment means that those Drexel is the first university to screen using a kiosk system. The kiosks use a 15 -question system to screen for issues including bipolar disorder, post-traumatic disorder and depression (Otto, 2015) who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences which could potentially reduce episodes of PTSD and major depression and improve the long-term health of a valued and essential workforce (Nauert, 2016).
AGERS OF THE ORGANIZATION SHOULD BE REQUIRED TO COMPLETE THE CERTIFICATION IN CRITICAL INCIDENT STRESS MANAGEMENT (CCISM) TO PROVIDE BENEFICIAL DEBRIEFING FOR ALL § Each leader/chief/sergeant/manager of the FIRST RESPONDERS. organization should be required to complete the CRITICAL INCIDENT STRESS MANAGEMENT (CISM). § Certified individuals are competent in recognizing and mitigating acute distress as commonly experienced by first responding emergency services personnel, first receivers such as those working in emergency medical and trauma venues, and disaster response professionals (UMBC Emergency Health Services, 2018). These qualifications would allow for the necessary debriefing after unfortunate events experienced by first responders in efforts to decreased potential for post-traumatic stress disorder in effected individuals.
§ The National Institutes of Health (NIH) has a $500, 000 funding opportunity to evaluate the effects of preventative interventions on mental health disorders. § The mission of the National Institute of Mental Health (NIMH) is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure (National Institute of Mental Health, 2019). A Letter of Intent would be sent to The National Institute of Mental Health touching on the needs of improving mental health in Mecklenburg County’s first responders. The Letter of Intent would include statistics that have declined over the past five years exemplifying the need for action. § The closing date is January 2, 2020 (“Search Grants | GRANTS. GOV, ” n. d. ).
§ Evaluating health care initiatives is important to gauge whether they should be modified, repeated, or abandoned. § A change team should be designated to not only spearhead the implementation of an initiative, but also its assessment. This change team should have representation from key leadership levels and stakeholders, such as a clinical expert, administrative executive, and a front-line leader. § The assessment should be based on specific goals, and its efficacy determined by whether it achieved these goals.
§ Suicide and self-harm incidence rates among NC first responders decrease by 33% § Self-report/disclosure rates of PTSD among NC first responders increase by 10% § Anti-retaliation state legislation bill drafted § Number of NC first responders educated about first responder PTSD and stigmas at 75%
§ Stringent and precise monitoring and evaluation is necessary for program success. § Honest, transparent analysis of progress is essential to enable further improvements and alterations of the plan’s implementation and tactics. § Safeguards against biased data are critical for progress and repeatability. § When progress is made, complacency should be avoided.
EVALUATION TOOLS Even with a change team, clear goals, and a management plan, health program evaluation is difficult. Certain tools and tactics can facilitate program assessment: The Hazeldon Foundation offers resources for early assessment and follow up screens to evaluate for potential or present mental health issues (Hazeldon, 2016). § Standardize reporting language and The Mental Health Screening Form and the PTSD Checklist could be utilized for evaluation of first responders. terminology § Align reporting expectations § Single reporting tool, framework, or IT infrastructure across domains § Decentralized data collection on a common software platform such as a Kiosk The leadership team of the organization or hiring party will hold responsibility for mandating theses screens are initiated and follow up is complete for all employees. If mental health triggers are presented through the screens, resources and tools should be provided to the individual and it should be seen by leadership that the individual receive follow up care.
Atrium Health. (2019). Being prepared for the unexpected: mental health first aid at a glance. Retrieved from https: //atriumhealth. org/dailydose/2018/01/16/being-prepared-for-the-unexpected-mental-health-first-aid-at-a- glance Bigham, B. (2016). Advocates in Canada Demand Legislation to Stem Responder Suicides. EMS World, 45(3), 14– 56. Bowman, J. , Mogensen, L. , Marsland, E. , & Lannin, N. (2015). The development, content validity and inter-rater reliability of the smart-goal evaluation method: A standardised method for evaluating clinical goals. Australian Occupational Therapy Journal, 62(6), 420 -427. Feather, J. L. (2018). Developing programme theories as part of a realist evaluation of a healthcare quality improvement programme. International Journal of Care Coordination, 21(3), 68 -72. Fernald, D. , Harris, A. , Deaton, E. A. , Weister, V. , Pray, S. , Baumann, C. , & Levinson, A. (2012). A standardized reporting system for assessment of diverse public health programs. Preventing Chronic Disease, 9. 147 -147. Foster, A. (2019). Charlotte firefighters, police address mental health initiatives, combating national suicide numbers. WBTV. Retrieved from https: //www. wbtv. com/2019/01/11/charlotte-firefighters-police-address-mental-health-initiativescombating-national-suicide-numbers Frieden, T. R. (2014). Six components necessary for effective public health program implementation. American Journal of Public Health, 104(1), 17 -22. Hazeldon Publishing. (2016). Screening tools. Retrieved from http: //www. bhevolution. org/public/screening_tools. page Jones, S. , Nagel, C. , Mc. Sweeney, J. , & Curran, G. (2018). Prevalence and correlates of psychiatric symptoms among first responders in a Southern State. Archives of Psychiatric Nursing, 32(6), 828– 835. https: //doi. org/10. 1016/j. apnu. 2018. 06. 007
National Institute of Mental Health. (2019). FY 2020 interim funding strategy for research grants. Retrieved from https: //www. nimh. nih. gov/funding/grant-writing-and-application-process/fy-2020 -interim-funding-strategy-forresearch-grants. shtml Nauert, R. (2016). Early Screening Can ID First Responders with mental health risks. Psych Central. Retrieved from https: //psychcentral. com/news/2016/06/29/early-screening-can-id-first-responders-with-mental-health-risks/105613. html North Carolina First Responder Peer Support. (2017). Retrieved on October 10, 2019 from http: //www. ncffps. org Otto, F. (2015, January 7). A 'Check-Up from the Neck Up' — Mental Health Screening Kiosks at Drexel. Health - Science & Technology. Retrieved from A 'Check-Up from the Neck Up' — Mental Health Screening Kiosks at Drexel The Code Green Campaign. (2019). Retrieved on October 10, 2019 from https: //codegreencampaign. org UMBC Emergency Health Services. (2018). About critical incident stress management. Retrieved from https: //ccismcert. org/cism/ Wells, S. (2019). First responders suffer: how mental health first aid can help first responders. National Council for Behavioral Health. Retrieved from https: //www. mentalhealthfirstaid. org/external/2018/10/first-responders-suffer- howmental-health-first-aid-can-help/ Wilkins, M. J. , Owen, T. , & Kilpatrick, B. (n. d. ). Trauma and Stress Related Disorders: Relevance to DSM-5 and Life Care Planning. 10. Yazdi, M. (2017). Suicide in nursing: much more common than you think. News. Retrieved from https: //nurse. org/articles/Need-to-knows-when-applying-to-nursing-schools/
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