Development of Posttraumatic Stress Disorder in Urban Emergency Medical Service Workers

Michael Blumenfield, MD, Daniel W. Byrne, MS


Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article

Abstract & Introduction

This study evaluated the potential risk factors for development of posttraumatic stress disorder (PTSD) in emergency medical service (EMS) workers. During mandatory training classes, 2051 New York City EMS employees were given a detailed questionnaire to assess background, attitudes, psychological symptoms, and the presence of PTSD. Among the 1826 subjects who completed the questionnaire, 9.3% met the full DSM-III-R criteria for PTSD. An additional 10% met the full criteria with the exception that symptoms had not been present for a month at the time the questionnaire was completed. Divorce, rural high school, military war zone experience, previous emergency work experience, years on the job, rank, and overtime were statistically significant risk factors for PTSD. A cumulative risk model was constructed with 10 factors. EMS workers at risk for developing PTSD may be identified by the additive effect of predisposing and work-related factors.

Posttraumatic stress disorder (PTSD) has been studied in many populations, with several variations and patterns described.[1] The severity and frequency of PTSD are related to the proximity and exposure to the trauma. High incidences have been reported for those in a combat zone and among wounded veterans.[2,3] Children who were directly exposed to gunfire in a playground incident experienced more PTSD than those less exposed.[4] Chronic exposure to stress has also been shown to be an important factor in the formation of posttraumatic stress symptoms.[5]

Emergency workers have been shown to be vulnerable to the development of symptoms of posttraumatic stress.[6] Most studies of this group have focused on a particular multicasualty traumatic event such as a plane crash,[7] a shooting incident,[8] or a fire.[9] To assist these emergency workers, specific debriefing and peer counseling techniques have been developed.[10]

While doing consultation work for New York City (NYC) Emergency Medical Services (EMS), we came to appreciate that these workers were frequently exposed to multiple traumatic events, including injury and death by fire, murder, and accidents, as well as injury and death in drug abusers and those who are ill. The workers often responded to multiple calls, with little time for a break or a return to station, and at times they worked in dangerous environments. They were exposed not only to major traumatic stressful events, but also to chronic stress. The EMS environment presented an ideal setting to study the development of PTSD because workers with varying amounts of time on the job and exposure to traumatic work environment could be studied.


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