From Harvard Medical School (Drs. Lewis-Schroeder, Murphy, Robinson, and Kaufman) and McLean Hospital, Belmont, MA (all).
Harv Rev Psychiatry. 2018 Jul/Aug;26(4):216-227. doi: 10.1097/HRP.0000000000000176.
First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.
急救人员经常面临创伤事件的暴露，包括潜在的危及生命的情况以及同事和平民的重伤和死亡。有证据表明，创伤后应激障碍（PTSD）在急救人员中的患病率明显高于普通人群。本文介绍了麦克莱恩医院 LEADER（执法、现役、应急响应）计划中的门诊创伤服务，以帮助在实践中遇到这些急救人员的临床医生，或专门对治疗这一患者群体感兴趣的医生。我们首先综合了有关急救人员在工作中接触创伤性应激后 PTSD 患病率的文献，并讨论了可能导致潜在风险增加的职业特定风险因素和第三变量风险因素。然后，我们讨论了我们计划中使用的评估策略和治疗选择，该计划专为因职业特定创伤性应激暴露而面临心理健康问题的个人量身定制。我们还讨论了治疗创伤后应激障碍的急救人员所面临的独特挑战，包括涉及整个生命周期的创伤性应激暴露和安全问题，包括急性自杀风险。最后，我们讨论了文献中的显著差距，包括需要研究为什么以及女性为何表现出与男性不同的 PTSD 症状，以及在确定女性的适当治疗方法时如何考虑这些差异。
