everything first responders need to know about ptsdmed.brown.edu/pedisurg/kiwanis2013/ptsd.pdf ·...

Everything First Responders Need to Know About PTSD

Nicole R. Nugent, Ph.DStaff Psychologist RIH Bradley/Hasbro Children's Research Center

Assistant Professor (Research) DPHB Alpert Brown Medical School

Disclosures

No financial conflict of interest

What is PTSD? Criterion A: TraumaDeath, threatened death, serious injury, sexual

violence Criterion B: Intrusion (1) Intrusive memoriesNightmaresDissociative reactions (i.e., flashbacks)Distress at remindersPhysiologic reactivity at reminders

Criterion C: Avoidance (1)Thoughts or feelingsReminders

What is PTSD? Criterion D: Negative Cognitions & Mood (2)Dissociative amnesia for eventPersistent negative beliefs about self and worldPersistent blame of self or othersPersistent negative trauma-related emotionsDiminished interest in pre-trauma activitiesFeeling alienated from othersConstricted affect

Criterion E: Altered arousal/reactivity (2) Irritable/aggressive behaviorSelf-destructive / reckless behaviorHypervigilanceExaggerated startlePoor concentrationSleep problems

PTSD Prevalence Overall 13-45% children

Traffic Accidents1-4 months - 12-46% children4-12 months - 13-25% children

PICU Admits5-28% children10-21% parents

Sexual Abuse34-58% children

Acute Predictors of PTSD Predictors you can’t change:Death of a loved onePrior traumaPrior mental health concernsFemale genderFamily SESBiological predictorsAspects of trauma:InterpersonalInjury mechanism rather than “severity”Parental presence

Acute Predictors of PTSD Predictors you can change:Parent presence/supportProvision of resources for parentsActive thought suppressionWillingness to talkHandling early avoidancePain managementIdentification/referral of kids having

difficulty

From: Screening for Risk of Persistent Posttraumatic Stress in Injured Children and Their ParentsJAMA. 2003;290(5):643-649. doi:10.1001/jama.290.5.643

Referral for Intervention Preventing PTSDChild and Family Traumatic Stress Intervention

Treating PTSDTrauma Focused Cognitive Behavioral Therapy

Secondary Traumatic Stress Firefighters: 13-18% PTSD

EMTs and Other Disaster Workers:25% PTSD

Coping with secondary trauma:

Resources Learn more: National Child Traumatic Stress Network

(NCTSN) Resources to share:See NCTSN siteSesame StreetSAMHSA

Local resources:Family Services of Rhode IslandLifespan Child and Adolescent Psychiatry

Contact Info:Nicole R. Nugent, PhD

Assistant Professor (Research)

Bradley/Hasbro Children’s Research CenterRhode Island Hospital

nnugent@lifespan.orgNicole_Nugent@brown.edu

Department of Psychiatry and Human Behavior

Brown Medical School