The emergency medics taking on post-traumatic stress disorder

In a country where terrorism and war are endured as a consistent, yet unpredictable, byproduct of a protracted and intractable geopolitical conflict, post-traumatic stress disorder is far from rare. While there is no recent data on the number of Israelis afflicted, Avi Steinherz, clinical director of United Hatzalah's Psychotrauma and Crisis Response Unit, said approximately 20% of those who experience or witness extreme violence will develop some form of PTSD. “Statistics-wise, what we have found from 15 to 20 years of experience – including the intifadas, wars and incursions from Gaza – is that the majority of the general population has a resilience to traumatic events, and most people exposed to them do get better on their own,” he said on Tuesday. “However, there is 20% of the population that enters into what is called 'acute stress reaction [ASR]' in the immediate aftermath of a traumatic event, and once you talk about that particular population the statistics flip around completely because among them almost 80% will develop PTSD, which is a condition which they, their families and communities can suffer from for the rest of their lives.” “Unfortunately,” he continued, “our population here in Israel has a huge amount of hyper-sensitive people walking around with PTSD from the numerous, unending amount of trauma we're exposed to from all the wars, intifadas and the danger of living under the gun and the threat of death at all times.” Steinherz said the country's first Psychotrauma and Crisis Response Unit was formed in 2016, at the height of the so-called “stabbing intifada,” following years of germination. “During our experience from the stabbing intifada, we had statistics from Magen David Adom indicating that there were between three and four more times the amount of people who were emotionally and psychologically traumatized than those physically wounded,” he noted. “But, the amazing thing we found, which is the driving force behind our unit, is that if the 20% of the population who enters ASR receives immediate stabilization, 75% of those people will not develop PTSD. So, time is of the essence.” A Psycho-trauma and Crisis Response Unit volunteer aids a soldier after a terror attack in Jerusalem (United Hatzalah) Today, more than 600 specialists, ranging from psychiatrists, psychologists, social workers and EMTs, volunteer in the unit throughout the country as psychological first-responders following all terrorist attacks, missile incursions, deadly accidents, and violent criminal activity. According to Steinherz, the Psychotrauma and Crisis Response Unit, which has been dispatched over 400 times since its inception, is divided into two segments. “Our Advanced Life Support Unit is made up of 300 mental health professionals at the advanced level,” he explained. “The second team, which also has 300 volunteers, is called the Basic Support Unit, which includes medics and first-responders who have gone through an intensive course to provide immediate psychological first aid stabilization in the field.” Based on the proven efficacy of these highly-trained volunteers, Steinherz said it has since become mandatory at United Hatzalah for all new EMTs to be trained in psychological first aid stabilization. “In the EMT courses, every single new incoming EMT must undergo five hours of psychological first aid training to help the medics themselves develop resilience to be able to deal with the traumatic experiences they are exposed to in the field,” he said. Moreover, Steinherz said that EMTs are trained to rapidly identify psychologically traumatized individuals, be they witnesses or family members of those physically wounded. Miriam Ballin, the psychotrauma unit's director who also works as a volunteer EMT and ambulance driver in Jerusalem, said the training is critical for first-responders. “When a person has just been exposed to an explosion, for example, it can be very difficult for the average medic to get these people out of their 'loop' because they are still in trauma,” she said. “Our tools enable us to recognize what is actually happening to that person, and gives us the ability to help positively break the loop, stop the pain, and ensure the person's current safety.” “Once we have done that, we can further stabilize them so that they can do what needs to be done,” she added. While effective psychological stabilization is largely subjective, Steinherz said key elements of immediate stabilization procedures are consistently incorporated. Sima Farkas, a trauma counselor and Psychotrauma and Crisis Response Unit responder who is training to be an EMT, said her training from United Hatzalah allowed her to hone her skills in a more intense and immediate environment. “This training has allowed me to make connections with people who are in a heightened state of shock and, with their willingness to allow us to help, bring them into a more calm position to cope with the situation they are in,” she explained. “I was called to a scene where a woman was sitting in her living room, having trouble talking, and when she did, she complained of dizziness and nausea. My EMT training was telling me that she was suffering from hyperventilation. I used my psycho-trauma and crisis response training to help make a connection with her through bilateral touch stimulation and deep breathing.” Psychotherapist and EMT Avi Tenenbaum said critical thinking is necessary to effectively treat a person in the midst of acute psychological trauma. “We are highly trained to assess a patient's most immediate needs and connect them with the resources that they require at that time – a task which requires a lot of skill and ingenuity,” he said. “Even before working with a patient, we understand that we must often first address their physical needs, and only then can we move forward,” he said. “At other times our patients are too highly agitated or dissociative to work with, and then we need to stabilize them until they reach a place where communicating their needs with us and others is even possible.” “Finally,” he continued, “we do not leave a patient experiencing the worst day in their life until we have made sure to help them create a firm support network that will remain with them after we leave the scene.” Ultimately, it is the unit's unique work, Tenenbaum noted, that makes it particularly gratifying. “No one quite does what we do,” he said. “It is an incredibly unique niche and expertise to be able to walk into tragedy and chaos and try to make it a little better, but that's what we've done already over 400 times since our unit's inception, and our experience only helps us do it better.”

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