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Traumatic Stress from COVID-19 Raises Concerns for Front-Line Responders

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By Dr. Tonia Parker, Faculty Director, School of Arts & Humanities, American Military University

As the world continues to deal with the COVID-19 pandemic, a lot of focus has been on the health risks to healthcare workers due to the infectiousness of the virus and the insufficient amount of personal protective equipment (PPE) available.

However, another health risk to these providers that is just starting to get attention are the physical and mental health effects from their constant exposure to the trauma of this disaster. Even without a pandemic, our healthcare workers are already at higher risk of psychiatric disorders including: burnout and suicide. However, the nature of the COVID-19 pandemic raises additional concerns about the mental health outcomes for our front-line responders.

Effects of Traumatic Stress Aren’t Felt Until Operations Slow Down

One of the things we see in disasters is that first responders and healthcare workers jump into action and will often work past their limits. Their training kicks in, and they enter what we often refer to as “operational mode.” They are focused on the mission of saving lives and they set aside their own emotional responses until the job is done. These professionals typically don’t start to feel the real effects of the traumatic stress of an event until operations slow down.

[Related: How First Responders Can Prepare for Traumatic Experiences]

Once the traumatic event ends or slows down enough, they start to think and process their experience and the effects start to show. These can be physical effects such as: increased aches and pains, fatigue, or gastrointestinal issues; cognitive effects such as memory problems, difficulty concentrating or difficulty with problem solving. Emotional reactions that could appear include irritability, inappropriate guilt, depressed mood or anxiety. And there are behavioral effects too, such as changes in sleeping or eating patterns, substance abuse, or engaging in other risky behaviors. Spiritual effects can include a loss of sense of meaning or purpose, anger at God, or withdrawal from a religious community.

Front-Line Responders Face an Increased Risk to Their Own Lives

In observing the response to the COVID-19 pandemic, several things make this situation particularly traumatic for front-line responders. On the job, they face an increased risk to their own lives due to the rationing of personal protective equipment (PPE). They make hard clinical decisions to maximize the benefits of limited resources such as intensive care rooms and ventilators. And there is the increased risk of aerosolizing the virus while performing certain procedures, including CPR. They have to make these hard clinical decisions with virtually no input from family members, due to the restrictions on family members being able to visit because of the virus’s rapid contagious effects.

Since family members are not present, healthcare providers must take extra steps to provide support to patients that would normally be provided by family members, such as holding patients’ hands as they take their last breath.

It is difficult enough for healthcare workers to cope with losing a patient, but having to give support normally provided by family members makes each death feel more personal.

Many Physicians and Healthcare Providers Are Suffering Financial Losses

In addition to the added stresses in the workplace, front-line responders also must deal with their own personal stresses related to this pandemic. Many physicians and other healthcare providers are suffering financial losses. “Ninety-seven percent of physician practices have experienced a negative financial impact from COVID-19,” according to a new survey by the Medical Group Management Association (MGMA). The financial impact is both directly and indirectly related to the outbreak, the survey said.

Many caregivers and healthcare providers are isolating from their own friends and family members to reduce the risk of exposing them to the virus. This removes an important coping resource, as social support is one of the key resources that helps mitigate traumatic stress.

Some caregivers and healthcare providers have family members who have already contracted the virus or have other health issues. Yet they must leave their family to take care of other people’s families. Others miss important milestones in family members’ lives, such as the Jonesboro, Arkansas, physician who watched his son crawl for the first time through a glass door due to social distancing. Sadly, compounding his stress experience, the physician and his family lost their home shortly afterward in a tornado. Many front-line responders have lost friends, family members, and colleagues to this virus as well.

Increased Psychiatric Symptoms and Suicides in Healthcare Workers

Even in “normal” times, healthcare workers and first responders are at a higher risk of suicide and burnout. We are already seeing increased psychiatric symptoms and suicides in healthcare workers related to this pandemic. Recent suicides included 49-year-old ER physician Dr. Lorna Breen and 23-year-old EMT John Modello, both of New York City, who became overwhelmed by the stress of responding to the pandemic. Unfortunately, we will likely see more such deaths, particularly when the crisis ebbs and healthcare workers start to process their experience. In addition to losing healthcare workers to suicide, we are likely also to see an increase in healthcare workers leaving the professions due to burnout.

[Related: Treating Invisible Wounds: Helping One Another with Unmanaged Stress]

The unique challenges of this pandemic make it difficult for disaster mental health professionals to provide the services we would normally provide to mitigate psychological effects. In a typical disaster, we would set up respite centers where front-line responders could take breaks, get refreshments, and receive psychological first aid through one-on-one or group support. However, the need for social distancing has made it difficult to provide some of these services. The current situation has pushed us to find alternative ways to serve those who serve others.

Two core components of psychological first aid are education about stress and coping, and linkage with needed services. Many professional associations, government agencies, universities, and other organizations have resources to educate first responders and healthcare workers about self-care and coping as they deal with the COVID-19 pandemic. The National Academy of Medicine has a comprehensive list and links to these educational and support resources.

[Related: Pre-Trauma Training Improves Emotional Resiliency in First Responders]

Several groups have come together to offer free crisis and mental health services to first responders and healthcare workers through telehealth. They include the Emotional PPE Project, Project Parachute and For the Frontlines. In addition, the American Academy of Experts in Traumatic Stress, Green Cross Academy of Traumatology, and CISM Perspectives have teamed up to coordinate virtual support groups for first responders and healthcare workers around the country.

There are also resources available through the 24-hour SAMHSA Disaster Distress Hotline (800- 985-5990 and the National Suicide Prevention Lifeline 800-273-8255.

Just as there have been casualties from the virus, there will be casualties from the stress of the response. While it is harder to do some of the outreach that we would normally do with people affected by a disaster, there are things we can do in this situation. Increasing visibility of the problem and access to the resources available can help to mitigate some of the psychological effects – and potentially save lives – that this pandemic is having on our front-line responders.

About the Author: Dr. Tonia Parker is a Faculty Director in the School of Arts & Humanities at American Military University. She holds a doctorate in general psychology from Capella University; a bachelor’s degree in psychology and master’s degree in community counseling from Georgia State University; and a master of public health from Argosy University. She is also a Licensed Professional Counselor (GA) with 18 years of experience in providing disaster mental health and other disaster services through organizations such as the American Red Cross, Medical Reserve Corps, Georgia Critical Incident Stress Foundation, and Augusta-Richmond County (GA) Community Emergency Response Team (CERT). She is a Diplomate of the American Academy of Experts in Traumatic Stress.

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