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Introduction

For those working as helping professionals such as paramedics, working with victims of trauma comes with the job. Sometimes the reaction to working with trauma may cause symptoms which can be compared to those experienced in post traumatic stress by the victim (Vicarious Traumatisation. 2001). The effects of repeated exposure to trauma were identified in the 1970s initially, after looking at the effects it had on emergency service workers. The workers which were studied experienced flashbacks and nightmares; symptoms which are demonstrated in posttraumatic stress disorder (PTSD). The researchers named the effects it had on these workers secondary trauma but by 1995 the condition was renamed to compassion fatigue as the researchers believed it was more suitable (Vicarious Traumatisation. 2001).

 

The existence of post traumatic effects on individuals has been known for many years and researchers agree on the negative effects it has on helping professionals. Although the effects were acknowledged since the initial studies, naming and describing the symptoms is ongoing (Vicarious Traumatisation. 2001). There are many names for the negative effects of working with trauma which include secondary trauma, compassion fatigue, vicarious trauma, and counter transference. These terms may be used interchangeably by some but they describe specific effects and symptoms and therefore relate to different conditions (Vicarious Traumatisation. 2001).

 

The term vicarious trauma was first introduced in studies done on therapists working with victims of sexual violence (Vicarious Traumatisation. 2001). It was defined by the two researchers Paerlmann and Saakvitne who believe that through listening to the traumatic stories shared by clients, our view of ourselves and the world is permanently transformed (Guide Book on Vicarious Trauma. 2001).“Vicarious trauma therefore can be described as the profound shift that workers experience in their world view when they work with clients who have experienced trauma. Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material” (Guide Book on Vicarious Trauma. 2001).

 

Vicarious trauma is a process that unfolds over time; through witnessing other people’s suffering and need. It is a direct result of negative changes that occur from caring for and caring about others who have been hurt (What is Vicarious Trauma? 2004). It is not just a response to an individual or situation but the cumulative effect of interaction with people who experienced violence, cruelty and struggling. It is a process that is ongoing; the change and effects associated with vicarious trauma are affected by not only what occurs in our professional experiences but also those which happen in our personal lives (What is Vicarious Trauma? 2004). The positive side of this change being an ongoing process is the fact that it offers many opportunities along the way to recognize the impact work has on our lives and gives a chance to think about ways to protect and care for ourselves at times of exposure (What is Vicarious Trauma? 2004).

 

The onset of vicarious trauma is a direct result of the fact that as helping professionals we care and empathize with people who are hurting; it is our ability to identify with another person and to understand or possibly share that person’s pain that results in vicarious trauma (Original Research. 2004). “Empathy doesn’t mean feeling exactly what someone else is feeling. Everyone is unique. Everyone has his or her own personal history, personality, and life circumstances. You cannot ever feel exactly what someone else is feeling. But to a certain extent (and more effectively in some cases than others), when you care, you can relate to other people’s experiences, reactions, and feelings. And when you care about and identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience and feel it along with them in some way (Original Research. 2004).”

 

It is often easy to feel deeply committed and responsible when working in a helping profession; which may contribute to the process of vicarious trauma. It can lead to very high (and sometimes unrealistic) expectations of oneself and others, and for the results you want to see from your work (What is Vicarious Trauma? 2001). It may become a very personal matter when assessing work and whether your performance has the impact you desire. Ironically, your sense of commitment and responsibility can eventually contribute to you feeling burdened, overwhelmed, and hopeless in the face of great need and suffering. It can also lead you to extend yourself beyond what is reasonable for your own well-being or the best long-term interests of beneficiaries (What is Vicarious Trauma? 2001).

 

 

 

Signs & Symptoms

Vicarious trauma has a lot of signs and symptoms and it can vary from person to person. It is imperative that everyone in the helping profession be aware of these common signs and symptoms to avoid eventual consequences such as burnout or emotional fatigue.

 

The signs and symptoms of vicarious trauma are nearly identical to PTSD (Jenkins & Baird, 2002). According to Jenkins et al., signs and symptoms of vicarious trauma includes, re-experiencing of the primary survivor’s traumatic event, avoidance of reminders and/or numbing in response to reminders, and persistent arousal (Jenkins & Baird, 2002). Re-experiencing of the primary survivor’s traumatic event is the repetitive occurrence of thoughts about the traumatic experience of the victim. One can only imagine how difficult it is to repetitively re-experience something of an extreme traumatic nature. Avoidance of reminders and/or numbing in response to reminders of the traumatic event is the process of consciously avoiding the traumatic encounter as if it never even happened. Persistent arousal is a state of continuously being awake and alert. This also means not getting enough rest. This suggests that one’s sympathetic nervous system is very active, possibly due to vicarious trauma. While these signs and symptoms are very common, one may experience totally different signs and symptoms of vicarious trauma.

 

Effects of vicarious trauma can be positive or negative. “Negative effects of vicarious trauma can lead to high levels of absenteeism, early ill health and burnout retirements, and premature mortality observed among paramedics” (Lowery & Stokes, 2005). Absenteeism can result from numerous causes. It could be due to the mental exhaustion brought by vicarious trauma or from developing disinterest in the profession due to vicarious trauma. One can also trigger early onset of illnesses that are normally seen later in life due to exposure to vicarious trauma. This could be because of decreased or impaired immune system during stressful conditions. These negative effects of vicarious trauma could eventually lead to professional burnout.

 

While it is common to associate vicarious trauma to negative experiences, some people are able to take advantage of such experiences to become better as a person or as a professional. After exposure to vicarious traumas, specifically death, some workers in the helping profession are able to discover strengths within themselves, appreciate life, and learn from the experience (Linley & Joseph, 2005). Discovering one’s strengths can be challenging. It is sometimes discovered only during trying times such as exposure to vicarious trauma. Another positive effect of exposure to vicarious trauma, specifically death, is the appreciation of life. One can easily overlook the beauties of life and exposure to vicarious trauma enables one to understand reality and appreciate their existence. Vicarious trauma could also be looked at as a learning experience to improve one’s self. Understanding and being able to recognize signs and symptoms of vicarious trauma is vital. This is essential to avoid the negative effects of vicarious trauma.

 

 

 

Risk Factors

When individuals consider working in the field of emergency operations, they rarely stop to consider what kinds of problems they will be introduced to during the period of employment as emergency personnel. Typically, it’s not that they choose not to think about these issues but rather, are simply unaware of them. As a result, many individuals going into this field (and EMS specifically) have unrealistic expectations of the job. Vicarious trauma is something that every paramedic faces, regardless of their background. There are however, ways to minimize the effects of secondary trauma; by recognizing factors that put an individual at risk, and how to react in situations that could potentially cause STS (secondary trauma syndrome). STS is a set of psychological symptoms similar to that of post-traumatic stress disorder, but differs in that it is acquired through exposure to another person’s suffering the effects of trauma (Baird & Kracen, 2006).

 

In acknowledging factors that put individuals at risk, it is important to remember the following: everyone is different and vicarious trauma is highly dynamic. (Institute, 2007). What is meant by these facts is simply this; what contributes to an individual’s experience of vicarious trauma may not contribute to someone else’s and secondly, factors that may be problematic for an individual today may not be a problem in the future (Institute, 2007). There are numerous factors that may put an individual at a greater risk of experiencing vicarious trauma but it is the purpose of this paper to go over the major issues that could result in an increased likelihood.

 

Relating specifically to the EMS profession is the idea of things getting in the way of you performing your job and helping your patient. Anything that gets in the way of you fulfilling your responsibility and commitment to help those in need can contribute to one’s own vicarious trauma (Institute, 2007). Additionally, EMS workers who have unrealistic expectations about themselves and the people they work with can result in more problematic vicarious trauma (Institute, 2007).

 

Factors associated to the individual but not specifically EMS or healthcare, include: personality and coping styles, current life situation, personal history and social support (Institute, 2007). Each of these things could be a factor capable of tipping the scales. For example, individuals who are afraid to talk to friends or family, are currently having problems with their wife, have a past history of being abused and have no one to support them through the rough patches in their life, are far more likely to become subject to the effects of vicarious trauma. For EMS personnel specifically, studies were conducted to conclude that paramedics and EMTs are more likely to have risk factors and greater fatigue leading to vicarious trauma and STS (Palm, Polusny, & Follette, 2004).

 

In a study conducted by Baird and Kracen, they utilised statistics to correlate certain risk factors with vicarious trauma and STS. Using these statistics, they then ranked each factor to give persuasive, reasonable or some evidence of correlation. The major persuasive and reasonable findings of their work include the following: having a personal history of trauma is linked to the development of vicarious trauma and STS, the amount of exposure (including hours with trauma clients) to the traumatic material increases the likelihood of STS, and perceived coping ability is a protective factor of vicarious trauma (Baird & Kracen, 2006).

Reactions

Regardless of one’s likelihood of suffering from vicarious trauma and STS, statistics would suggest it is an unavoidable result of trauma intervention and counselling (Iliffe & Steed, 2000). Health care professionals that dealt with severe traumas have been recorded to have immediate life-altering reactions such as permanent changes to beliefs, assumptions and expectations of themselves and others (Iliffe & Steed, 2000). Additionally, individuals working with trauma victims often felt helpless, vulnerability, despair, over identification, ambivalence, and fear (Iliffe & Steed, 2000). Immediately following a day of witnessing trauma, emergency service personnel were found likely to react by consuming alcohol (Palm, Polusny, & Follette, 2004). It was also found that emergency service personnel were more likely to develop alcohol-use disorders than the direct trauma victims themselves (25% versus the 10% of trauma victims) (Palm, Polusny, & Follette, 2004). It is clear that vicarious trauma is a serious issue, able to plague anyone. Reactions to trauma can be intense and sometimes irreversible (Iliffe & Steed, 2000).

 

According to research by Palm, Polusny, and Follette, these reactions to trauma of others can be minimized by exposure to multiple events. Previous experience working with trauma survivors seems to be a protective barrier against developing vicarious trauma reactions (Palm, Polusny, & Follette, 2004). Also, in order to ensure an effective response for a disaster survivor, it is crucial to create conditions that will enhance personal and occupational functioning among individuals who are indirectly exposed to trauma through their occupations (Palm, Polusny, & Follette, 2004). In addition, Palm et al., suggest that “for these professionals there should be regular training on general strategies for dealing with trauma, including normalizing responses to these abnormal situations” (Palm, Polusny, & Follette, 2004). In the future, it is possible that those involved with traumatic intervention will be educated and better prepared for what they are going to face.

 

Coping Mechanisms

As noted previously, not everyone will be affected by vicarious trauma in the same manner. What affects one person may not affect another, making it unique to the individual (Headington Institute [HI], 2009). As a result of vicarious trauma being so dynamic, coping with vicarious trauma will also be unique for each individual; they will reflect ones needs, experiences, resources, culture and values (HI, 2009). Many front line workers including EMS personnel will witness or hear about a great deal of suffering and as a result, experience vicarious trauma (HI, 2009). Coping with vicarious trauma involves accepting it as part of one’s job and learning to manage it effectively on a daily basis (HI, 2009). Coping with vicarious trauma also involves learning to live with it as an ongoing process so that one can perform their job efficiently (HI, 2009). To effectively deal with vicarious trauma a person must be able to find ways to help prevent vicarious trauma from becoming too severe, and also by finding ways to help manage it should it become severe to the individual (HI, 2009).

 

On an airplane, the emergency instructions regarding oxygen administration are to “secure your own oxygen mask before securing the mask on your children” (Morrissey, 2009). Likewise paramedics need to ensure that they are taking care of themselves (Morrissey, 2009). “An effective self-care plan should address the whole person – physically, emotionally, behaviourally, and spiritually and include stress relieving activities in which a person will regularly and habitually engage” (Morrissey, 2009) To cope well with vicarious trauma a person needs to take care of himself or herself, and engage in activities that let them escape, rest, and play (HI, 2009). Escape is in the sense of getting away from work, either physically or mentally. Examples of this would be reading books, watching movies or communicating with friends about things unrelated to work (HI, 2009). Things that let one rest would be things which do not incorporate a personal goal or time-line and doing things one typically finds relaxing such as taking a nap or getting a massage (HI, 2009). Activities which incorporate the idea of playing that include partaking in actions that make one laugh or improve your mood such as sharing funny stories with friends or engaging in physical activities (HI, 2009). People experiencing vicarious trauma will question their deepest beliefs and values about life and hope (HI, 2009). As a result of the experiences people have had with vicarious trauma and in conjunction with their beliefs and values being challenged and changed, they will change as a person (HI, 2009).

 

Support systems

It is also important that one has enough support systems to reinforce the coping mechanisms in case the coping mechanisms alone are not sufficient. “Lack of support can result in social isolation, difficulty finding mentors, and decreased status in the workplace. Access to social support may prevent stress and its negative consequences” (Niiyama et al., 2008). An individual may feel like a helpless victim during the process of vicarious traumatisation, but they can transform their vicarious trauma experiences and help use those painful experiences for good (HI, 2009). “Transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope” (HI, 2009). Finding sources of meaning, purpose, hope, and perspective in one’s life will be their support systems to help one through their vicarious trauma experiences (HI, 2009). One can connect or reconnect with these support systems by: reminding themselves of the importance and value of the work they do, staying in contact with family, friends, and colleagues, and discussing your experiences with them – ask for support and accept support from your social networks (HI, 2009). One’s colleagues in particular are likely to be one of the most important support systems since they may have already experienced vicarious trauma and have successfully managed it (HI, 2009). Additionally, noticing and paying attention to the little details so that you are not always thinking about your vicarious trauma experiences, marking changes, celebrating joyous occasions, morning losses with people you care about are helpful means of reducing the effects of vicarious trauma (HI, 2009). Reflecting on the things you do (by writing or meditating), identifying and challenging your cynical beliefs, and undertaking in activities that promote growth and learning are also a crucial means of support for an individual in a time of vicarious trauma (HI, 2009).

 

Paramedics will be exposed to numerous patients suffering, either by hearing about it or witnessing it. This fact makes experiencing vicarious trauma almost inevitable. Employing preventive measures to reduce the likelihood of vicarious trauma getting too severe and learning to cope with it (with the help of adequate support systems) when it becomes burdensome is key to an individual keeping their career and reducing the level of stress to maintain personal health.

 

Vicarious trauma is a serious issue which has the potential to be debilitating to individuals who become victim to its symptoms. As a result, it is crucial to recognize the signs of vicarious trauma and also any factors that would put an individual at risk. Should an individual fall victim to vicarious trauma, it is imperative they employ strong coping mechanisms and use support systems to reinforce those coping strategies in order to proceed to a recovery. Only through coping adequately and being supported can an individual successfully be rid of the vicarious trauma and carry on in the world and career in which they work.

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