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Doc_Pardue
10-15-2006, 20:01
Ever since I came home from being a medic in Vietnam I tried to get the Army to do two things: 1) provide more trauma care training and 2) How to deal with the stresses of the job.

Well the Army has changed the medic training, it has more trauma care and is extremely real. High tech training aids are key to make all medical care persons better able to handle emergency first aid in both the Army and Navy programs.

However, there still needs to be able to help the care givers deal with the death, injuries, and war. PTSD is something I did not fully understand, I thought I was going nuts and was afraid to get help. Today, we need to educate those that there will things that will happen and it is normal and here is what to look for.



Why is my PTSD different than Yours

SIGNS AND SYMPTOMS OF PTSD
--------------------------
Major signs and symptoms of PTSD in Vietnam veterans include
helplessness, survivor guilt, anger, isolation and estrangement,
low tolerance of frustration, severe loss of memory. The unique
aspects of these symptoms in medical personnel are described
below.

HELPLESSNESS. Many medical personnel still experience a feeling
of pervasive helplessness because of the futility of their efforts
to deal with an overwhelming wave of human casualties. Often
coupled with this feeling of helplessness is a lingering
preoccupation with death, which is sometimes manifested in somatic
symptoms.

SURVIVOR GUILT. Interviews with several medics, corpsmen, and
nurses indicate that the guilt common to many of the combat
soldiers who served in Vietnam takes a special form with health
personnel. Despite the incredible and heroic lifesaving acts they
performed almost daily, many are plagued by the feeling that what
they did was not enough. This sense of inadequacy is often seen
in those who performed triage duty, which carried with it the
probably consequence that someone would die so that others might
live (5). To react emotionally to that responsibility could
render one dysfunctional and incapable of performing essential
lifesaving duties. Becoming close to people could mean inevitable
pain, since the probability of losing them would be high. The
implications for subsequent psychic numbing and emotional
distancing are evident.

ANGER. Anger resulting from the Vietnam experience is probably
the most common denominator among Vietnam veterans(6). The degree
of anger varied among members of the medical profession whom we
studied. Some felt ill prepared for the experience and continue
to blame the military for inadequate training. Others felt the
frustration of not being able to retaliate or vent frustration as
some "grunts" (combat soldiers) were able to do. Some were not
authorized to carry weapons, despite the fact that a red cross was
often a prime target.
Anger also resulted from the fact that during their Vietnam
experience nurses, corpsmen, and medics performed lifesaving
techniques, including surgical procedures, that they were not
permitted to perform when they returned to the States. After
their return nurses often abandoned their profession in
disillusionment because they were not able to use the valuable
experience gained from trauma medicine in Vietnam. Medics
discovered that they would have to undergo additional training to
receive certification as emergency medical technicians.
It is interesting to note that medical personnel seemed to feel
less anger and resentment toward the Vietnamese people than did
some Vietnam veterans. That may be due to the fact that they had
more interaction with the Vietnamese culture on a personal basis
through such activities as medical civilian action patrols.

ISOLATION AND ESTRANGEMENT. Feelings of isolation and estrange-ment are especially prevalent among medical personnel.

Not only did they feel alienated from their society, like many other
returning veterans, but also from their peers. A combat medic or
corpsman solely responsible for between 12 and 20 men often felt
uniquely alone, with no other medical personnel to share his
experience. Medics in combat vet rap groups describe feeling on
the periphery of the group, since they were not considered combat
personnel. "But I wasn't really in combat" or "I didn't see that
much action" are not uncommon responses of medics, despite the
revered role they held and the trauma they endured. Their isol-
ation may have been increased by such situations as being asked
for drugs by peers or to care for one soldier before another.
Medical personnel rarely saw the result of their efforts. Field
medics often never knew if those they helped were alive, since
they were quickly evacuated to other facilities. Hospital
personnel routinely performed patchwork surgery on soldiers, and
the fruits of their labors often remained unknown to them.
The physicians who served in Vietnam are a generally silent
population. It is probably safe to assume that they felt as
isolated as or even more isolated than other health personnel.
Perhaps the omnipotence attributed to physicians makes it even
more difficult for them to show human emotions.

LOW FRUSTRATION TOLERANCE. Frequently a medic or corpsman who made split-second lifesaving decisions in Vietnam finds it
difficult to make simple decisions ten years later. The same
people who performed admirably during round-the-clock medical
emergencies may have a low tolerance for frustration. These
problems may derive from a fear of failure or of taking risks,
since making a mistake in Vietnam could literally mean the
difference between life and death.

SEVERE LOSS OF MEMORY. Memory loss relating to incidents
occurring not only in Vietnam, but uncomfortable or painful
moments throughout the veterans life is an all too common
occurance. Although these periods of amnesia are frequent,
they are treatable through psycho-therapy and counseling with
peers.

DISCUSSION
----------
Although treatment techniques for PTSD do not differ for medical
personnel and other veterans, any successful intervention with
medical personnel requires a sensitivity to their unique
experiences.
It is possible that the premorbid personality of many members of
the medical corps included a high sensitivity to human suffering.
This predisposition may increase the likelihood and severity of
post traumatic stress disorder. In addition, the initial idealism
of some helping professionals could compound the disillusionment
they felt when they were confronted with the futility of their
position.
Therapists should be keenly sensitive to the sense of loss that
these particular veterans feel. For them the sense of loss is
often compounded by the fact that they saw it as their duty to
prevent loss and yet most likely experienced it the most(7). As
would be expected, grief work has proven effective with this
population, as it has with other veterans. Individual
intervention can also be geared toward tapping and reframing
(cognitive restructuring) the unique strengths they needed to
perform their responsibility in Vietnam.
Involving medical personnel in a group with other Vietnam
veterans can provide an opportunity for them to receive absolution
from peers and can help reduce the isolation some have felt from
their fellow veterans. However, a homogeneous group, consisting
solely of those who served in caretaker roles, can be extremely
effective and may be the ideal approach to take before involving
medical personnel in a heterogeneous group with other combat vets.
Above all, this group of veterans should be treated as
survivors, as has been suggested in working with all veterans(8).
However, they should be viewed not only as survivors of a
disaster, but also as the rescue workers who tried to help others
survive. Recent research has shown that rescue workers suffer
much the same reaction as victims of a catastrophe because of the
responsibility they bear for undoing the effects of the
tragedy(9). In civilian life, rescue workers are on the scene
after the event. However, in Vietnam some medical personnel were
present during and after the catastrophe and had to maintain a
high level of intensity throughout. This intensity and duration
combined to cause protracted stress.
It is generally accepted that the severity of post traumatic
stress disorder is proportionate to the level of exposure and
intensity of stress. It would seem that the exposure to trauma
and the intensity of stress endured by medical personnel in
Vietnam was extraordinary. PTSD among these veterans takes
special forms, combining the caretaker, combatant, and survivor
aspects of their experiences.

Da-Chief
10-15-2006, 23:56
Doc,

I am going to pass this around some people I know who should read this.

ALL, Please read Doc's post. I have friends who did not recieve the care etc they needed when they returned from the theater of today's missions.

You are not brave sucking this up by yourself, seek help, just ask.

Thanks Doc,

Da-Chief

Doc_Pardue
10-16-2006, 00:17
DIAGNOSTIC CRITERIA FOR 309.81 POSTRAUMATIC STRESS DISORDER

/A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, a threat of the physical integrity of self or others.

2. The person's response involved intense fear, helplessness, or horror.

/B. The traumatic event is persistently reexperienced in one (or more) of the Following ways:

(1) Recurrent and intrusive distressing recollections of the event, including Images, thoughts, or perceptions.

(2) Recurrent distressing dreams of the event.

(3) Acting or feeling as if the traumatic event were reoccurring (includes a sense of reliving the experience, illusions, hallucinations, and sweating flashback episodes, including those that occur on awakening or when intoxicated or drugged

(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

/C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) Efforts to avoid activities, places, or people that arouse recollections with the trauma

(3) Inability to recall an important aspect of the trauma.

(4) Markedly diminished interest in participation in significant activities.

(5) Feeling of detachment or estrangement from others

(6) Restricted range of affect (e.g., unable to have loving feelings)

(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span

/D. Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:

(1) Difficulty falling or staying asleep.

(2) Irritability or outbursts of anger

(3) Difficulty concentrating

(4) Hyper vigilance

(5) Exaggerated startle response

/E, Duration of the disturbance (symptoms in Criteria B,C, and D) is more than one month

/F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(Specify) ACUTE: if duration of symptoms is less than 3 months


CHRONIC if duration of symptoms is more than 3 months



PTSD (a note and links) (3 pages) (http://www.angelfire.com/ny2/SGTFATS/ptsd2.html)
What is PTSD? (http://www.angelfire.com/ny2/SGTFATS/what.html)

2002 C&P EXAM INFO in Adobe pdf format (http://www.angelfire.com/ny2/SGTFATS/imagesWeb/C_P_Exam_.pdf)