Standardized Screening Protocols to Improve PTSD Surveillance in First Responders

This week we will be discussing an article written by Eric Wayne Robertson that outlines the utility of a standardized screening protocol that would improve the early identification of PTSD symptoms in first responders. The article is titled “Implementation of a Standardized Screening Protocol to Improve Post-Traumatic Stress Disorder Surveillance in First Responders”, and was published in the Journal of Occupational and Environmental Medicine in December 2019.

What did they do?

Using a sample of local firefighters and police personnel (here on out collectively referred to as “first responders”), researchers implemented a standardized screening protocol for PTSD symptoms. The self-report screener was administered during new employment physicals, and results related to identification of symptoms and referrals to a mental health provider were compared to retrospective data collected from existing electronic medical records (EMR).

Why did they do it?

The research we’re discussing today was conducted not only to inform researchers about the utility of a self-report screening protocol, but also to serve the general community. The author highlights that this project was highly supported by city officials, who expressed “significant interest” in the mental wellness of first responders (we love to hear that!).

Post-traumatic stress disorder (PTSD) is more commonly diagnosed in first responder populations, relative to individuals working in other occupations. The day-to-day stress, exposure to traumatic events, and general potential for chaos associated with being “on the job” increases the risk for a variety of negative outcomes, both physically and mentally.

As cited by the author, approximately one-quarter of first responders report significant symptoms of PTSD as a result of prolonged exposure to traumatic events. As we know, this kind of repeated exposure to trauma can impact all aspects of day to day life, including, but of course not limited to, work performance. Among many examples of the detrimental impact that PTSD can have on first responders is the aftermath of 9/11. As rationale for the present study, the author cites a previous study based on this tragedy where a self-report checklist was effective in screening firefighters following the event. This study was carried out with the primary goal of implementing a standardized screening protocol using a validated self-assessment tool to identify first responders at risk for PTSD and increase necessary referrals for further mental health evaluation.

How did they do it?

Four months of retrospective data (i.e., pre-intervention data) collected from an EMR was compared to 4 months of data collected following the implementation of a screening measure (i.e., post-intervention data). The self-report screening instrument that was implemented during this project was The PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5).

The PCL-5 was included in the employment physical packet, which was to be completed by all first responders presenting for an annual medical evaluation. Pre-intervention, there was no existing standardized system for screening for mental illness. The primary outcome measures included screening tool completion, positive screener results, and referral to an employment assistance program (EAP) or firefighter support group (FFSG). A secondary outcome was also defined as endorsement of significant PTSD symptoms.

What did they find?

Overall, 331 first responders participated in employment physicals during the duration of this project. Pre-intervention data was collected from 173 first responders, and post-intervention data was collected from 158 first responders.

In the post-intervention group, 96% of participants completed the screener. There was an increase in the proportion of first responders who screened positive for PTSD symptoms from less than 1% in the pre-intervention group, to almost 5% in the post-intervention group. 71% of participants who screened positive for PTSD received a referral of some kind. Regarding the secondary outcome measure of PTSD symptomology, 26% of first responders who completed the PCL-5 reported at least 1 significant symptom of the disorder.

What does it all mean (our take)?

Simple - yet brilliant. This article demonstrates how effective one simple measure can be when it comes to ensuring that high risk populations (e.g., first responders) are appropriately evaluated. We must continue working toward a system that confidentially and comprehensively assesses the mental wellbeing of our first responders, perhaps on an ongoing basis, to make sure they are constantly provided with the resources they may require.

It’s also worth mentioning that first responders are not only at risk for PTSD, but other concerns as well, such as substance use/abuse, depression, and anxiety. Accordingly, a measure that more comprehensively evaluates the mental status/behavioral health of first responders has the potential to yield even more positive results and continue to help us move in the direction of providing continuous and comprehensive care to this high risk population.