Guilt, shame and need for a container: a study of post-traumatic stress among ambulance personnel

https://doi.org/10.1016/j.aaen.2004.05.001Get rights and content

Abstract

Post-traumatic stress symptoms among ambulance personnel are regarded as a natural behaviour and reaction to working with the severely injured, suicides, injured children and dead people. The findings show that post-traumatic stress symptoms, guilt, shame and self-reproach are common after duty-related traumatic events. To handle these overwhelming feelings it is necessary to talk about them with fellow workers, friends or family members. By using another person as a container it is possible to internalise the traumatic experience. Poor and un-emphatic behaviour towards a patient and their relatives can have its origin in untreated traumatic experiences. Personnel in ambulance organisations who perform defusing, debriefing and counselling have to be informed of the importance that the roll of guilt and shame may play in the developing of post-traumatic stress symptoms.

Section snippets

Background

People working in high or medium risk professions such as police officers, ambulance personnel or firefighters are frequently exposed to critical situations, for example, confrontations with injured, dying or dead people. Until recently, researchers have mainly focused on studying the consequences of traumatic stress for the victims involved. Ambulance personnel are thought to be adequately trained to handle the emotional effects of witnessing dead humans or injured survivors. However,

Approach

The phenomenon approached in this study could be described as `the way ambulance staff experience and handle traumatic events'. To study this, the researcher aims to gain an understanding about the life world of the ambulance personnel. The descriptive phenomenology developed by Giorgi, 1985, Giorgi, 1997 was chosen for its potential to grasp the meaning of such phenomena through the description of lived experiences. In the final part of the analysis some limitations were shown. To reach a

Findings

The structure of a traumatic experience, as experienced by the ambulance personnel, is described as a sixfold experience that begins before the traumatic event occurs and ends with the handling and recovery. The traumatic experience can be divided into pre-trauma experience, mid-trauma experience, post-trauma experience, and how to handle a traumatic experience. For an experience to be considered “traumatic”, as expressed and defined by the ambulance personnel, it should be understood as the

Preparing for the unknown

When preparing for a situation without knowing all the information, the “inner dialogue” is used. The “inner dialogue” is a technique used to handle stress by having a conversation within oneself and by creating pictures of how it will be. The “prepare inner dialog” phase continues from the first alert until the contact with the victim. This initial inner dialog is based upon earlier experiences and can therefore be described as a reflection based on previous knowledge and understanding. The

The touchdown

The first encounter with the victim is characterised by the discrepancy between the pictures of how it will be and how it really is on the scene. The ambulance personnel therefore have to create a new mental picture. They describe how they strongly identify with the victim and get more and more deeply involved in the situation. The participants express feelings of recognising that it could have been their family or that they themselves could have been the victims. The participants talk about

To stay with the risk of failing

The risk of making mistakes is expressed by the ambulance personnel in terms of fear of misjudging or of failing in their desire to help the patient. Even if the ambulance person is trying to distance themselves from the patient and her relatives, it can be impossible to do so when the demands from the patient or relatives are of such a nature that you cannot reject their need for closeness. The feeling of not doing enough for the patient and their families makes the personnel feel insufficient

To be caught in turmoil

After they have left the patient at the emergency entrance or at the scene of the accident, the ambulance personnel can feel confused, upset, exhausted, sad and distressed, and that the world is chaotic. To be in a chaotic world is characterised by confusion, guilt, shame, and post-traumatic distress symptoms. All participants express and share the same feelings but the intensity and duration varies considerably. Some of the participants pass all stages of stress symptoms in a few hours but

Guilt and shame

The participants described suffering from feelings of guilt, shame and self-loathing. They expressed that the traumatic event was accompanied by guilt-related memories of the event, which triggered a negative response. The participants said that they felt guilty when they thought that they had failed in their attempt to save the life of the victim especially if they had given a promise to the patient or relatives that the outcome would be positive. The feelings of guilt appear even if they know

To heal in a chaotic world

The participants showed a variation of methods used to cope with their traumatic experiences. In an inner dialogue, the participants asked questions that they themselves answered based on their own experience. It is this inner discussion that guides them when they are deciding how to act. In this inner conversation the participants discuss pros and cons of how to handle the experience and the inner stress. The stress becomes manageable when they see the meaning of the experience and potential

Discussion

The purpose of this study was to uncover and deepen the understanding of the way ambulance staff experience and handle traumatic events and to develop the understanding of the life world of the participants.

The participants expressed how difficult it was to be prepared for many of the situations they regularly face in ambulance service. However, just a few situations were expressed as truly traumatic. A traumatic event seems to occur when, pre-mid- and post-trauma phases are strongly

References (42)

  • W. Corneil

    Traumatic stress and organizational strain in the fire service

  • C. Crafoord

    Utvecklande förtrolighet

    (1991)
  • A. Dyregrov

    Katastrofpsykologi (Catastrophe Psychology)

    (2002)
  • A. Dyregrov et al.

    Voluntary and professional disaster-workers: similarities and differences in reactions

    Journal of Traumatic Stress

    (1996)
  • A. Dyregrov et al.

    Work with traumatized children – psychological effects and coping strategies

    Journal of Traumatic Stress

    (1992)
  • R. Fullerton et al.

    Psychological response on rescue workers, Fire fighters and trauma

    American Journal of Orthopsychiatry

    (1992)
  • A. Giorgi

    Sketch of a psychological method

  • A. Giorgi

    The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure

    Journal of Phenomenological Psychology

    (1997)
  • C.A. Harrison et al.

    Correlates of physiological distress following armed robbery

    Journal of Traumatic Stress

    (1998)
  • Hedlin, M., Petersson, G., 1998. Kartläggning av ambulanspersonals arbetsmiljö (Survey of ambulance personnel working...
  • M. Heidegger

    Being and Time

    (1962)
  • Cited by (73)

    View all citing articles on Scopus
    View full text