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Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2004 Sep;21(5):568–572. doi: 10.1136/emj.2003.008540

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims

J Crabbe 1, D Bowley 1, K Boffard 1, D Alexander 1, S Klein 1
PMCID: PMC1726427  PMID: 15333532

Abstract

Objectives: To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department.

Methods: A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory.

Results: Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0–88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a "high" degree of professional burnout in the three sub-scales of the Maslach burnout tnventory—that is emotional exhaustion, depersonalisation, and personal accomplishment.

Conclusions: Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander D. A., Klein S. Ambulance personnel and critical incidents: impact of accident and emergency work on mental health and emotional well-being. Br J Psychiatry. 2001 Jan;178(1):76–81. doi: 10.1192/bjp.178.1.76. [DOI] [PubMed] [Google Scholar]
  2. Alexander D. A., Wells A. Reactions of police officers to body-handling after a major disaster. A before-and-after comparison. Br J Psychiatry. 1991 Oct;159:547–555. doi: 10.1192/bjp.159.4.547. [DOI] [PubMed] [Google Scholar]
  3. Beaton R., Murphy S., Johnson C., Pike K., Corneil W. Coping responses and posttraumatic stress symptomatology in urban fire service personnel. J Trauma Stress. 1999 Apr;12(2):293–308. doi: 10.1023/A:1024776509667. [DOI] [PubMed] [Google Scholar]
  4. Bowley Douglas M. G., Khavandi Ali, Boffard Kenneth D., Macnab Cara, Eales Jocelyn, Vellema Jeanine, Schoön Heloïse, Goosen Jacques. The malignant epidemic--changing patterns of trauma. S Afr Med J. 2002 Oct;92(10):798–802. [PubMed] [Google Scholar]
  5. Clohessy S., Ehlers A. PTSD symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol. 1999 Sep;38(Pt 3):251–265. doi: 10.1348/014466599162836. [DOI] [PubMed] [Google Scholar]
  6. Coombes R. Violence: the facts. 1998 Oct 28-Nov 3Nurs Times. 94(43):12–14. [PubMed] [Google Scholar]
  7. Fernandes C. M., Bouthillette F., Raboud J. M., Bullock L., Moore C. F., Christenson J. M., Grafstein E., Rae S., Ouellet L., Gillrie C. Violence in the emergency department: a survey of health care workers. CMAJ. 1999 Nov 16;161(10):1245–1248. [PMC free article] [PubMed] [Google Scholar]
  8. Findorff-Dennis M. J., McGovern P. M., Bull M., Hung J. Work related assaults. The impact on victims. AAOHN J. 1999 Oct;47(10):456–465. [PubMed] [Google Scholar]
  9. Gates D. M., Fitzwater E., Meyer U. Violence against caregivers in nursing homes. Expected, tolerated, and accepted. J Gerontol Nurs. 1999 Apr;25(4):12–22. doi: 10.3928/0098-9134-19990401-05. [DOI] [PubMed] [Google Scholar]
  10. Guntupalli K. K., Fromm R. E., Jr Burnout in the internist--intensivist. Intensive Care Med. 1996 Jul;22(7):625–630. doi: 10.1007/BF01709737. [DOI] [PubMed] [Google Scholar]
  11. Hayter M. Burnout and AIDS care-related factors in HIV community clinical nurse specialists in the North of England. J Adv Nurs. 1999 Apr;29(4):984–993. doi: 10.1046/j.1365-2648.1999.00973.x. [DOI] [PubMed] [Google Scholar]
  12. Jenkinson W. R. Attacks on postmen in Northern Ireland. What features of the attacks are associated with prolonged absence from work? Occup Med (Lond) 1993 Feb;43(1):39–42. doi: 10.1093/occmed/43.1.39. [DOI] [PubMed] [Google Scholar]
  13. Kamphuis J. H., Emmelkamp P. M. Crime-related trauma: psychological distress in victims of bankrobbery. J Anxiety Disord. 1998 May-Jun;12(3):199–208. doi: 10.1016/s0887-6185(98)00009-7. [DOI] [PubMed] [Google Scholar]
  14. Kilfedder C. J., Power K. G., Wells T. J. Burnout in psychiatric nursing. J Adv Nurs. 2001 May;34(3):383–396. doi: 10.1046/j.1365-2648.2001.01769.x. [DOI] [PubMed] [Google Scholar]
  15. Lee V., Henderson M. C. Occupational stress and organizational commitment in nurse administrators. J Nurs Adm. 1996 May;26(5):21–28. doi: 10.1097/00005110-199605000-00006. [DOI] [PubMed] [Google Scholar]
  16. Luce Anna, Firth-Cozens Jenny, Midgley Simon, Burges Clive. After the Omagh bomb: posttraumatic stress disorder in health service staff. J Trauma Stress. 2002 Feb;15(1):27–30. doi: 10.1023/A:1014327110402. [DOI] [PubMed] [Google Scholar]
  17. Nolan P., Dallender J., Soares J., Thomsen S., Arnetz B. Violence in mental health care: the experiences of mental health nurses and psychiatrists. J Adv Nurs. 1999 Oct;30(4):934–941. doi: 10.1046/j.1365-2648.1999.01163.x. [DOI] [PubMed] [Google Scholar]
  18. Papadatou D., Anagnostopoulos F., Monos D. Factors contributing to the development of burnout in oncology nursing. Br J Med Psychol. 1994 Jun;67(Pt 2):187–199. doi: 10.1111/j.2044-8341.1994.tb01785.x. [DOI] [PubMed] [Google Scholar]
  19. Payne N. Occupational stressors and coping as determinants of burnout in female hospice nurses. J Adv Nurs. 2001 Feb;33(3):396–405. doi: 10.1046/j.1365-2648.2001.01677.x. [DOI] [PubMed] [Google Scholar]
  20. Ramirez A. J., Graham J., Richards M. A., Cull A., Gregory W. M. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996 Mar 16;347(9003):724–728. doi: 10.1016/s0140-6736(96)90077-x. [DOI] [PubMed] [Google Scholar]
  21. Regehr C., Hill J., Glancy G. D. Individual predictors of traumatic reactions in firefighters. J Nerv Ment Dis. 2000 Jun;188(6):333–339. doi: 10.1097/00005053-200006000-00003. [DOI] [PubMed] [Google Scholar]
  22. Smith M. E., Hart G. Nurses' responses to patient anger: from disconnecting to connecting. J Adv Nurs. 1994 Oct;20(4):643–651. doi: 10.1046/j.1365-2648.1994.20040643.x. [DOI] [PubMed] [Google Scholar]
  23. Whittington R., Shuttleworth S., Hill L. Violence to staff in a general hospital setting. J Adv Nurs. 1996 Aug;24(2):326–333. doi: 10.1046/j.1365-2648.1996.18114.x. [DOI] [PubMed] [Google Scholar]

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