They are the front line in emergency and disaster situations, responding quickly and often without regard for their personal safety to car crashes, accidents, injuries and fires. Police officers, fire fighters, ambulance personnel and other emergency responders deal with death, destruction and debris every day.
But while they work to keep the population safe, often too little attention is given to the toll these traumatic events have on the emergency responders themselves.
New post-traumatic stress disorder guidelines for emergency services staff, launched today by the Black Dog Institute, hope to change that.
Black Dog says at least 8000 police, fire and ambulance workers currently live with PTSD, but that there are no consistent diagnoses or treatment guidelines for the group. They have hailed the new guidelines as "the world’s first clinical guidelines for the diagnosis and treatment of post-traumatic stress disorder (PTSD) in emergency service workers".
Professor Zachary Steel, of the School of Psychiatry at the University of NSW and the St John of God Trauma and Mental Health Initiative at Richmond Hospital, was involved in the writing of the guidelines. He also treats PTSD-affected emergency workers in his clinical work.
He told The Huffington Post Australia the new guidelines, giving guidance for medical facilities to address PTSD in front line responders, were long overdue.
"There are a plethora of guidelines for PTSD generally, but the problem is often they're directed to supporting civilians who have experienced one horrific event. Most people would experience a handful of life threatening events with exposure to mortal threat, but emergency services workers would encounter this many numerous times," Steel said.
"The reason they become unwell and the nature of being affected by PTSD is very different."
He said PTSD in emergency workers can manifest itself in different ways, from a number of harrowing incidents building up over the years to one single incident pushing a responder over the edge.
"You can have 20 years of work then one job can turn on the PTSD. It can gradually accumulate across time, or it can happen with no forewarning and then fire up," Steel said.
"It can be highly debilitating. It's a mortal threat response system being misfired and going off in everyday life, making everyday life difficult to manage."
He said the typically tough, hard-edged attitude of emergency services workers often made it diffcult for them to reach out and ask for help, or to even realise or admit they were suffering from a post-traumatic episode.
"This is a very resilient, hardy population. They go in with eyes open to what to expect, but they don't expect to get sick. When they begin to get PTSD, it's quite a shock and a severe blow," he said.
"This is not just a job for them. It's something they want to do all their lives, then suddenly they can't go to work.
"Many workers are very hard on themselves, wondering if they're weak or if there's something wrong with them. But the truth is, there's no immunity from PTSD."
The guidelines say a recent study of PTSD showed 10 percent of emergency workers experienced PTSD, which the guideline's authors say would likely be an underestimate.
The guidelines recommend emergency workers experiencing, or at risk of developing, PTSD should be assessed and treated by psychologists with specialty in dealing with the condition in such responders and that emergency staff be fast-tracked through the mental health system to get help quicker.
"It is critically important that health workers, when someone from the emergency services presents to them, adopt a different model. It's about trying to encourage health service staff to connect emergency workers with treatment quicker, rather than go through the convoluted pathways that currently exist," Steel said.
"We often see people get referred to psychologists but not necessarily psychologists with experience in emergency personnel. Their ability to deliver interventions is limited.
"There is lots of time taken up with getting people getting income support entitlements, rather than ensuring people get timely access to treatment. Those things are important to resolve, but its important to get people into treatment quickly."
To read the full guidelines, click here.