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New legislation across the country is prompting questions about PTSD, what exactly the definition should be, and its real impact on front-line responders.

Many people don't really know what post traumatic stress disorder is, nor do they understand the signs and symptoms and when they should ask for help.

The PTSD conversation has grown with the recent missions involving the Canadian military. It's now expanding with changes in workers' compensation boards across Canada to support first responders who are psychologically injured on the job to get easier access to benefits for PTSD.

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Who is considered a first responder can depend on the province you live. Typically, it's fire fighters, police officers, paramedics, and members of the military, but it can also include emergency ward nurses and doctors, as well as social workers.

In Ontario, Bill 163, covers about 73,000 first responders through what is defined as "presumptive legislation." This means that the provincial workers' compensation board will presume that all diagnosed cases of PTSD are work-related, unless proven otherwise. A successful claim requires a PTSD diagnosis from a psychiatrist or psychologist.

Several other provinces have made similar adjustments to their WCB legislation, such as Alberta's Bill 1, Manitoba's Bill M 203, British Columbia's Bill 205, and Nova Scotia's ammendment in its Chapter 10 legislation.

Professionals who believe their jobs fit under the umbrella of first responder should not assume that any PTSD diagnosis will be attributed to their work. Instead get the facts on their province's WCB position on PTSD, the jobs that qualify and the test required to make a successful claim.

It's estimated that six out of 10 males and five out of 10 females of the general population will be exposed to a traumatic event in their lifetime, and around 7 to 8 per cent of the overall population will experience some form of PTSD, according to data from the U.S. Department of Veterans Affairs. A first responder is twice as likely to develop PTSD. As a result, prevention, early intervention and treatment are critical.

What exactly is post-traumatic stress disorder?

PTSD can happen to anyone; no one is invincible. But how a stressful situation will affect a person varies from individual to individual. For example, if two people fall down the same set of stairs, one could break a bone and wind up in a cast while the other person could walk away unscathed. PTSD also is unpredictable – no one knows what kind of event has the potential to overwhelm their nervous system.

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PTSD is a mental health illness that falls in the category of anxiety disorders. The PTSD symptoms outlined below must persist for more than a month and a full diagnosis is not made until at least six months after the trauma, even if symptoms begin immediately, due to current diagnostic criteria. About 25 per cent of cases of PTSD can be delayed onset – and not show up right away – sometimes not until two years or more after a traumatic incident.

The psychological standard used to define and evaluate PTSD is the Diagnostic and Statistical Manual of Mental Disorders, also called DSM-5. When a person is exposed to a traumatic event that threatens death, serious injury or sexual violation, they can be at risk for developing PTSD.

The exposure must result from one or more of the following scenarios, where the individual:

-directly experiences the traumatic event;

-witnesses the traumatic event in person;

-learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental);

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-experiences first-hand repeated or extreme exposure to details of the traumatic event.

As a result of the trauma, home and work are negatively impacted. The individual may feel that they can't do their job, don't fit in at home or work, can't relate to people or handle social interactions.

Four key indicators for PTSD are:

1) re-experiencing stressful memories of the trauma;

2) attempt to avoid stressful memories, as well as people and places that trigger memories of the trauma;

3) re-occurring negative thoughts about oneself, feeling moody and emotional;

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4) feel the nervous system is super charged and that can result in angry outbursts, jumpiness, problems sleeping and concentrating.

How can I reduce my PTSD risk?

There are actions a person can take to reduce their risk for PTSD, such as taking charge of their total health (physical, mental, work, relationships, and finances). One skill we have found that promotes and supports mental health is developing and improving your coping skills to help manage your daily stress load.

After a traumatic event, the quicker you build up your support system, the better. Most employee and family assistance programs offer some form of critical incident debriefing that helps an individual to process a traumatic event.

If you feel that something is not right after being exposed to a traumatic event, know that this can be common. To help you judge if a traumatic event is causing you difficulties, complete this PTSD quick survey. It can help you assess your feelings and let you know if you need to take action or get help.

Many front-line responders feel there's an unwritten rule that they need to be invincible to the events they witness. They feel it will be interpreted as a sign of weakness if they talk about how they have been affected by a traumatic event. But by stopping and taking a short survey to evaluate their feelings, it can help give them direction and let them know if they need to ask for help.

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Bill Howatt (@billhowatt) is chief research and development officer, work force productivity, at Morneau Shepell, Halifax. He is also president of Howatt HR Consulting and founder of TalOp, in Kentville, N.S.

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