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Article Excerpt
"Our nights are broken by sounds of nearby mortars, the drone of medevac (medical evacuation) helicopters, and endless nightmares. Each new day brings us more patients who wrench our hearts. Then we get up and do it all again. We've become intimately familiar with the brutalities of war" (Duncan et al., 2005, p. 62).
Medical personnel serving in Iraq and Afghanistan frequently think, and sometimes utter, these or similar words. This quote provides a glimpse of the battle against death, human destruction, and suffering that deployed health care providers fight every day.
Medical personnel are charged to render emergency care to anyone who arrives at the medical treatment facility regardless of its location. Without exception, they must provide that care consistently and conscientiously. Given the variety of patients and injuries, sometimes achieving this standard causes distress for health care providers. Incoming patients may include American military personnel, coalition troops, contractors, non-combatant Iraqis or Afghans, and insurgents. The patients run the gamut from infants to adults, males and females.
Having to turn away patients also creates stress for health care providers. The primary mission of medical units is the care of American Soldiers and, because resources are limited, other injured persons who are not at risk for loss of life, limb, or eyesight are sometimes turned away (Duncan et al., 2005). The stress that accompanies the provision of medical care for the casualties of war and the decision regarding who gets care, as well as personal circumstances of the care providers, produce their own casualties. As an occupational hazard, some doctors, nurses, medics, and other hospital personnel fall victim to compassion fatigue.
Compassion Fatigue Defined
"Compassion fatigue describes the emotional, physical, social, and spiritual exhaustion that overtakes a person and causes a pervasive decline in his or her desire, ability, and energy to feel and care for others" (McHolm, 2006, p. 12). No medal is given for these wounds and acknowledgment of the condition is often missed. The wounds nevertheless are present and the suffering, without intervention, can continue to affect an individual for a lifetime.
The phenomenon of compassion fatigue (also called secondary traumatic stress syndrome, secondary victimization, secondary survival, emotional contagion, counter-transference, or provider fatigue) is similar to post-traumatic stress disorder (PTSD) and burnout. In all these maladies, the victim is affected emotionally and psychologically by events associated with the workplace. However, while compassion fatigue, PTSD, and burnout all require attention and intervention, significant differences exist among these conditions (Linley & Joseph, 2007).
Post-Traumatic Stress Disorder
Described as a psychiatric disorder, PTSD (shell shock, combat neurosis, or war neurosis) occurs as a result of experiencing a traumatic event. Typical events that can result in PTSD include "combat, physical attack, sexual assault, torture, severe abuse, transportation accidents, and natural disasters" (Regan, Hagwood, Hamer, & Wright, 2006, p. 40). Essential to the diagnosis of PTSD is the individual's personal experience of the traumatic event. The re-experiencing of the traumatic event must include intense fear, horror, or helplessness, and is characterized by avoidance, emotional numbing, and increased arousal (Howard-Ruben, 2002).
PTSD is recognized widely...
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