Immediate Psychological Reactions in the Emergency Department Following Exposure to Potentially Traumatic Events

Although a significant percentage of admissions to the Emergency Department (ED) are subsequent to potentially traumatic events, little is known about the immediate mental health needs of these patients. Longer term follow up studies have shown that between 17-35 % of ED admissions after traumatic events develop posttraumatic stress disorder(PTSD)(Shalev & Freedman, 2005). Immediate psychological reactions to traumatic events have always been considered salient to the development of PTSD; indeed, until the publication of DSM 5 (American Psychiatric Association, 2013) these initial reactions formed part of the definition of a traumatic event (Karam et al., 2010). Studies have shown that both levels of distress and symptoms of dissociation in the early aftermath of a traumatic event are predictive of PTSD (Nishi et al., 2010).

In terms of immediate mental health interventions, a number of publications have outlined the use of Psychological First Aid (PFA) in the hours following a traumatic event (Brymer et al., 2007) .These guidelines give important direction for clinicians and others in contact with individuals in the immediate aftermath of a traumatic event, and their use is predicated on common reactions seen during these hours.However, most data available regarding these very early reactions have been collected retrospectively. In some cases, individuals reported what happened during and after the event months or even years afterwards (Nishi et al., 2010).This brings into question the reliability of such reports, since these have been shown to be less consistent in those suffering from PTSD (David, Akerib, Gaston, & Brunet, 2010). Read more.............