As a professional urban firefighter for the past 11 years, I have regularly worked alongside some of the strongest and seemingly most resilient men and women, working in the heat, cold and rain at all times of day and night. Time and time again, we deal with traumatic scenes, and the devastation caused at the center of fires, car crashes and rescue missions, assisting with the very sick and the very old.

As a consequence of all we see, it is intuitive to expect that all firefighters, police officers, paramedics and soldiers will at some point suffer from PTSD, a growing scourge in these industries that seems to strike down even the most resilient of individuals. However, while on most days things don’t impact on these men and women, on others, the grief and horror can rapidly overwhelm some of them, sometimes ending careers, and sadly lives. However, picking which individuals are likely to suffer continues to elude practitioners and policy makers.

PTSD and occupational exposures

What if resilience changes with the environment that we expose workers to?

Traditional treatment and resilience training in these workforces has focused on the psychological trauma of witnessing and participating in workplace events beyond the scope of understanding of the general public. To my mind this concept relies on an assumption that resilience is a fixed thing. What if it isn’t though? What if resilience changes with the environment that we expose workers to?

Emergency workers and military personnel work in the most hostile of environments. In addition to the personal danger present from the work itself, they work in extreme heat wearing heavy protective clothing. They are exposed to smoke and prolonged bouts of strenuous activity. They work long shifts with changing patterns, and are at risk of serious injury.

The pathophysiology of depression

Collectively, occupational challenges could result in fatigue and exhaustion, contributing to a state of chronic low-grade systemic inflammation and/or altered immune status. These responses have in turn been linked with changes to brain function, particularly in the areas of memory, learning and resilience. What if these exposures change the resilience of an individual such that the traumatic event they were able to deal with yesterday, brings them to their knees today? What if we could proactively intervene  to minimize the effects of these occupational exposures so that their resilience isn’t compromised to the point of failure?

A dual approach is needed to tackle PTSD

It is timely that we also look at the environments that we require people to work in

It is time to rethink how we approach the scourge of PTSD and depression in these vulnerable populations. Whilst an approach that prioritizes the psychological effects of  acute trauma will always remain at the forefront of treatment approaches, it is timely that we also look at the environments that we require people to work in, as a possible contributor to reduced resilience and increased risk of PTSD when exposed to traumatic events at work. The hypothesis can be tested by including environmental and occupational measures when comparing individuals with PTSD or depressive disorders with healthy colleagues and wearable technology will add useful data to these investigations.

With more research in this area, we can then examine ways to manage these exposures and hopefully, reduce the number of individuals suffering from these debilitating conditions.