Post -Traumatic Stress: Causes Between The Disease And Work

Post -traumatic stress: Causes between the disease and work

Introduction

This work is an investigation into the causal link between mental and behavior disorders with work, specifying the study in the TPE at work as a firefighter. The main characteristic of this theme is the legal vacuum on the subject in our country, since there is a list of regulated occupational diseases, in which the diseases of mental and behavioral disorder are not contemplated; where it is mentioned that the conditions are not given from the technical point of view to reliably determine the causal relationship between disease and work.

To carry out this work it is necessary to mention the causes that motivate this research. The main is the health involvement that generates a profession that has as its main objective “to intervene in the extinction of fires and in those incidents, whatever its nature, that rise an immediate danger for lives, goods and for the environment., and face the most diverse situations or sinister, putting their own lives at risk to save lives and property of others. Another fundamental cause is the lack of culture in our country, in terms of prevention of diseases of psychosocial origin, and the lack of awareness regarding the prevention of all actors in the workplace and in general of Uruguayan society.

Developing.

As a professional in the area of ​​occupational safety and hygiene there is interest in knowing in detail the reality of the target audience, which is the affectation in the health of workers for exposure to the different risks of psychosocial origin, and the relationship between this disease and work.

Identify and evaluate what psychosocial risks are at work as firefighters, thereby generating the necessary measures to eliminate or minimize health effects.

In this instance, an advance will be made where the justification of the subject will be described, with its conceptual theoretical framework, establishing the main study question, naming both the general and specific objective, and the methodology to be used in the investigation of the subject, In any case, this methodology can be modified according to field work requirements.

General objective

Know what are the technical conditions necessary to establish the relationship between the TPE and work as an executive firefighter who performs tasks as a combatant in the city of Montevideo.

Specific objectives

• Study the mental involvement records of firefighters.
• Identify what are the tasks where there is a greater possibility of affectation to the mental health of firefighters.
• Describe the main consequences.
• Select an evaluation method of exposure risks to TPE.
• Recommend prevention and action measures to episodes that expose firefighters to TPE.
• Justify the need to include the list of occupational diseases the TPE.

Hypothesis

Due to exposure to risks derived from their functions, firefighters have a high probability of developing TPEP.

Justification

This issue was chosen because the existence of psychosocial risks and the complexity of the identification of the dangers that can be triggered in the risks mentioned in the workplace is proven; The most known risks as mechanical, physical, hygienic or ergonomic, can be easier to identify, while psychosocial risks are invisible in most cases and can be triggered in mental and behavioral disorders, being its causes of conception, organization and management of work, as well as the social and environmental context; summarizing its origin in working conditions deficient mainly of the organizational type.

The difficulty that exists is the relationship between disease and work, for this it is important to establish guidelines that facilitate the causality of the disease with the workplace. This process implies a responsibility for determining whether a disease is due to work, and this decision affects directly and in its environment to the worker who suffers from the disease; In addition, the latter generates expenses indirectly to the company, and the State for the payment of policies of its insured through the BSE.

Then it is important to know what reality is in our country on the affectation of mental diseases or disorders caused by psychosocial risks in the workplace, design a basis for specific regulations that provide tools to identify, evaluate, and generate measures to avoid or minimize adverse effects on workers’ health.

This theme is very wide to address and the different work environments must be taken into account, which depending on the exposure of workers to psychosocial risks in the different circumstances of the workplace, and the personal characteristics of each one, can influence greater or lesser degree in your health. For this reason it is necessary. Being a firefighter implies in case a health risk, concurring to an emergency means facing limit situations that emotionally affect staff, this research will have to establish the relationship between the TPE and the work done by firefighters, and hence power know what are the technical conditions necessary to confirm the aforementioned relationship.

The National Fire Department is an Executing Unit, with the denomination of “… Professional Technical Organization, with competence in fire risks and claims throughout the national territory. It is a specialized technical institution that depends directly on the Ministry of Interior.

The target population are executive firefighters who perform tasks as a combatant in the city of Montevideo, these workers have a 24 -hour work schedule for 48 hours free. According to data provided by the Fire Union (ABU), on morbidity and mortality in fire personnel, the following is described:

Morbility: Data extracted from the medical service based in the Centennial Barracks in 2006 that paid health care to Montevideo and Canelones staff, in the period between March-August of that year, 429 consultations were made meaning more than 45% of the staff that composed the DNB in ​​that year, being in third place the medical diagnoses for psychological-psychiatric disorders with 18% (surpassed by traumas and musculoic muscle injuries 33% and infectious tables 28%).

Mortality: Data taken in the period of 24 years (between 1982 and 2006), according to the retirement age that is between 50 and 60 years, the life expectancy of the firefighters in retirement ranges between 58 and 61 years , 12 to 15 years below the average for the male in Uruguay, in the period mentioned 15 % of the officials who went to retirement died; 8% for some type of cancer and 7% died from heart failure or vascular cardio accident; These deaths were given before 2 years after their withdrawals.

These data are relevant but you cannot specify what kind of mental disorder these firefighters suffered, so the study objective between PTSD and work is considered.

At present, the cases of mental disorders are treated in the Department of Mental Health, this is a national service and depends on the Police Health Sub Directorate, headquarters in the Police Hospital, in the city of Montevideo, it is formed by the unit of Stress (UDE), psychiatry and psychology service. The main reasons for consultation are acute stress, chronic stress, Bornout, PTS. Between January 1 and October 31, 2018, more than 600 officials were attended, to which different treatments were given.

For the investigation it is intended to interview qualified informants of the Department of Mental Health of Police Health, to obtain data on the PTSD in the target population.

Conceptual theoretical framework

In Uruguay there is a list of occupational diseases that are recognized to cover workers’ disease insurance, in this list there are many diseases that are caused by the exposure of workers to different working conditions, such as chemical products, to noise, vibrations, repetitive works, forced posture, etc. But the diseases caused by psychosocial risks are not contemplated, in Decree 210 of June 13, 2011, the list of named diseases is established, where mental and behavior illness are not contemplated, because the conditions are not given the conditions From the technical point of view to reliably determine the causal relationship between disease and work, so they are excluded at the moment and without prejudice to the incorporation of the same..

According to the definition of occupational disease extracted from the legal regulations of Uruguay, “professional disease caused by physical, chemical or biological agents, used or manipulated during work activity or that are present in the workplace is considered a professional illness.”5, It can be seen that occupational diseases caused by the risks of ergonomic origin (anyway diseases of skeletal muscle origin are contemplated in Decree 210/011) and those caused by psychosocial risks.

However, the definition of occupational disease of the International Labor Organization (ILO) is any disease contracted by exposure to risk factors that result from work activity., This definition is broader and refers as a cause, exposure to risk factors resulting from work activity, where we can include psychosocial risks. The definition given by ILO contains two fundamental elements. One of them is the causal relationship between a specific environment or activity and a certain disease; The other element is that within a set of exposed people, the disease occurs with a frequency above the average morbidity rate of the rest of the country’s population.

In reference to the above, the Ministry of Public Health (MSP) according to studies carried out in the Census of the year 2011, places mental and behavioral disorders within the first 10 causes of hospital discharge in public providers, in the eighth place With a frequency of 5877 representing 5.3 %, (for a reference the first place is occupied by pregnancy, childbirth and puerperium with a frequency of 17670 representing 16.1 %), in this data there are no numerical records that discriminate against the Cases for labor causes.

According to what was appointed by ILO, the fundamental thing is to establish the relationship of the cause of the disease with work, for this we must base ourselves on the medical diagnosis, and on the identification and evaluation of risk in the workplace, such as Preventionist technologist I must focus on research, at this point without ignoring what are the consequences that mean the psychosocial risks for workers’ health. 

For the evaluation it is necessary to use an internationally recognized method such as ISISTAS 21 (COPSOQ) of Spain, this method must be carried out by a work team made up of the employer, the workers’ representative and the security advisor, The method includes 4 large dimensions: psychological demands; influence and skill development; Social support in the company Leadership quality; and compensation.

There are also other evaluation methods such as the "Maslach Burnout Inventory", created in 1981 by psychologists Chistina Maslach and Susan Jackson, this questionnaire measures the three aspects of Burnout syndrome, they are emotional tiredness, depersonalization and personal fulfillment.

At the regulatory level in our country, Law 18561 on sexual harassment in the workplace and student teacher relationship, is approaching a regulation of control of psychosocial risks, also Law 19313 on night work and its regulatory decree 234/015, they try to Establish controls on work at night and the physiological and psychological affectation that means for the worker.

In international literature, PTSD is defined as “… a traumatizing event that is foreign to the normal variety of events of everyday life and that the individual lives as overwhelming. It usually involves a threat to one’s own life or that of someone close, or the contemplation of a serious death or injury, especially if it occurs suddenly or violently.”11, summarizing the PTSD affects people who have lived accidents or traumatizing situations.

This disease has as a history what was known as "combat fatigue" during world wars, not being able to establish their characteristics as diagnosis, treatment, etc. Anyway, it was for the 1970s that “… they discovered the great incidence rates of PTS.”12 Only in 1980 was identified and described in the“ 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) (American Psychiatric Association 1980).

The PTSD is characterized by symptoms of numbness, psychological and social withdrawal, difficulties in controlling emotions, especially anger, and living and intrusive memory of the experiences of the traumatic situation.

Following the international literature on mental disorders, we can name other diseases such as Bunout syndrome that means "be burned", "consumed", "off"; In 1974 the psychiatrist Herbert Freudenberger working as a volunteer in the Free Clinic of New York, for people with drug use problem, observed that after a more or less long period, between one and three years, the majority of the majority of His classmates (who were young volunteers), suffered a progressive loss of energy, demotivation, lack of all interest in work until they reach exhaustion, along with several symptoms of anxiety and depression.

The type of work carried out by the people affected by the Burnout, “… was characterized by lack of fixed schedule, having a very high number of hours, having a very scarce salary and a very demanding social context, usually tense and committed.”15 Freudenberger described that these people‘… become less sensitive, little comprehensive and even aggressive in relation to patients, with a distance and cynical treatment with a tendency to blame the patient for the problems he suffers.”16

In 1976 the psychologist Cristina Maslach studied the emotional responses of the workers who developed their care tasks to other people, and she also used the term Burnout, to name this disease. Authors such as Edelwich and Brodsky (1980) propose four phases through which every individual suffers from Burnout: enthusiasm, stagnation, frustration, apathy.

The Burnout, is very common in those professions that work or serve people, and according to what some authors mention, they are characterized by affecting workers who feel their vocation for the service, and that sometimes they are overwhelmed by the situation or work environment. There are two aspects to take into account, one are the personal conditions of each individual (for many authors it is the most important), and the other is working conditions and social context.

Conclusions.

This work has a qualitative approach, where a triangulation is intended, using tools such as interviews, observation and surveys, with an exploratory and descriptive depth, to know the theme more depth, and to know in detail that “technical conditions” are missing for The causal link between mental disorders and work. Beyond the qualitative approach, a technique with a quantitative approach will be used to contribute to the investigation.

For the investigation, a significant sample of the population of the fire detachments of the city of Montevideo will be extracted, there are 5 detachments that have an approximately 160 firefighters cash, these operational units were chosen for the reason, which have the largest amount of professional outputs compared to the other detachments of the country.s.

To this representative sample of the population of executive firefighters of Montevideo, pre -established interviews and some other technique that is timely will be carried out, such as some survey with a quantitative approach that contributes to the investigation; Quantitative variables such as age, years old, etc. will be taken into account. and qualitative variables such as function, grade, etc. 

The expected results are obtaining data for analysis, and with it the elaboration of the thesis document, where the causal relationship of mental disorders with work can be evidenced. In Annex I, the tentative schedule is observed, with the planning of works to be carried out for research.