For awhile back (8 months or so) I was posting on here at the height an emotionally challenging incident that blurred my sense of understanding of PTSD being specifically traumatic or tragedy related due to the environment of working as security member in a busy ER unit in a hospital. This particular incident took 23 days to come to an end. It was a stressful issue, but not an outright traumatic issue or tragedy. Absolutely affecting nonetheless. Still dealing with that issue, I know it’s going to haunt me further down the road. But, there wasn’t a death, tragedy or threat to life, his or mine. It was a damaging 23 days nonetheless. So now, eight months later I am the proud owner of many initials and acronyms in discussion with psychologist. (OSI) Operational Stress Injury, (ASD) Acute Stress Disorder and (PTSD) Post Traumatic Stress Disorder. All three run concurrently as I still face incidents ongoing, react to some in varying degrees in the short term, haunted by some in the long term. I had a meeting with my HR department, supervisors, senior management in discussion about where and how any of this could have been prevented. To my sadness I realize that there is a significant problem in how management categorizes it’s need for debriefing and incident de-escalation. Their plan falls into ‘substantial’ tragedy or trauma. I asked what qualified for them to enact debriefing or de-escalation. Their benchmark was fairly extreme. Mass casualty, weapon use (presenting with a knife or gun is not the same as firing said gun or using said knife), bomb threat. Significant personal injury or life threatening injury. (Patient punching you three times in the face did not count) and the list goes on. I left that meeting more angry than I have ever been because I realized the failure that is facing those of us who work in Emergency / First Resonder related situations. I’m angry that they are waiting for the ‘big events’ without understanding the cumulative effects of far less stressful situations are having during the long term. I’m currently off work because of a patient caused injury (unrelated to the event I mentioned above), two months ago. The long term care dementia patient who injured me died four days after injuring me. For the short term, I do carry a burden of guilt that our violent interaction was his last moments of consciousness. The cause for our violent moment was that he had open heart surgery, the anaesthetic wore off, through the disorientation and dementia, patient went combative. His death due to complications from the surgery, age and other health factors. I’m also not blind to the fact that our violent interaction did not help his cause. Although I have never been questioned nor blamed for his death in any manner. I do carry that burden of ‘what if’. My employer did not see this as an incident requiring debriefing or counselling because cause and effect were unrelated. This is my opinion, but I think the direct failure in all this. That agencies are so focused on major events, they don’t pay attention to the cumulative effects that daily exposure to lesser incidents is affecting our long term mental health, so that when those big ones do come. It’s far more impactful than it may have been if we had healthier ways to unload the little events along the way. I’m writing this with a lot of sadness..... because someone I worked closely with at my hospital ER, a member of the local paramedic team decided to end his life a couple days ago, I remember talking to him a year or so ago. He said, ‘after awhile, they all start hurting in some way’. I feel those words very much. He was right.