Executive Summary

A review of the available literature concerning the vulnerability and resilience of those exposed to traumatic events suggests multidisciplinary remote health practitioners are at particularly high risk of developing posttraumatic stress disorder (PTSD) as a result of job related exposure to traumatic events. This is particularly so for resident health practitioners whose level of exposure to traumatic events is likely to be high and prolonged due to the multiple roles they adopt and limited opportunities for rest or time out for the duration of the event. Factors likely to intensify reactions and prolong recovery include: moral conflict and responsibility trauma as a result of their inadequate preparation for extended professional roles; the lack of anonymity of practitioners, victims and perpetrators, and their families; and the often public nature of such events. Following the event, recovery may be compromised by: limited opportunities for time out to appraise the impact of the event; lack of control over rest or recovery time; likelihood of subsequent traumatisation; the community wide impact of the event coupled with lack of natural circuit breakers between home and work; confidentiality issues, such as risks to their personal and professional standing and increasing distress of the victims' family if the practitioner vents thoughts and feelings associated with the event within the remote community; and the high likelihood of inadequate or inappropriate management response.

A review of the evidence suggests that a range of generic, selected and targeted interventions are likely to reduce the incidence and severity of PTSD among remote health practitioners. These include the prevention of traumatic events where possible, the provision of skills to manage predictable traumatic events, stress management training, and the provision of an emotionally supportive organisational environment which recognises and validates practitioners' responses to difficult situations and facilitates recovery and early referral.

Support services to facilitate recovery following exposure to trauma can be provided at a number of levels. These include the provision of information, help lines, employee assistance programs and supportive management of job related traumatic events, including on-site interventions for individuals, teams and communities.

Following a risk assessment, support strategies should be mapped onto the risk status of the employee, accommodate the support needs of the practitioner over time, and provide a safety net of follow up support, counselling and early referral if necessary. Risks identified with group debriefings suggest such interventions may not be therapeutic and may be potentially harmful in remote areas, particularly in cross-cultural contexts.

Guidelines for assessing risk and for providing safe and appropriate interventions in remote areas are offered. These include supportive strategies for individuals, teams and communities.