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From devastating wildfires to mass shootings to heated demonstrations to life-threatening viruses, our first responders face more dangerous and potentially traumatic situations today than ever before.

Although many people believe that all first responders are desensitized to acts of violence, statistics suggest otherwise. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and posttraumatic stress disorder (PTSD), as compared with 20 percent in the general population. During the pandemic, bouts of anxiety, depression, and even suicide rose to record levels for everyone. While mental illness is endemic to the human condition, first responders live on the edge of danger and trauma in their jobs every day, making them particularly susceptible to behavioral health problems.

Often, state regulations consider these conditions to be work-related and therefore, compensable under workers’ compensation systems. These injured workers suffer the same loss of income, ability to work, and sense of self as others who are recovering from work-related injuries. However, previous episodes of violence or danger can compound their stress, anxiety, and trauma. As a result, the recovery of first responders can be more complicated than that of other employees.

Risk managers who oversee workers’ compensation claims and treatment for first responders – firemen, police, security guards, EMTs, and others—need a broader perspective on treatment options to help them navigate their recovery. Unfortunately, standard approaches to treating and managing these employees are not very effective. Reliance on prescription drugs to suppress symptoms and pain contributes to a deadly opioid epidemic; often, patients become dependent on drugs that may suppress pain and emotional symptoms but leave them unable to think or react quickly. The use of mental health services is hindered by the lack of available therapists. Law enforcement personnel in particular may have trust issues that make them more skeptical of behavioral health services. First responders pride themselves in being strong when everyone else is in danger; the lingering stigma of seeking help or appearing vulnerable discourages many from even acknowledging their situation or being open to treatment.

First responders deserve better. As heroes who put their lives on the line for us every day, they should receive the best chance for a full recovery and access to treatment options that work. Fortunately, promising outcomes from out-of-the-box solutions are emerging via technology and an understanding of how the brain works to heal itself. New approaches and care philosophies that are being used effectively include:

(1) Recognizing that injuries are a form of trauma, and that treating the symptoms of trauma, as well as the physical injury, is necessary for a full recovery.
(2) Understanding how the process called neuroplasticity can create different neural pathways in the brain, changing the way injured workers experience pain, depression, and anxiety.
(3) Harnessing new technologies such as virtual reality – combined with behavioral coaching – that yield breakthroughs in treating and healing trauma and pain WITHOUT drugs or unnecessary surgery.
(4) Capitalizing on digital connectivity to treat patients in the comfort of their own home to reduce the stigma of “going to therapy.” An added benefit is that home-based treatment overcomes the challenge of accessing therapists who are experienced in treating first responders’ unique situations.

A study published in the peer-reviewed journal, Pain and Therapy, documented results from a treatment protocol that combines virtual reality therapy with behavioral coaching and artificial intelligence to treat debilitating workplace injuries. Patients reported an average 40 percent reduction in pain while in the program and an additional 2.8 hours of continued pain relief at the conclusion of 90 days. In addition, 69 percent of patients reported either a decrease in opioid use or complete cessation after 90 days of treatment. The majority of patients also reported reduced depression, fatigue, and sleep disturbance.

Changing the Mind

Michael* is one such patient who made great strides in his recovery. For two decades, Michael enjoyed a successful career as a police officer. His first year on the job, he was involved in a shooting incident that left one suspect deceased. It was the first of many violent episodes over the years in which he was involved. By the time he reached the rank of sergeant, Michael had seen it all including suicides, active shootings, car burnings and accidents. He never imagined that he himself might be a victim, until an on-the-job car crash proved him wrong. The accident left him with tears in his shoulder and lower back, compressed disks and a concussion that eventually led to some memory loss. The physical injuries were just the beginning of emotional trauma that would haunt him for months.

Michael was put on leave and started the long road to recovery. He was having difficulty walking, sleeping, sitting, and with activities of daily living. He began experiencing anxiety-related symptoms such as hypervigilance, avoidance, night terrors, and severe anxiety. Post-traumatic stress disorder (PTSD) caused him to relive many of the violent episodes that had occurred during his 20-year career.

To cope, Michael had more than 25 sessions of physical therapy, participated in a pain management group with other first responders, and tried acupuncture, meditation, and yoga. After five weeks, his doctor asked him how he was, and Michael admitted he was not faring well. Amenable to trying a new approach, his physician referred him for a new type of therapy. Michael was unsure if anything could work for him, but he agreed to try it.

Michael was treated via a virtual reality headset, behavioral counseling, and artificial intelligence to change the way he experienced pain and trauma. The treatment approach helps form new neural pathways in the brain to manage pain and stress. The virtual reality headset transports users to different scenes that re-focus the brain on pleasant sensations instead of pain. Patients can re-program their brains to change the sensation of trauma, which in turn alleviates their symptoms on a permanent basis.

Despite his initial skepticism, Michael saw results shortly after starting the therapy. After three months, he returned to a more normal sleep pattern, logging seven to eight hours a night. He saw a 58% improvement in his PTSD-related symptoms and a 62% overall improvement in quality of life through a marked reduction in pain, anxiety, and depression. His ratings on the pain scale--with 1 being lowest and 10 being the worst—went from an 8 or 9 to 2 or 3.

The Path to Faster Recovery and Reduced Risk for Injured First Responders

How can risk managers improve the care of injured first responders, help them heal, and return to work? Consider these steps:

--> Recognizing that mental health is foundational to overall well-being.
--> Cultivating awareness within the organization and workers’ compensation partners of the hidden cost of untreated trauma, which impacts recovery from the physical injury as well as the ability to return to work.
--> Incorporate a philosophy of assessing the whole patient, including their job situation, exposure to trauma, and what he or she needs to be whole again in body and mind.
--> Considering innovations like virtual reality, behavioral coaching, and remote technology early in the treatment plan, to engage workers and get them started on a rapid road to recovery.

Focusing on the importance of mental health and capitalizing on the role of technology such as virtual reality can have many benefits. It is not only highly effective, but more readily accepted than “therapy” by many first responders. By recognizing that tapping into the healing power of the brain is essential for recovery from pain, trauma and mental illness, risk managers can help first responders heal themselves.

*Patient name has been changed to protect his privacy.

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    About The Author

    • Gerry Stanley, MD, Senior Vice President & Chief Medical Officer, Harvard MedTech; Karen Thomas, Vice President, Clinical Solutions, CorVel; Pearl Monroe, Vice President, Program Manager, MC Innovations LLC.

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