Many Israeli healthcare professionals who have been treating trauma are themselves traumatized

Since October 7, healthcare professionals in medicine, mental health, education, welfare, first responders and rescue workers face such great difficulties in getting help to those who need it that many of them suffer from fatigue, apathy, burnout, stress, and distress.

Recently, in a roundtable meeting in which researchers in the healthcare field participated, the main topic was coping with the impact of exposure to trauma in general and during the current period in particular. The participants raised the need for a literature review and the formulation of recommendations in the area of assistance to medical professionals.

They drafted recommendations in conjunction with researchers from the Taub Center for Social Policy Studies in Jerusalem; the University of Haifa, Tel Aviv University, Ben-Gurion University of the Negev (BGU), the Forum for Promoting Trauma-Informed Healthcare, the Shlomut organization, and other organizations concerned with the treatment of those who have experienced trauma.

Epidemiology Prof. Nadav Davidovitch, one of the authors of the paper from the Taub Center, who is also dean of BGU’s School of Public Health, stated: “Professionals who are in the communities directly affected by the trauma incur a double exposure – experiencing the damage first hand and then in their dealings with those who have also experienced the trauma.

They are required to continue working even if their friends and family were killed or taken hostage, or close family members are serving in the armed forces or have been called up to reserve duty. This situation is reminiscent of the early months of the COVID pandemic, when medical teams and their families were more exposed to the virus than the general population.

When October 7 hit, Israel’s health, mental health, education and welfare systems were already compromised. We must not repeat the same mistakes and ignore the secondary trauma suffered by healthcare professionals. It is imperative to draw up an organized plan to allocate the necessary labor force resources.”

Healthcare professionals, who are in the first circle of care for those suffering from trauma, were thrown into a reality of joint trauma, and experienced, together with those who were directly harmed, the consequences of these events.

Among the problems suffered by the professionals are:

1. Compassion fatigue from working with patients suffering from emotional pain.    
2. Secondary traumatic stress among healthcare professionals or family members of those suffering from trauma who are taking care of those who have been directly affected by trauma.
3. Vicarious trauma, in which the internal experiences and perceptions of healthcare professionals are adversely affected due to empathy towards their patients who have survived trauma.
4. Moral distress – the psychological impact of moral and ethical tension on healthcare professionals resulting from behavior contrary to their ethical code, whether that involves avoiding doing the right thing, doing something that goes against their values, or bearing witness to such an event that they were unable to prevent.
5. Burnout – a response to long-term stress resulting from the work environment and the nature of the work that leads to physical, emotional, or mental exhaustion, a decline in performance, and negative attitudes towards oneself or others.
6. Retraumatization – re-experiencing traumatic moments following exposure to a situation or environment that is not necessarily traumatic in itself but is reminiscent of the previous trauma and evokes emotions and reactions linked to that trauma.
7. Collective occupational trauma, in which professionals experience the same traumatic reality as their patients and those associated with their various support systems such as family members.

The Taub team noted that there are several programs and methods in Israel and abroad to reduce the impact of exposure to trauma and coping with the traumatic effects on healthcare professionals. They aim to develop coping skills and apply them not only in emergencies but also in day-to-day routine so that when healthcare professionals are faced with complex situations, they can avoid fatigue, burnt-out, and exhaustion. The aim is to equip them with the skills of emotional resilience required to provide those in need of care with the highest level of professionalism and experience.

Strategies for coping

Beyond the variety of methods available including cognitive-behavioral therapy (CBT), sports, maintaining a healthy lifestyle, seeking social support, setting boundaries between personal life and work, it is important to highlight the abilities that contribute significantly to personal coping. These include:

1. Vicarious resilience – the ability to draw strength from the successful coping of other professionals in dealing with trauma in ways that effect a positive change in the internal world of the healthcare giver.
2. Self-awareness and self-regulation and correct empathic regulation — developing an awareness among healthcare staff with respect to their opinions and feelings towards patients along with a balance between maintaining professional distance and empathic concern towards their patients in a way that allows them to function optimally without being overwhelmed.
3. Strategies for developing organizational coping ability. In organizations that provide social services to the population – from health funds to educational institutions and local authorities – it is important to develop comprehensive systems to support staff. The following are some key organizational methods:
4. Advancing trauma-informed organizational leadership. The welfare of professionals giving care is also for the good of those served. Creating an organizational culture that is aware of the broad impact of trauma and responds to trauma at all levels, including secondary trauma among healthcare providers, is essential.
5. Treating signs of trauma among the organization’s employees and creating safe and healthy spaces for patients and preventing re-traumatization is an important step in strengthening and protecting staff from the negative experience of trauma as well as improving the quality of their care to service users.

The team recommended that efforts should be made to create a mutual and supportive system of relationships and to also take practical steps, such as encouraging employees to take personal time for mental recharging, organizing team-building days, ensuring healthy nutrition, addressing the health and well-being of employees by, for example, monitoring stress levels, conducting two-way communication including explanations and rationalization of guidelines.

Occupational health and well-being, psychosocial risk management involves a set of guidelines for implementing an occupational health and safety management system at the organizational level in order to identify psychosocial risk factors endangering the health and well-being of an organization’s employees.

These risk factors are related to the organizational structure, the social factors at work, and aspects of the work environment, such as the equipment used by employees and the activities they engage in, which can adversely affect their physical and mental health, as well as the economic costs to the organization and society as a whole. An organization committed to employee health and well-being would be expected to assess the risks inherent in the work environment and act accordingly.

Appointment of a chief wellness officer (CWO), a senior-level official responsible for promoting employee well-being within the organization and ensuring the implementation of this approach throughout the organizational structure. He or she is tasked with, among other things, identifying sources of anxiety among employees, utilizing the organizational infrastructure to support employees experiencing difficulties, evaluating employee well-being, and promoting systemic initiatives for improving well-being. They are solely focused on promoting employee resilience, health, and well-being within the organization and are expected to maintain direct communication with the organization’s management.