Hico host and digital producer wajahat ali is here bricking in all of your feedback throughout the show. It is stunning that nearly one in ten americans will experience ptsd symptoms during they lifetime. Yeah, i also soldiers vets, but sa bean that says we reco r recovering victims of abuse also ex experience ptsd. There is another trigger that increases your chances of developing the mental disorder, your zip code. Researcher were astonished toz find that one in four patients with traumatic injuries like gunshot wounds and stabbings had signs of ptsd. And its also where you go. Hospitals and clinics are stressful environments. Up to 35 of patients in the icu experience ptsd long after being released. We have a great lineup of guests today. Dr. James jackson, clinic psychologist and clinical professor of medicine. From chicago, illinois, dr. Kimberly joseph, a trauma surgeon, and carol rees violence and prevention coordinator to at her hospital. They are both at cook county hospital. Thanks to all of you for being here. Dr. Jackson, about 5 Million People a year are in the icus across america. And up to 35 of those patients have ptsd symptoms for up to two years after they leave the hospital. What is triggering such extreme response . It could be a number of things. One of them is the suddenness of the events that lead people to the icu. When you go to combat, you are often mentally prepared for the fact that there is danger around every corner, however, when you become acutely ill that happens very quickly. Sometimes you are feeling fine on monday and tuesday you wake up and you are on a ventilator. Youre not sure what happened. Your family is holding a death vigil around your bed. Its sudden, intense and terrifying. Kind of intensity and immediacy can foster difficult problems can make it hard to cope and can generate pstd. What are the kinds of systems that were talking about . People after Critical Illness after intensive care has classic systems of ptsd. They often remember their time in the icu. Sometimes they remember things that they think happened that actually didnt happen under the influence of heavy sedatives for instance, they often have dilutions in the icu, dilutions of things that are quite terrifying. Those sorts of memories are reexperienced by them. They also have symptoms of avoidance which can be quite problematic. Every time they drive by a hospital they have a panic attack. If they get short of breath for some reason, they remember what it was like on a respirator when they couldnt breathe. Sometimes they are concerned they could be readmitted and the last thing they want is to go back to the icu, so we see symptoms of reexperiencing and symptoms of avoidance. Dr. Jackson, icus and Trauma Centers have been around a long time, is this just newly recognized . People had a perception that trauma was combat. Trauma was perhaps ra rape sexual assault. Those things are all traumatic. But there are a lot of things that can constitute a traumatic event. A miscarriage, for example, diagnosis of cancer, and importantly, the experience of Critical Illness. I think we now are a little more sophisticated and understand that these events, although a bit nontraditional in their description, these are absolutely potential sources of trauma. People are talking about it more. Its being discussed in various media forums to a degree that it wasnt. There are Robust Research articles being published. It is getting quite a bit of attention and it should. We asked our community what is the next step. Dr. Jackson what is being done now to prevent this Alarming Number of ptsd in the icu. I think its challenging prevention, because by the nature of a medical Critical Illness, its very hard to prevent, it is hard to not get sepsus for instance. For that reason a lot of our energy has focused on what you might call early intervention. Management practices in the icu that hopefully reduce ptsd. One of the biggest ones is decreasing sedation. Patients are increasingly less sedated. They are more aware of what is going on around them. The idea there is that even though they are more aware of traumatic things, because they are less sedated they are less likely to have these delusional experiences that are profoundly frightening, and we think that they can deal with reality better, if you will, than with the impact of these dilutions and hallucinations. So decreasing sedation is probably one strategy. Icu followup clinics, probably another strategy. That is specialized clinics, targeting the unique needs of isusurvivors. Dr. Joseph you see about 2,000 people a year with violent injuries. Recently 43 of patients examined in the center exhibited signs of ptsd, given this is the place you work, you would expect a degree of ptsd, did you expect to see these kinds of numbers . So i think thats the important thing, lisa. We knew we were going to see some elements of ptsdtype symptoms in our patients. I think he surprise was it was as prevalent as it was, and not only our parents, but our patients families were experiencing these symptoms. The hyperarousal, the avoidance, the reexperiencing the incident. And since we rely on our social and emotional systems to get us through, if that system is experiencing stress, then it makes it that much harder for us to recover. I think im sorry. I didnt mean to interrupt you. I read that postTraumatic Stress disorder patients out of traumatic situations like for in your case were talking about your hospital, that they are experiencing this at the same rate as veterans do. Is that a stretch or an accurate representative of what is going on . I think its accurate. And i would turn to chaplain rees to talk more about that. Yeah, actually what the literature would support is the rates of ptsd symptoms that we found among our patients is probably almost twice what you would experience expect in veterans who have come from active conflict. Did you say its twice . Yeah, 40 is what we found among our patients and their family members. So trauma patients are experiencing ptsd at twice the rate of war veterans. I think we need to be clear, were talking about a screen for ptsd, although clearly if you screen positive, your chances of having the diagnosis are much higher. So we looked at the screen and saw that we were screening positive at those rates so showing symptoms showing symptoms. And thats concerning. Don from our community go ahead. Specifically its about symptomology. So we had to figure out how to address. Don says. So dr. Joseph, what needs to be done here . We have heard about the grim reality, we know the stats, moving forward what should be a solution. Lets first be clear this is not just a problem in the inner city. People experiencing motorcycle crashes for example, they were screening positive at similar rates, perhaps not quite as high a our gunshot wound victims but close. So if we think about trauma and injury as something that happens to other people were not going to have the political will to move forward on this. So we have to recognize that the things happening to my patients and im seeing more blunt trauma then penetrating trauma, so this is happening to all of our pare patients. So this could happen to any of us. And i agree with your viewer ship, the people who called in. We do need to develop a robust infrastructure to help people deal with not just the emotional spiritual and fiphysical issues happening to them but also help their family and community. Doctor so go ahead. Im sorry. I was just curious do you think there is a broader social cost to neglecting ptsd in the civil population . Looking at personal experiences, i think that study still has yet to be done. Now people will be focusing on the cost benefit analysis, but certainly when i look at my patients recovering from a traumatic illness, there is the physical aspect. But if their Mental Health, emotional health, and Spiritual Health are not also supported, then that makes their physical recovery harder. And thats what we would like to do, build that infrastructure for all of our patients. Not just those that are victims of violent injuries. Thanks so our guests dr. Kimberly joefs, carol rees, and dr. James jackson who well be seeing later in the program. Up next the disturbingly high number of pstd cases. And a former sheriff talks about the emotional toll of First Responders. And Community Wide ptsd in Global Attack areas. A syrian man joins us to discuss the images that still haunt him. Welcome back. Were discussing what some in the medical community are calling the quiet civilian crisis in america, ptsd. Joining us is a trauma surgeon at the university of arizona. From connecticut, a retired debty sheriff living with ptsd, and a former Mental Health officer for doctors without borders. Dr. Joefs, we were talking about patients that were suffering from ptsd, but a very surprising component to the medical discussion is the number of trauma surgeons that experience symptoms of it or actual onset of the disorder. Talk about what is going on among the trauma surgeon community. Its very interesting. We deal with the most sick patients and there has been a lot of studies about how patients are affected by the traumatic disorder, and seeing so many ill patients over time, was a question we had here, was does that effect us, and i think Physician Wellness and physician stress is a big component and a new push we never discussed previously. We surveyed about 1200 trauma surgeons across the country. And we found almost 40 exhibited symptoms of ptsd and 15 were diagnosed with the disorder. From your perspective is that high . Thats higher than the veteran rate for the diagnosis, and more than half of the work force is actually bothered by this stress, and i think that in itself and the other big question here is that theres really no avenues or education or provenn shun that goes out to physicians to help manage that stress so do they go home with nightmares, do they have trouble in personal relationships . Can this effect their perform on the job . When you are diagnosed with it, this is a lifelong disease and they are at a higher risk of divorces, more stress at work, less sleep, and ultimately that effects your ability to perform. And our study was the first to even bring this theory out, or actually the realization that this is real and it does effect us. We had a lot of push back from within the community itself, a lot of the senior surgeons didnt want us to let this out. Our community is chiming in. Karen your work with doctors without borders, how did you turn it off . Well, i dont know that you turn it off, but you certainly learn how best to cope with it. Yeah, i think the first thing is to be aware that you are impacted by what you see and what you are doing, and then to take that time. Take that time in the evening to shut down and quiet yourself or one of the biggest things that happens in the field is people tend to work maybe 12 hours, 16 hours, and to not take that downtime in the evening. Karen what about communities that experience natural disasters . Floods, tornados, hurricanes, thats got to be an entire community affected with these sorteds of traumas. Honestly what we see not everyone develops ptsd from trauma. A lot depends on what was going on previously. What was their trauma, the history, their Mental Health in general . So we see people coming with symptoms and those we can address, and i think the key there is early intervention. If we can get to those symptoms and help them manage those symptoms we can help them avoid the risk of long term ptsd. Now derrick, you suffer from ptsd. We think about people in your profession being built to deal with the stress, and obviously that is not the case. I would say a large majority of the police officers, firefighters, medics, were trained to save peoples lives, but in the end i was actually never trained to save my own life, and ptsd for me was a slow poison, so many violent incidents, auto accidents, suicides, homicides. We were told that they were going to be gruesome, but who is built for that kind of trauma day in and day out . We just werent given the tools, and education Going Forward would make a tremendous difference with first recorders as far as developing post Traumatic Stress syndrome symptoms later on in your career. Yeah what is the connection between First Responders and doctors . Yeah, its interesting. There is no specific training for this, and it may not be a mull tip tuesd multitude of symptoms. I had a younger gentlemen that had been shot and he said i dont want to die, said you are not going to die, and he ended up dying in the operating room. And that incident is still in my mind. So i dont know if it is one particular incident or over and over, and we are trained to be machines. How would increased admission of ptsd affect your profession . I think it brings a National Spotlight to this issue, and we will look earlier and right now if someone had an issue, it would almost be like you would be looked bad upon. And there are no resources from within our trauma community to deal with this. And some of the factors were like less than four hours of sleep a night. Less than two weeks of vacation, which are normal things we take for granted. Solution start with conversations and i hope more like these continue to happen. Thank you to our guests. Still ahead, as we watch intense conflict unfold around the globe, how are whole communities coping with communitywide ptsd . Coming up next a syrian man who survived a chemical weapons attack joins us to discuss the images that still haunt him. And find out why he hasnt chosen to seek professional help. Stay right where you are. Well see you in two minutes. E e perspectives on every issue. E e al jazeera america. Welcome back. Were talking about the surprising number of people suffering from ptsd symptoms, like trauma surgeons, icu patients and inner city residents. But what about entire communities . Joining us now is a syrian native who survived a chemical attack in syria last year. You were a translator, a citizen journalist, you are an activist in syria. I mean you have been in places where you have seen the absolute worst that humanity has to offer. Yes. Were you prepared for what was going to happen to you . For what you were going to see and the effects . Nobody can be prepared to see this amount of violence and terror. We witnessed things that we never learned about not in schools, not by our parents, not by history, not anything. We never knew that this amount of violence does exist. When you see little children torn up to piecing by the shelling or see them starving to death or you see your own government gassing you can chemical weapons. I was gassed and my heart stopped for three minutes, and i was placed among the deceased for 45 minutes. Is there any one incident that triggered the ptsd for you . I remember during the chemical attack, after i was exposed, i was trying to help a small kid at the age of 13. He was laying on the ground suffocating. So i ran to check on him. And the expression i saw on his face was one of the most terrifying that i had seen, because he seemed to innocent and pure to die this very ugly way without doing anything wrong except living in a town which rose up against a dictator. Dr. Jackson whether its entire communities in syria, or in nigeria where more than 200 little girls were kidnapped, is there any precedent in the medical community of dealing with large communities who have shown signs of ptsd. Well, there are challenges on a couple of levels. One is when an entire community is traumatized there are a few who can support their peers and the ones most in need. Everyone is hurting, so there are relatively few people you can turn to for support in that context. And that certainly makes it challenging. I think what we know, certainly what i have learned over the years doing research at vanderbilt and at the va, trauma impacts people and if you ratchet that trauma up enough, and if it happens enough times it doesnt matter how resilient you are, you are going to be affected adversely. Not everyone will develop ptsd, many will. But being impacted psychologically is unavoidable. And thats why as communities, we need to think hard about how to help build resilient people, people who are powerful copers if you will, because the hope is that those people will perhaps be relatively less affected by these horrors, even though theres no way to leave these sortsover experiences unscathed. Thank you all for joining us. Until next time, waj and i will see you online another aljazeera. Com ajamstream. Welcome to al jazeera america, im del walters in new york these are the stories were following for you. Key primary races taking place across the country, some veteran republicans trying to hold on to their seats in congress. Newcomers are hoping for upsets. There is a debate on Net Neutrality on capitol hill. And you might have to pay a little more for your morning cup of joe a new disease is crippling some Coffee Growers and you could pay the price