Picture a trauma victim, someone who has endured a gunshot wound, a car crash or an industrial accident, a person whose body is broken and is rushed into surgery to be mended by physicians racing against the clock.
But what happens during recovery, when thoughts ricochet through the mind of the victim? What happens if symptoms of post-traumatic stress disorder (PTSD) take hold?
This is where clinical psychologist Terri deRoon-Cassini steps in.
Working alongside surgeons at Froedtert & the Medical College of Wisconsin, deRoon-Cassini is deeply engaged in research that identifies neurological, biological and psychosocial markers for PTSD. She also provides psychological care to injured trauma patients. It’s not just soldiers in combat who can suffer from PTSD. Civilians who encounter trauma in their daily lives also can get PTSD, which can lead to severe mental health problems.
DeRoon-Cassini said PTSD is the biggest predictor of quality of life in trauma patients. A 2010 study conducted at Froedtert showed that up to 40 percent of civilian survivors developed PTSD.
“Why is PTSD important? It’s important because if people can no longer engage in their everyday lives, they can’t support themselves, be there for family and loved ones,” she said.
Ultimately, she said, untreated PTSD “creates a large health burden on society”.
Froedtert is among only a few hospitals in the United States that routinely screens trauma patients for PTSD symptoms. It also is unique for having a clinical psychologist like deRoon-Cassini working in the surgical department.
The American College of Surgeons Committee on Trauma recommends PTSD and depression screening at Level I trauma centres like Froedtert.
According to deRoon-Cassini, the hope is that in five years such screening treatment will be mandated and more psychologists will be embedded in trauma centres. The hospital also has started a trauma mentoring programme. Four former patients who have been through the system, and then received training, volunteer their time to talk with new patients about recovering from a traumatic event.
“Our psychological intervention is targeted to people at risk,” deRoon-Cassini said. “PTSD can’t be diagnosed until 30 days after a trauma. We want to prevent that diagnosis.”
Stephen Hargarten, chief of the Emergency Department at Froedtert Hospital, said deRoon-Cassini plays a vital role.
“She’s an expert at understanding how a traumatic event affects an individual and she is an expert at recognising and intervening before debilitating post-traumatic stress takes over,” Hargarten said. “People generally associate PTSD with military engagement, but they don’t often associate this with day-to-day events that are similar in quality, a kinetic energy exchange from a car crash or a bullet,” Hargarten said.
At 36, deRoon-Cassini is deep into a career centred on detecting and treating PTSD. Born and raised in California, she attended the University of Wyoming, where she studied zoology and physiology.
While in college, she got an internship at a domestic violence shelter. She recalled helping one client, a woman who suffered abuse at the hands of her husband, a member of the military. The woman, a mother of four, had cuts on her face. She needed dental care because several teeth had been knocked out. But before she could get her teeth fixed, she had to undergo a magnetic resonance imaging test to see if there were any fractures.
The clicking sound of the MRI triggered a flashback for the woman. DeRoon-Cassini later learned why. The woman told her that during one weekend, she had been kept in a box in the basement of her home, and anytime she made a noise, her husband hit the box with a baseball bat. DeRoon-Cassini said that woman’s story pushed her toward her life’s work.
She earned her master’s and doctorate degrees in clinical psychology at Marquette University. During an internship at the Zablocki Veterans Affairs Medical Center, she focused on health psychology and PTSD after combat trauma.
DeRoon-Cassini completed postdoctoral work at the Medical College of Wisconsin, where she is now assistant professor in the Department of Surgery, Division of Trauma & Critical Care. She and her colleagues are involved in several studies that she hopes “can give us a more complete picture of risk for PTSD”.
“Can we look at the biology of a person at risk? Can we look at their neurological state?” she said. Just as important, she is in the trenches, trying to help patients cope with trauma. Others are, too.
The Trauma Peer Mentor Program was unveiled at Froedtert in October. Former patients talk with current patients, imparting advice and listening. The initiative grew out of the Trauma Survivors Network, which works to connect patients and families after serious injury.
“We visit patients who are newly injured,” said Chris Prange-Morgan, who fell 30 feet at a local climbing gym in 2011. Three years later, her right leg was amputated just below the knee. “One of the things I’ve found in connecting with people is there is a great network of very old souls out there who know what it is like to suffer,” she said.
Prange-Morgan did not suffer PTSD after her injury, but said she knows what to look for in patients who might be in distress.
“I think it can help people to know there is hope, particularly when faced with not just a physical injury, but the emotional scarring of knowing they have been violated in their home or a victim of a serious car accident outside their control,” she said. “Having someone come and help you feel you can get control back is pretty important.” — Milwaukee Journal Sentinel/Tribune News Service