Les équipes mobiles d’urgence et de réanimation face aux interventions potentiellement traumatiques

RésuméLes médecins, infirmiers et ambulanciers des services mobiles d’urgence et de réanimation (SMUR) sont confrontés à de nombreuses interventions à caractère traumatique (morts violentes, blessés graves, catastrophes…). Cette étude vise à identifier les interventions potentiellement traumatiques des intervenants et à nous interroger sur le vécu et les répercussions psychotraumatiques de ces interventions. L’étude porte sur 69 intervenants SMUR, tous les sujets ont répondu à un entretien clinique semi-structuré et à un questionnaire mesurant les troubles psychotraumatiques (Posttraumatic stress disorder de Watson et al.). Sur l’ensemble de notre population, nous observons que 77 % des intervenants SMUR ont vécu une intervention à caractère traumatique. À long terme, l’intervention traumatique reste fixée en mémoire ; cependant, les répercussions psychopathologiques sont relativement faibles. L’événement traumatique n’est pas à appréhender dans une dimension psychopathologique, mais davantage dans le sens d’un rituel de passage permettant un réaménagement de l’identité professionnelle afin de faire mieux face aux interventions suivantes.

The doctors, nurses and ambulance drivers of the mobile emergency medical service (“SMUR” in French) are confronted with the death of their patients in their daily occupation (Laborie et al., 2002). In this context, the patients’ death is often unforeseeable and brutal; the deaths result from forms of violence, accidents, suicides and aggressions. Thus, two dimensions emerge from the urgency department; on the one hand the unpredictability of the operations and on the other hand the confrontation with death. These two dimensions refer to the two principal psychopathological aspects concerned in the psychic traumatism: the brutality of the event and the meeting with death.ObjectiveThe goal of our study is to describe potentially traumatic intervention by the SMUR staff and to find out about their personal experiences and also to measure the psychotraumatic repercussions. All along this research, we will rely on a qualitative and quantitative methodology, in order to confront the subjective richness of the clinical interviews with the data resulting from the questionnaire.MethodologyThe study is based on 69 members of the mobile emergency medical service: doctors, nurses and ambulance drivers. Everybody has answered a semi-structured clinical interview and a questionnaire measuring the psychotraumatic disorder: posttraumatic stress disorder interview of Watson et al. (1996). From the clinical interview, we carried out a thematic analysis in order to identify the various topics emerging from each person's personal experience. We observe that the most exceptional interventions, such as catastrophes for example, are not more upsetting for the members of the SMUR. In a way, these interventions are regarded as a springboard for any professional career, a feeling of valorization is associated with it. On the contrary, it is more during their “daily” interventions that professionals express their traumatic experience. In this case, the professional is suddenly confronted with the horror, and the lack of preparation makes him more vulnerable to the “traumatic break down”.ConclusionsThe traumatic event is not to be understood in a psychopathological dimension, but more like an “initiatic ritual” allowing reorganization of the professional identity to cope with the following interventions. Thus, we witness the appearance of new faculties: the members of SMUR change their values, they get new competences: from now on, they can apprehend their work in a new way. Thus, the professionals seem to escape from the “traumatic curse”. However, time only reveals the true nature of the event, which has been experienced, since trauma is also what we do with it afterwards.