Acute Stress Disorder in the Prehospital Setting
Written by: Aleena Ansar
Edited By: Adam Jones
Acute Stress Disorder in the Prehospital Setting Introduction
Acute Stress Disorder (ASD) is a short-term psychiatric condition that arises in response to experiencing or witnessing a traumatic event. Introduced in the DSM-IV as a distinct diagnosis, ASD serves as a potential early indicator for the development of post-traumatic stress disorder (PTSD). For prehospital clinicians, recognising the signs and symptoms of ASD in patients, or even within themselves and their colleagues, is vital for early intervention and support.
How does Acute Stress Disorder Develop?
ASD typically develops within three days of a traumatic incident and may last for up to four weeks. It is characterised by a cluster of dissociative, intrusive, and hyperarousal symptoms that cause significant distress or impairment.
Key diagnostic criteria (DSM-5) include:
- Exposure to actual or threatened death, serious injury, or sexual violation.
- Presence of at least nine symptoms across intrusion, negative mood, dissociation, avoidance, and arousal categories.
- Functional impairment in social, occupational, or other areas of functioning.
If symptoms persist beyond four weeks, the diagnosis may shift to PTSD.
Imaging evidence of arthritis is observed in more than one-third of the American population, and the prevalence progressively rises with the age.
Clinical Symptoms of Acute Stress Disorder
Intrusive thoughts:
Recurring, involuntary distressing memories or dreams related to the trauma.
Flashbacks:
Intense psychological distress when exposed to reminders.
Dissociation:
Including dissociative amnesia or feeling detached from one’s body (depersonalisation).
Avoidance behaviours:
Avoiding reminders, conversations, or people associated with the trauma.
Emotional Numbing:
numbering and disconnection from others or from one’s emotions.
Sleep disturbances:
Difficulty falling or staying asleep.
Hypervigilance:
Exaggerated startle responses and heightened alertness.
Irritability:
or aggressive behaviour.
Somatic symptoms:
such as tachycardia, sweating, and gastrointestinal upset.
Risk Factors
- Female gender
- Intellectual disability
- Lack of education
- History of traumatic events
- History of psychiatric disorder(s)
- Personality disorder(s)
- Genetics
- Trauma severity
- Assault
- Rape
- Physical injury
- Acute stress disorder (ASD)
- Tachycardia
- Poor socioeconomic status
- Physical pain severity
- ICU stay
- Brain injury
- Dissociative symptoms
- Disability
- Subsequent life stress
Differential Diagnosis
ASD shares overlapping features with several other conditions:
- Post-Traumatic Stress Disorder (PTSD) – when symptoms persist beyond four weeks.
- Major depressive disorder or other mood disorders.
- Adjustment disorder – milder response to a stressful event.
- Brief psychotic disorder – includes psychotic symptoms not typically seen in ASD.
- Organic mental disorders – such as dementia or brain tumours.
Assessment Of Acute Stress Disorder
Prehospital providers may not be responsible for making a formal diagnosis, but recognising features suggestive of ASD can prompt appropriate referrals and support.
Key assessments may include:
- Focused history – Recent trauma, psychological symptoms, past mental health history.
- Observational findings – Emotional distress, agitation, detachment, or dissociation.
- Basic psychosocial screening tools, where feasible such as the National Stressful Events Survey Acute Stress Disorder Short Scale (Adults) or Acute Stress Checklist for Children (ASC-Kids)
Note: In cases of extreme distress or suspected psychiatric emergency, hospitalisation or referral to mental health crisis teams may be necessary.
Management Strategies For Acute Stress Disorder
- Ensure the physical safety of the patient.
- Provide a calm, supportive environment.
- Validate the patient’s emotional response without pressuring them to talk.
- Refer to mental health services as appropriate.
- Trauma-focused cognitive behavioural therapy (TF-CBT).
- Exposure therapy to help process trauma-related triggers.
- Psychotherapy for long-term management.
- Pharmacological support for symptomatic relief (e.g. beta-blockers for anxiety, prazosin for nightmares).
- Monitoring for escalation to PTSD or other psychiatric conditions.
Implications for Prehospital Clinicians
Prehospital workers are frequently exposed to emotionally challenging scenes, which places them at increased risk of developing ASD themselves. Providers should be vigilant about their own wellbeing and consider peer support, reflective practice, and occupational mental health resources.
Tip: If a colleague seems withdrawn, unusually irritable, or excessively jumpy after a traumatic job, check in with them. Early intervention makes a real difference.
Key Points
- ASD is a time-limited response to trauma, lasting between 3–28 days.
- It can precede PTSD and shares many overlapping symptoms.
- Recognition in the prehospital setting aids timely referral and support.
- Management includes psychological therapies and sometimes medication.
- Prehospital professionals are also at risk and should be mindful of their own mental health.
References
Bryant, R. A. (2017). Acute stress disorder. Current Opinion in Psychology, 14, 127–131. https://doi.org/10.1016/j.copsyc.2017.01.005
Fanai, M., & Khan, M. A. (2023, July 10). Acute stress disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560815
Winston, F. K., Kassam-Adams, N., Vivarelli-O’Neill, C., Ford, J., Newman, E., Baxt, C., Stafford, P., & Cnaan, A. (2002). Acute Stress Disorder Symptoms in Children and Their Parents After Pediatric Traffic Injury. PEDIATRICS, 109(6), e90–e90. https://doi.org/10.1542/peds.109.6.e90
