Preparation for traumatic events prior to exposure for service personnel

Military personnel, first responders and health professionals on the front line of service are at risk of being exposed to non-mutable traumatic events. However, their professional education and training do not typically include ways to minimise their distress caused by witnessing a future trauma. The purpose of this scoping systematic review is to analyse the impact of intervention studies on measures of psychobehavioural adjustment to exposure to a future traumatic event. A systematic search was conducted using PubMed, CINAHL, PsycINFO and the Cochrane Library plus a hand search of five journals, including Military Medicine and Journal of Trauma. A total of 100 articles from an initial pool of 15 306 were assessed for inclusion on criteria and 10 manuscripts meeting the inclusion criteria were evaluated. Interventions focused on combating stress, relaxation techniques, resilience training, psychological skills training, preventing psychological morbidity or post-traumatic stress disorder, and stress management skills. Only 50% of the interventions significantly changed any outcomes. Studies had multiple methodological limitations including a limited number of training hours, trial bias, statistically underpowered designs, short follow-up periods and using inconsistent methods and measures to assessed impact. The paucity of preparatory intervention studies shows there is an urgent need for future research.