A B.C. paramedic says the province's outdated rules mean first responders who suffer psychological trauma on the job are treated like "disposable heroes."

Joanne Trofanenko was shocked when WorkSafeBC refused to compensate her when she became too ill to work after a 2010 accident.

"We have a saying. You never know when your career-ending call is going to come in."

This B.C. Ambulance carrying Joanne Fuller and Ivan Polivka plunged over a cliff and sank eight metres to the bottom of Kennedy Lake near Ucluelet. (CBC)

For Trofanenko, it was Oct. 19, 2010. She was the first paramedic on scene after a B.C. ambulance plunged over a cliff and sank eight metres to the bottom of Kennedy lake.

"As soon as I approached the hill at Kennedy lake, I knew that this was not good," said Trofanenko, fighting back tears as she recalled that early-morning search for survivors.

The driver, 59-year-old Joanne Fuller, was Trofanenko's close friend.

'You just go numb'

She watched helplessly until divers confirmed that the bodies of Fuller and Ivan Polivka, 65, were inside the ambulance.

View of the cliffs showing the sheer dropoff from the roadway surrounding Kennedy Lake near Ucluelet. (CBC)

"You were able to see that the ambulance was at the bottom of the lake and you could see all the debris and the path that the ambulance took going down the cliff, " she said. "I just shut down cause that's all you can do.You just go numb."

The coroner ruled Fuller likely fell asleep at the wheel while fellow paramedic Polivka, napped in the back. It was just after 4:30 a.m. PT and the Ucluelet-based ambulance team had just transferred a patient to Port Alberni.

The two years following the accident were difficult for Trofanenko, who transferred to another ambulance station, but could no longer perform at the same level.

"My brain would freeze and I wasn't processing as quickly as I used to," she said.

It wasn't until she responded to another drowning call, at a lake that resembled Kennedy Lake, that she realized she needed help.

Joanne Fuller and Ivan Polivka died when the ambulance driven by Fuller went over a cliff in the early morning hours of Oct. 2010 and plunged to the bottom of Kennedy Lake. (CBC)

"I just burst into tears and I had a panic attack. My throat closed off and I said, 'Oh my god, it's Kennedy Lake again,'" said Trofanenko, describing what she later learned was a flashback.

She went on sick leave and was diagnosed with post-traumatic stress disorder as a result of what she experienced the day her friend died.

But in a letter from WorkSafeBC, she learned her claim was denied because she didn't file it within one year of the date of the injury. The Kennedy Lake tragedy had happened more than two years earlier.

'I didn't know I was sick.'

Trofanenko was shocked WorkSafeBC didn't take into account that she didn't recognize the symptoms in that first year.

"I didn't know I was sick," she said."I didn't know I had PTSD. I knew I was struggling, but I didn't know I had this."

Dr. Nicole Aube is a psychologist who works with first responders. She says delayed onset of symptoms is common among PTSD sufferers.

Joanne Trofanenko takes a walk with her support dog, medically prescribed for PTSD sufferers. Trofanenko says she knew she was sick but didn't know why until she was diagnosed with PTSD well after the accident. (CBC)

"It happens frequently that people do not see their signs of PTSD, or PTSD does not manifest immediately" explained Aube.

Left untreated, Aube says PTSD can be dangerous for emergency workers, who may lose control of their emotions and may not be able to think clearly.

Aube says Trofanenko would have been particularly vulnerable, "especially if it was a best friend."

"If it's someone we don’t know, we have more of an immune system to cope with that, but if it's someone close, you will have a stronger impact," she said.

In Trofanenko's case, the loss was profound.

"Somebody asked me well who is your go-to person you can go and talk to, and that's when it really hit me, that it was Joanne," she said. "I didn't have anybody to talk to. The person that I would talk to is the person that was killed."

Paramedics at 30 per cent higher risk

Trofanenko says at that time, she didn't realize her sleep disturbances, irritability and lack of concentration were all signs of PTSD.

Dr. Nicole Aube is a psychologist who works with first responders. She says PTSD doesn't always manifest itself right away, but can be dangerous for emergency workers if left untreated. (CBC)

She appealed WorkSafe’s denial of her PTSD claim as of a result of the 2010 incident. She lost that, but won an appeal of a second claim made because of the flashback she experienced at a drowning in 2013.

She received wage-loss benefits for six months, but was cut off after a failed attempt to return to work as a paramedic. She has since filed a third claim, saying her working as a paramedic was too traumatic, but WorkSafe disagrees.

"They're just denying [3rd claim] outright saying it wasn't bad enough to cause distress and PTSD" says Trofanenko.

Bob Parkinson, the Health and Wellness Director for Ambulance and Paramedics of BC says his members have a 30 per cent higher rate of PTSD than the general population, and too many claims are being denied by WorkSafe.

"It's inconsistent," he said. "Claims that seem as though they should go through don't and other claims slide on through. We have a lot of members suffering."

The union says more than half of all their WorkSafe injury claims are stress related.

PTSD not occupational disease in B.C.

B.C. is the one of the only provinces in Canada that does not consider stress caused "by acute reaction to a traumatic event" as an occupational disease, where a claim can be made at any time.

In Alberta, legislation introduced in 2012 and subsequently passed, means emergency workers now don't even have to prove their PTSD is work related. Presumptive coverage means claims are assumed to be the result of psychologically traumatic work-related incidents.

Bob Parkinson, the Health and Wellness Director for Ambulance and Paramedics of BC says more than half of all their WorkSafe injury claims are stress related. (CBC)

"I would really like to see something in that manner or fashion in BC. We have a lot of paramedics who go year-after-year suffering from these traumatic calls and eventually it takes effect on all of us." said Parkinson.

In an emailed statement, Labour Minister Shirley Bond, told CBC News, "the province does have legislation with a broad definition of workplace mental disorders that would include PTSD."

But those claims still have to be made within one year.

The province also says that in 2012, B.C. passed Bill 14 which allows compensation for workers who develop a mental disorder as a result of bullying and harassment.

But the paramedic’s union says that does nothing to help workers exposed to trauma.

In a statement, WorkSafeBC says it accepted 25 mental disorder claims from paramedics last year but would not say how many were rejected.

WorkSafe can make exceptions to one-year limit

WorkSafeBC says it does consider "special circumstances" if a worker fails to file an injury claim within a year. Such circumstances include "injury such as a delayed onset of symptoms" and a delayed diagnosis.

It is not clear why WorkSafe failed to waive the one-year limit in Trofanenko`s case as medical records show she was not diagnosed with PTSD as a result of the 2010 accident until 2013.

Trofanenko says she believes Worksafe BC discriminates against emergency workers who suffer a mental injury rather than a physical one.

"We're the ones on the other end of 911, but when we get sick, we're thrown to the curb, and that’s how I feel" said Trofanenko who is now appealing WorkSafe's latest decision on her third claim for PTSD.

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Full statement from B.C. government

The safety of all B.C. workers is a priority for our government. British Columbia does not have specific presumptive PTSD legislation.

The province has legislation with a broad definition of workplace mental disorders that would include PTSD. In May 2012, B.C. passed Bill 14, an important piece of legislation that recognizes the importance of mental health in the workplace.

This legislation makes B.C. the only jurisdiction that recognizes (in legislation) diagnosed, work-related mental disorders. We passed these legislation amendments to expand workers compensation for diagnosed work-related mental disorders, including mental disorders that result from stressors like bullying and harassment.

WorkSafeBC informs us that between July 1, 2012, and Aug. 31, 2014, WorkSafeBC has 5,237 new mental disorder claims registered. Of the 5,237 new mental disorder claims registered, 1,400 were from the health care sector (including paramedics).

Statement from WorkSafeBC

The Workers Compensation Act, Section 5.1 applies to all workers in B.C. who experience significant work-related mental disorders including post-traumatic stress disorder [PTSD]).

In 2013, WorkSafeBC accepted 25 mental disorder claims from paramedics.

In adjudicating mental disorder claims, WorkSafeBC officers take the following into consideration:

A worker's exposure does not have to be immediate, but can be cumulative over time building towards a mental disorder even if they were able to tolerate similar traumatic events in the past,

A worker may not be diagnosed with a mental disorder until many months or even years after exposure to a traumatic event. This is not uncommon with PTSD claims, as there can be a delayed onset of symptoms.

Where a worker applies for compensation outside of the one year deadline, consideration will be given to the reasons for the late application

Special circumstances could include where a worker's mental disorder is so psychologically incapacitating that the worker is medically incapable of filing a claim within a year. Another example could be where the worker experiences a delayed onset of symptoms, and is diagnosed with a mental disorder one to two years after the incident.

There are often multiple causative factors to be considered when someone has a mental disorder, and consideration must be given to the impact of all the different stressors in that worker's life, work related and non-work related.

The law and related policy states that a mental disorder caused by an employer's decision relating to employment is excluded from coverage. If a mental disorder is caused by any of the following decisions or actions, it will not be eligible for compensation coverage:

a change in work or working conditions

discipline

termination of employment

workload and deadlines

work evaluation

performance management

transfers, lay-offs, demotions, and reorganizations

For more information: http://www.worksafebc.com/claims/MentalDisorders/assets/FAQs.pdf

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