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Few investigations have assessed the prevalence of posttraumatic stress experiences among Crime Scene Investigators (CSIs). We recruited a nationwide sample of 225 CSIs to complete online questionnaires assessing PTSD symptoms, use of specific coping tactics, perceived social support, trait resilience, and demographics. Seven symptoms had been experienced by at least 50% of participants during the previous month, and 9.3% had total checklist scores suggestive of PTSD. A significant regression analysis revealed that higher PTSD scores were associated with drinking alcohol more frequently to deal with stress, admitting more frequently one could not deal with stress and not trying to do so, lower social support, getting angry and letting emotions out more frequently, lower resilience, and finding comfort in one's religious beliefs. Given the proportions of CSIs that experience exposure-related stress, more should be done to mitigate the prevalence and severity of these symptoms.

Background Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) holds promise for increasing the use of EBPs such as prolonged exposure therapy (PE) in military treatment facilities. TACTICS combines a needs assessment, a rubric for selecting implementation strategies based on local barriers, an implementation toolkit, and external facilitation to support local champions and their implementation teams in enacting changes. This paper describes the rationale for and design of a study that will evaluate whether TACTICS can increase implementation of PE for PTSD and improve patient outcomes in military BH clinics relative to provider training in PE alone. Methods The study is a multi-site, cluster randomized, stepped-wedge trial, with the military treatment facility as the unit of analysis. Eight facilities undergo a provider-training phase, followed by 5 months of TACTICS implementation. The timing of TACTICS at each facility is randomly assigned to begin 9, 14, or 19 months after beginning the provider-training phase. Primary analyses will compare the proportion of PTSD patients receiving PE and patients' mean improvement in PTSD symptoms before and after the onset of TACTICS. Discussion TACTICS endeavors to balance standardization of empirically-supported implementation strategies with the flexibility of application necessary for success across varied clinical settings. If successful, TACTICS may represent a systematic and scalable method of promoting and supporting EBP implementation. Trial registration Clinicaltrials.gov Identifier: NCT03663452

This case presented is a patient with non-ST elevation myocardial infarction with angiographic non-flow limiting linear opacity in coronary artery with fractional flow reserve in ischemic range secondary to recanalized organized thrombus.