TORONTO, Ont. – At one time or another, we’ve all been in situations where we thought we could have altered an outcome if we had just done things a little differently.

But these constant doubts and “what-ifs?” take on a different meaning for truck drivers who find themselves being used as a weapon for someone attempting suicide.

Kim Richardson, president of Kim Richardson Training School in Caledonia, Ont., remembers just one such scenario, in which a KRTS instructor-student team found themselves facing this type of situation.

About 10 years ago on a Sunday evening near Delhi, Ont., an instructor was out with a student providing some nighttime driving experience, when they encountered an oncoming car that had pulled out to overtake another car but didn’t appear to be moving back into its lane, Richardson said.

The team did what they could to avoid the car by swerving into the ditch but the car swerved with them and ended up underneath the front axle of the tractor-trailer.

The driving team were physically fine but shaken up emotionally.

The police investigation of the accident and the car driver’s emotional stability showed that it was a suicide attempt.

The driver of the car lived, but is now paralyzed from the neck down.

Richardson told the student driver to take some time away from the truck and come back to it when and if he was ready to do so.

“The student was going to college in the U.S. on scholarship and wanted to get his licence to get a summer job hauling for one of the breweries. I remember sitting down with him and I didn’t know what to say except to tell him to take his time. A few days later he came back in to see me and said he was ready to start again. He realized that it wasn’t his fault and he was able to move forward,” said Richardson.

Dealing with the adversity and tragedy experienced by students, no matter how difficult, is part of the KRTS training curriculum, Richardson said, because every case and every person is so different.

“I think a lot of it depends on the make up of the person. “Some people can accept tragedies and move forwards, but other personalities don’t allow for that. Anyone who is in a situation like this starts to question everything and ask him or herself, what if I hadn’t stopped for that coffee? Or what if I had taken a different route today? Some people can get over these doubts while others have a more difficult time.”

Unfortunately, the suicide by truck scenario is more prevalent than one might suspect.

And there’s even been an increase in the phenomena in recent years, according to Ed Knoblauch, vice-president of claims for Markel Insurance Company of Canada.

“In the past we might have gotten one or two cases but as of last fall we are up to about six already. One problem we are seeing is that while truck drivers are trying to avoid collisions with people attempting to commit suicide, they are injuring them nevertheless. Unfortunately in Ontario, we have to pay them accident benefits which can be quite substantial,” said Knoblauch.

If the person attempting suicide has car insurance, his or her insurance company can be called upon to pay accident benefits, which can include medical, psychiatric or physiotherapy, he said.

But if that person doesn’t have car insurance, the truck driver’s insurance company must pay for the incident.

“The important part of it is that this is a psychological trauma for the truck driver. He likely realizes it is not his fault, however, he has witnessed the whole thing and was directly involved, so depending on how this aspect is dealt with, it could be the difference between the driver getting back behind the wheel again or never driving again,” said Knoblauch.

In fact, the way the motor carrier’s management team deals with the driver and the situation can impact greatly on whether or not he drives again, said Maura O’Keefe, who has a master’s degree in social work and acts as the clinical liaison for the psychological trauma program at the Centre for Addiction and Mental Health.

“The employer’s response is one predictor in terms of whether or not the driver develops post-traumatic stress disorder (PTSD). If the driver perceives that his employer isn’t flexible or understanding, it will make the driver more vulnerable to depression or developing PTSD symptoms,” said O’Keefe.

O’Keefe said she has encountered many truck drivers, train drivers and bus drivers who have been through traumatic events such as suicide by truck – many have been sent to her for assessment or treatment.

They are prime candidates for developing PTSD, O’Keefe said.

There are three clusters of symptoms indicating PTSD, according to O’Keefe.

The first group includes suffering from nightmares, flashbacks or obtrusive thoughts.

Sufferers feel they are reliving the moment of the trauma. They also replay the scenario over and over again wondering what they could have done differently.

A second group of symptoms indicate avoidance.

Sufferers may avoid driving and driving related noises. They may also become more vigilant about the driving safety of family members.

The third symptomatic behaviour is hyperarousal, in which state sufferers feel they are constantly on red alert.

Hyperarousal sufferers are generally more irritable, more easily distracted, impatient and tend to develop a sensitive startle response.

“The big thing to remember is that people react differently to traumatic experiences. We have seen drivers who will never drive again after going through something like this, but then we have also encountered drivers who, with minimal support and treatment, will get behind the wheel again,” said O’Keefe.

After a traumatic event occurs, many companies bring in a therapist or counselor to conduct a debriefing.

This involves talking to the driver and usually the entire company, because in many cases all have been affected by the event. O’Keefe does not recommend group therapy, however, because of the fact that every person affected is not necessarily at the same stage of healing.

“PTSD symptoms don’t generally take shape until about a month after the event. Generally speaking, a person is still in shock for the first little while after an event and if they are still experiencing symptoms after a month, more active PTSD treatment should be given,” said O’Keefe.

PTSD treatment generally consists of cognitive behavioural therapy (CBT) which includes a gradual and structured exposure system that helps the driver become more comfortable with his or her memory of the accident so that it doesn’t invoke the same anxious responses, said O’Keefe.

“We would generally set up a hierarchy of anxieties with the patient, and begin with the one that provokes the least amount of anxiety and in a controlled environment, expose the patient to the event and when they can control their anxious feeling with that event, we move up the hierarchy to the next one,” said O’Keefe.

There are a couple of important predictors, said O’Keefe, that can help indicate what type of rehabilitation the driver will have after experiencing a traumatic event:

Support from family, friends and employers is a big factor;

Involvement with other traumatic events or accidents in the past;

Previous problems with alcoholism, depression or psychological issues.

Another thing that can help recovery is if the driver takes the initiative to resume driving.

“This is another reason we take the time to consult with the driver immediately after the traumatic event (and prior to more prolonged treatment) because if a driver can try to face the avoidance on their own, they already have that model in their head, they are usually more confident about overcoming the anxieties, and usually have a better outcome,” said O’Keefe.