Persistent Traumatic Stress Exposure: Rethinking PTSD for Frontline Workers

Frontline workers across health, emergency and social care sectors are repeatedly ex-posed to distressing events and chronic stressors as part of their occupational roles. Un-like single-event trauma, these cumulative exposures accrue over time, generating per-sistent psychological and physiological strain. Traditional diagnostic frameworks, par-ticularly post-traumatic stress disorder (PTSD), were not designed to capture the layered and ongoing nature of this occupational trauma. This commentary introduces the con-cept of Persistent Traumatic Stress Exposure (PTSE), a framework that reframes trauma among frontline workers as an exposure arising from organisational and systemic con-ditions rather than solely an individual disorder. It aims to reorient understanding, re-sponsibility and intervention from a purely clinical lens toward systems, cultures and organisational duties of care. PTSE is presented as an integrative paradigm informed by contemporary theory and evidence on trauma, moral injury, organisational stress and trauma-informed systems. The framework synthesises findings from health, emergency and social care settings, illustrating how repeated exposure, ethical conflict and institu-tional pressures contribute to cumulative psychological harm. PTSE highlights that psychological injury may build across shifts, careers and lifetimes, requiring preventive, real-time and sustained responses. The framework emphasises that effective support is dependent on both organisational readiness, the structural conditions that enable trauma-informed work, and organisational preparedness, the practical capability to enact safe, predictable and stigma-free responses to trauma exposure. PTSE challenges prevailing stigma by framing trauma as a predictable occupational hazard rather than a personal weakness. It aligns with modern occupational health perspectives by advocating for systems that strengthen psychological safety, leadership capability and access to support. By adopting PTSE, organisations can shift from reactive treatment models toward proactive cultural and structural protection, honouring the lived realities of frontline workers and promoting long-term wellbeing and resilience.