Arash Javanbakht, Associate Professor of Psychiatry at Wayne State University, wrote an article on the recent mass shootings and the effects on first responders, stating, “Mass shootings leave emotional and mental scars on survivors and first responders. While victims try to run away from an active shooter, the police, firefighters, and paramedics rush into the danger zone. They frequently face uncertainty; threats to themselves, their colleagues; and terrible bloody post-shooting scenes.”
are trained professionals who use strategies in crises to protect lives and property quickly. However, high-crisis incidents, like mass shootings, can trigger traumatic incident stress in even the most highly trained frontline worker. When civilians are in crisis, they call 911. When first responders are in trouble – who do they contact? In this article, we will cover the signs of traumatic incident stress, how acute stress responses can lead to PTSD, and effective critical incident stress management interventions and resources that can help those on the frontline and their loved ones.
Signs & Symptoms of Traumatic Stress
When traumatic incident stress occurs on the job, first responders may not be able to stay focused on their safety or rescue injured victims. Additionally, if symptoms are chronic or interfere with daily activities, workers need to seek medical attention. According to the Centers for Disease Control and Prevention (CDC), after a traumatic incident, first responders may experience the following physical, cognitive, emotional, and behavioral signs/symptoms:
Physical Symptoms:
- Chest pain and difficulty breathing
- Signs of shock (rapid or weak pulse, shivering, pale and damp skin, mental confusion, shallow breathing, and dilated pupils)
- Nausea, vomiting, and dizziness
Cognitive Symptoms
- Heightened or lowered alertness
- Poor concentration and memory issues
- Nightmares
Emotional symptoms
- Anxiety and depression
- Guilt and grief
- Blaming others or self
Behavioral symptoms
- Intense anger and outbursts
- Excessive alcohol/drug consumption
- Inability to rest, pacing
According to Dr. Heather Twedell, a psychologist specializing in first-responder stress and trauma, “First responders and trauma go hand in hand. In my years of experience in working with this population, I have yet to meet an individual that does not, to some degree, have physiological and psychological responses that are altered by occupational exposures. So while many first responders may strongly dislike the letters PTSD (due to cultural stigma), it’s imperative they understand that as long as they have a nervous system, trauma can leave a mark. Now to what extent and exactly how it will manifest can vary from person to person.”
Mental & Fiscal Costs of Traumatic Stress
According to EMS1, besides taking a toll on the frontline worker, traumatic stress impacts the organization and can break down communication between teams. These issues can also lead to higher fiscal costs within the agency. Other negative effects may include:
- Decreased morale
- Deteriorating group cohesiveness
- Increased healthcare costs, i.e., increased worker’s compensation and disability claims.
- Decreased employee efficiency and productivity
When Traumatic Incident Stress Results in PTSD
One study found that individuals confronted with high-impact and high-frequency stressors are at an increased risk of experiencing an acute stress response. While such reactions are normal, some of these individuals subsequently develop more severe impairments that require treatment – for example, acute stress disorder (ASD) or PTSD. One large review study revealed that law enforcement officers, paramedics, and firefighters are exposed to violence, serious injury, and death at significantly higher rates than most civilian professionals. Given the increased frequency of traumatic stress exposures, it is not surprising that first responders are at an elevated risk for developing PTSD. The review also states that several non-occupational and occupation-specific risk factors may increase the likelihood of developing PTSD after traumatic stress exposure in the same group.
Non-occupational risk factors were organized into three categories, including historical, posttraumatic, and peritraumatic. Historical risk factors involve a family history of mental health disorders, education, intelligence, early conduct problems, and childhood abuse. Studies also show other posttraumatic risk factors, including inadequate access to healthy coping skills, limited access to mental health resources, absence of social support, and other life stressors. In one comparative study, occupational environments that include exposure to extreme heat, fire, smoke, the risk for repeated physical injury, and erratic sleep patterns may change inflammatory and physiological stress responses and compromise resilience in the face of PTSD risk factors.
Coping with Traumatic Stress During the Incident
According to the CDC, the following guidance is offered to help those who experience frequent stress cope during a traumatic incident and is recommended for first responders:
- Pace yourself as rescue and recovery efforts at the site may continue for days or weeks.
- Be conscious of those around you. Responders who are exhausted, stressed, or even temporarily distracted may place themselves and others at risk.
- Take frequent rest breaks. Mental fatigue, particularly over long shifts, can greatly increase emergency workers’ risk of injury.
- Eat, drink fluids, and sleep regularly. Maintain as regular a schedule as possible and adhere to the team schedule and rotation.
- Monitor mental/emotional health and talk to people when you feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it.
- If your employer provides you with mental health support, use it.
How to Deal with Trauma Long After the Incident
According to EMS1, critical incident stress management (CISM), also referred to as “critical incident debriefing,” is a psychological first-aid intervention strategy recommended to help mitigate long-term mental health issues for first responders. CISM interventions encourage individuals to emote the impact of the cognitive, emotional, and psychological symptoms that manifest as a direct result of exposure to traumatic stress. CISM aims to return those involved to a pre-event “normal” status quicker than if left to their own devices.
The EMS article suggests that first response workers’ impressions and understanding of their experiences will change over time. No matter how they react to the traumatic event, workers can follow some basic steps to help themselves adjust to the experience, including:
- Reconnecting with family, community, and spiritual supports.
- Spending time doing the things you enjoy to refresh, ground, and recharge yourself.
- Appreciate humor in yourself and others. It’s okay to laugh again.
- Avoid drugs or alcohol. You do not need to complicate your situation with a substance abuse problem.
- Get plenty of rest and routine exercise. Eat well-balanced, regular meals.
To reinforce the idea of abstaining from drugs or alcohol, Dr. Twedell suggests, “Remember that repeated stress exposure can dysregulate the nervous system, so adding depressants (alcohol) or stimulants (nicotine, caffeine) will only make those lows during shift recovery lower and the highs of an overactive system even higher. The first responder must be mindful of these patterns when choosing when and how much of any external elements they put in their systems. Ideally, after a shift and especially after a critical incident, the first responder should engage in healthy behaviors to support the nervous system’s attempt to return to baseline. This should include exercise and other forms of movement (yoga, tai chi, martial arts), being outdoors, breathwork/grounding/meditation, healthy eating, and good sleep habits.”
When first responders do not have access to immediate mental health resources, the following organizations and resources may be beneficial:
The Tema Foundation provides a valuable collection of videos, ebooks, audiobooks, and more. Their mission is to help first responders, frontline workers, public safety personnel, and the essential people in their lives make mental health healthier.
This foundation is committed to supporting the emotional and mental wellness of first responders and their support network. They provide funding for emotional and mental wellness services and access to peer-supported outdoor activities and events designed for personal health.
Its mission is to educate and train law enforcement about mental health and suicide prevention.
The Code Green Campaign is a first responder-oriented mental health advocacy and education organization.
Assists providers with PTSD treatment.
All Clear Foundation – Supporting First Responders
This foundation amplifies and funds innovative programs to improve the life expectancy and wellbeing of first responders.