Friday, March 8, 2024

Responding to Mass Casualty Incidents: The Traumatic Distress Faced by First Responders


First responders are exposed to and must handle situations that most civilians would never want to encounter. Disasters, whether man-made or natural, can have a profound effect on the well-being of those involved. When a disaster strikes, various first responder departments, including the military, fire department, police department, emergency medical, and search and rescue teams, may all be called upon to assist. Unfortunately, these high-stress environments put first responders at an increased risk of developing symptoms of post-traumatic stress disorder (PTSD).

During a mass casualty incident (MCI), first responders face extremely critical and challenging scenarios. While most people may only experience one disaster in their lifetime, first responders often encounter multiple incidents throughout their career.

One crucial thing first responders have had to respond to with alarming regularity lately are the ongoing active shooter tragedies that seem to multiply in frequency every year. Active shooters, or violent attacks by organized groups, have placed increased violent crime response and physiological stressors on law enforcement officers (LEOs). These violent attacks and chaotic scenes often result in multiple critically injured persons and mass casualties. In an active shooter situation, LEOs are the first to enter the scene. Fire and/or emergency medical service (EMS) personnel cannot enter the incident scene until the situation is deemed safe, which means LEOs often encounter victims while pursuing the shooter. In these cases, they cannot stop to perform emergency medical lifesaving procedures. Remember when we mentioned moral injury? This is one of those cases. It is the right course of action to secure the scene, find the shooter, and prevent more injuries. However, for that LEO facing a potentially dying person, the inability to help them in that moment can have lasting effects on their psyche.   

Whether a disaster or active shooter situation, ground zero is a chaotic and overwhelming place to be, filled with potentially wounded, disoriented, confused, in shock, and scared people. Only when a shooter has been apprehended or the scene is deemed safe can EMS, fire, and search and rescue teams begin to assess, triage, and provide care to the injured.

By this point, the immediate danger may have passed, but this is where the toll on mental health is intensified. Due to the nature of their work, first responders must maintain emotional control in order to effectively help victims. There is no time to process their reactions or the emotions they’re experiencing as they treat severely injured individuals, handle deceased bodies or body parts, comfort those who have lost loved ones, and cope with unsuccessful attempts to save victims.

MCIs evoke intense emotions that cannot be processed immediately and have the potential to cause later psychological difficulties.

In the immediate aftermath of an MCI, first responders have reported that what affected them the most was not when their own safety was threatened, but rather when they were unable to alleviate the suffering of others. Incidents involving children, suicides, and severe mutilation are especially traumatic, and the lack of control in these situations greatly increases their level of distress.

On a global scale, there has been a 10x increase in disasters since 1990 and disasters are predicted to continue increasing in frequency along with the demand for first responders. The incidence of psychological issues such as PTSD is also predicted to continue to rise as first responders are exposed to more of these highly traumatic incidents.

I know it sounds all doom and gloom, but you need to know that even staring into that dark horizon, there is hope.

Providing emergency psychological care has consistently been shown to reduce chronic mental illness in trauma survivors, and it is widely accepted that first responders involved in MCIs require immediate support. Knowing what works and how to help has led to the development of culturally sensitive, evidence-informed, early intervention strategies like Psychological First Aid (PFA) which can be established within the disaster environment. PFA is a widely endorsed and promising evidence-informed early intervention model grounded in research on trauma recovery and resilience.

Findings from studies on PFA suggest it has a positive impact on survivors of MCIs and first responders, with most reporting reduced symptoms of anxiety, depression, posttraumatic stress, as well as improved ratings of mood, the experience of safety, connectedness, and a sense of control.

This is an excellent example of how recognizing the need for psychological support and making help available to those experiencing trauma can deliver a positive outcome.

PFA is useful as a first line of support during disaster situations but it shows the clear impact of having support mechanisms in place, removing the stigma associated with experiencing emotional distress, and how providing education and good mental health and coping options can go a long way to mitigating major psychological damage.  

This is an important tool, but we can’t only think about mental heal during a disaster. There is still work to do, especially when it comes to removing stigmas and providing more access and support, but it shows how protecting the mental health of people experiencing trauma can be implemented when needed.


If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

No comments:

Post a Comment