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 PTSD, The Soldier's Workbook,
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