Melissa Paulsen, MA, LMFT, RPT-S
Witnessing Trauma as a First Responder
“I’ve always seen first responders as unsung heroes and very special people because, when everyone else is running way from danger, they run into it.” – Dwayne Johnson
Can you imagine our lives or communities without our First Responders? Law Enforcement Offices (LEOs), EMTs/Paramedics, and Firefighters experience trauma routinely. In our small rural communities, most of these EMTs/Paramedics and Firefighters are volunteers who devote their time and energy helping their community whenever they are called upon and expect nothing in return. They sign up to help others and, in the process, may not realize that the calls they show up to may be for someone they know, especially in our small rural communities.
How Common Is It?
According to a 2019 study of traumatic stress in first responders (link #1 below), 7%-12% of adults in the United States will develop Posttraumatic Stress Disorder (PTSD) at some point in their life. For First Responders, the prevalence of developing PTSD is much higher due to the increased exposure to traumatic events. For Law Enforcement, rates of PTSD range from 6%-32%, for EMTs/Paramedics this estimate is 9%-22%, and for Firefighters this estimate is 17%-32%. I would guess these percentages may actually be higher due to underreporting, not seeking support due to mental health stigma, and not wanting a formal diagnosis that may impact their job and worry about being deemed “unfit for duty”.
What Symptoms Will I Experience?
After experiencing a traumatic event, it is normal to experience post-trauma symptoms. Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) have very similar symptoms but ASD lasts for a period of 3-days to 1-month and a PTSD diagnosis cannot be given until 1-month post-trauma. So ASD is short-term while PTSD is long-term.
Symptoms of ASD (according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) include:
Recurrent, involuntary, and intrusive memories of the distressing event.
Recurrent distressing dreams that are related to the event.
Dissociative reactions and flashbacks where the individual feels or acts as if the event is happening again.
Intense or prolonged psychological distress or physiological reactions.
Persistent inability to experience positive emotions.
An altered sense of reality of surroundings or self (seeing self from another perspective, in a daze).
Inability to remember an important aspect of the event (due to dissociative amnesia).
Efforts to avoid distressing memories, thoughts, or feelings about or related to the event.
Efforts to avoid external reminders (people, places, things, activities) that arouse the distressing memories.
Difficulty falling asleep or staying asleep.
Irritable behavior and/or anger outbursts.
Hypervigilance (increased alertness, sensitivity to surroundings).
Exaggerated startle response.If 9 or more of the 14 symptoms are present for 3-days to 1-month, you may be experiencing Acute Stress Disorder.
What Can I Do About It?
The Substance Abuse and Mental Health Services Administration (SAMHSA) quarterly journal from 2018 talked about this specifically. “One of the best ways to avoid burnout and PTSD is for first responders to bond with their fellow rescuers as a team, or ‘family’. This extended family then becomes a source of strength both during and after an event.” Life is all about connections and these connections of having a shared experience are crucial for healing.
Other tips include:
1. TALK about your experience and feelings. A coworker with a shared experience is great but confiding in your partner, friends, and family can also be helpful. Texting or emailing may be easier for some.
2. If it’s too difficult to talk, WRITE. Write your thoughts and feelings in a journal, type it into the notes of your phone, or type it out on your computer. Getting your thoughts OUT will help them from getting stuck inside and will further help you process the event.
3. Practice deep breathing! Breathe in through your nose and out through your mouth. I always tell little kids to imagine chocolate chip cookies fresh out of the oven and to first smell the cookies and second blow on the cookies. Do this slowly. (Further information in source #5 below.)
4. Make sure you are eating. Healthy food will be best but any food is better than no food.
5. Make sure you are sleeping. Temporarily utilizing Melatonin or Tylenol PM may be helpful.
6. Limit substance use including caffeine and alcohol.
7. Set boundaries and take a break when you need to.
8. Exercise when you can. Even going for a walk will create bilateral stimulation that will help your brain heal. Spending time in nature will also be helpful.
9. Listen to music, read a book, or engage in other hobbies that bring you joy.
10. If several symptoms continue to persist for more than 1-month, seek out additional support through a Licensed Mental Health Therapist and/or consult your doctor regarding the potential need for psychotropic medications. – “All too often, behavioral health needs are seen as a sign of weakness, and those who admit such needs are stigmatized. Very few first responders will take initiative to seek out behavioral health care…” – SAMHSA Journal (link #3 below Design ).
Please take care of yourself to avoid burnout. You cannot help others unless you help yourself first. Like they always say on an airplane, you need to put your own oxygen mask on first. Invest in your wellbeing so you can continue to be of service to others.
Thank you for your service!