First responders – EMS, firefighters, police, and search-and-rescue teams (including divers) – are the public safety professionals who come running when there’s an emergency. They rescue us when we are in danger; they put their lives on the line for us every day. But what happens when they need rescue from either physical, emotional, or mental duress? How can we serve our community heroes by helping them decrease the rate of stress-related disorders among them?
First responders are susceptible to stress-related mental disorders such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). In fact, the occurrence of PTSD among first responders is comparable to that of combat veterans with first responders averaging at 16.1% (Stellman, Smith, et. Al, 2008). Combat veterans (veterans of OEF/OIF) average at 16.35% (Richardson, Frueh, & Acierno, 2010).
ASD VS PTSD
ASD is characterized by symptoms similar to those of PTSD, except the symptoms begin during or immediately following the traumatic event, last at least two days, and either resolve within a month or the diagnosis is changed. These symptoms include dissociative reactions (feeling “numb” or detached, appearing dazed or unaware of surroundings), intrusive thoughts, avoidance, and hyperarousal (APA, 2010).
PTSD is a mental disorder characterized by intrusive thoughts (which include nightmares and flashbacks), avoidance of people, places, or situations that remind one of the traumatic experience, and hyperarousal (in which the sufferer feels “edgy” or “keyed up” most of the time). While this disorder is well-known, though not always well-understood, it is still often stigmatized among first responder communities (APA, 2010). First responders often do not seek help because of concerns about appearing weak, what their fellow public safety workers will think, or because they think they can get through it alone. Unfortunately, PTSD is so disruptive and invasive a mental disorder, it often leads to suicidal ideation due to feelings of guilt, inability to cope, or hopelessness (Hudenko, Homaifar, & Wortzel, 2017).
The current attempted suicide rate among first responders is an astounding 6.6% as of 2016; in fact, family and friends reported 132 suicide deaths among first responders last year (Venteicher, 2017). That number seems very high – too high for our community heroes. Why is this such a problem?
How can we help?
Where many police departments have psychologists on staff to provide officers with ready access to mental healthcare, most volunteer departments (fire, search-and-rescue) do not have the funds to make mental health support immediately available. There are critical response teams to call in the event of a difficult call, but what about the first responder who has been exposed to secondary trauma for a decade or more and now is beginning to struggle with stress-related issues? CRTs can take days to arrive. All first responders should have ready access to trained professional or paraprofessional mental health workers – those with a working knowledge of trauma, common reactions to trauma, PTSD, and other stress-related mental issues.
It is my belief that we should make mental health awareness part of the training for first responders – not just police but firefighters, EMTs, and search-and-rescue teams – including divers. Divers often work in low-to-zero-visibility conditions and can come upon human remains suddenly and without warning. This, itself, is a traumatic event and can compound with other traumatic experiences for the diver. It is well-documented that repeated exposure to trauma increases the risk of PTSD and suicidal thoughts; if the diver does not process the trauma in a healthy way, but suppresses or ignores it, eventually he or she may suffer some stress-related illness. Awareness training can teach rescuers what to look for in themselves and other rescuers, how to tell if they or their fellows are under stress or struggling, and how to calm themselves (and others) until they can be relieved at the scene of an emergency, if necessary.
It is vital that we take any and all necessary steps to reduce the number of first-responder suicide attempts and deaths. The percentage is too high. It is time for us to take care of our community heroes so they remain healthy enough to come to the rescue.
American Psychological Association (2010). Diagnostic and Statistical Manual of Mental Disorders -version 5.
Hudenko, W, Homaifar, B, & Wortzel, H (2017). The Relationship Between PTSD and Suicide. The National Center for PTSD, US Department of Veterans Affairs.
Richardson, LK, Frueh, BC, & Acierno, R (2010). Prevalence Estimates of Combat-Related Post-Traumatic Stress Disorder: Critical Review. Australian & New Zealand Journal of Psychiatry 44(1). pp. 4-19.
Stellman JM, Smith RP, Katz CL, Sharma V, Charney DS, Herbert R, Moline J, Luft BJ, Markowitz S, Udasin I, Harrison D, Baron S, Landrigan PJ, Levin SM, Southwick S (2008). Enduring Mental Health Morbidity and Social Function Impairment in World Trade Center Rescue, Recovery, and Cleanup Workers: The Psychological Dimension of an Environmental Health Disaster. Environmental Health Perspective, 116(9). pp. 1248-1253.
Venteicher, W (2017). Increasing suicide rates among first responders spark concern. Pittsburgh Tribune Review.
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