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Disaster Prep and First Response

How Does PTSD Manifest in Emergency Personnel?

Photo: Courtesy of Jan Koutek

Dr. George Everly, PhD, CCISM aims to destigmatize those first responders suffering from PTSD so they can get treatment and heal more quickly. 

Dr. George Everly, PhD, CCISM

What are post-traumatic stress injuries and how do they affect first responders?

Post-traumatic stress results from exposure to some traumatic event, such as a life-threatening situation, seeing human remains, seeing someone severely injured or killed, and may even result from loss of a significant other. First responders are at perhaps the highest risk of developing a post-traumatic stress injury or even fully-developed PTSD by virtue of their extraordinary exposure, potentially day-in and day-out. The stress injury may take on may forms: anger, depression, stress-related physical illness, marriage discord, strain on other significant relationships at home or at work, quitting one’s marriage, quitting one’s job, moving away, unrelenting obsessive thoughts, nightmares, making pre-existing psychological problems more severe, descending into an abyss of despair, even suicidal thoughts.

Why are therapy and counseling so important for first responders dealing with mental injuries such as post-traumatic stress and depression?

Most cases of posttraumatic stress resolve on their own as emergency professionals tend to be highly resilient. For the cases where the psychological injury is especially severe or is especially chronic, some form of outside assistance can be very helpful. The generally accepted firstline intervention for emergency professionals is some form of psychological first aid delivered by other specially-trained emergency personnel. This is called “peer support.” Over the last 30 years, the International Critical Incident Stress Foundation, a non-profit organization, has developed numerous variations of psychological first aid (for individuals, groups, families). Counseling and psychiatric interventions can be very effective in helping the relatively small numbers of people who seem “stuck” and unable to move past the trauma psychologically, when applied at the appropriate time. But there is some evidence that psychological first aid-like interventions may be more effective in the acute stage of the traumatic response.

What are signs that an individual or a loved one may be suffering from a mental injury?

Sleep disturbance, horrific nightmares, self-medication, extreme irritability, arguments over seemingly small matters, relationship discord, declining personal hygiene, withdrawal and isolation from family and friends, loss of appetite, loss of energy, extreme pessimism, hopelessness, helplessness, to mention just a few.

How can we help get rid of the stigma attached to mental injuries that may make some hesitant to reach out for help?

Emphasize that seeking help is a sign of strength, not weakness. Explain that consulting a psychologist is simply about getting an objective opinion about a problem. The psychologist should be viewed as a consultant. But most importantly, remind people that seeking help when needed is not a prerogative, it’s an obligation one we all have to those who love us or depend upon us.  

How has the COVID pandemic affected those suffering from mental injuries and how can we offer support to them?

The pandemic is fraught with fear and uncertainty. It is likely to make pre-existing illnesses worse. For those injured by the pandemic, the longer it lasts the greater the chance the injury will persevere. Given that the pandemic will easily create a mental health surge (increased demand for mental health resources) that will exceed our mental healthcare capacity, we must expand our capacity. This can be done by training educators, first responders, clergy, primary care physicians, even leadership in community associations in advanced psychological first aid/ psychological crisis intervention techniques. In doing so we can not only respond to the pandemic but begin to approximate some aspect of universal mental healthcare. At least it would be a start.

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