Traumatic Incident Stress for First Responders

Emergency workers must respond quickly to natural disasters, such as earthquakes or hurricanes, and to man-made disasters, such as technological failures, accidents, or terrorist attacks. These workers are at risk of experiencing stress from what psychologists refer to as a traumatic incident. A traumatic incident is one that may involve exposure to catastrophic events, severely injured children or adults, dead bodies or body parts, or a loss of coworker. All workers involved in the response activities are recommended to help themselves and their coworkers, and to reduce the risk of experiencing stress associated with a traumatic incident by utilizing simple methods to recognize, monitor, and maintain health on-site as well as following such experiences.

Symptoms of Stress

Workers may experience physical, cognitive, emotional, or behavioral symptoms of stress. Some people experience these reactions immediately at the scene, while, for others, symptoms may occur weeks or months later.

Physical Symptoms

Workers experiencing any of the following symptoms should seek immediate medical attention:

• Chest pain
• Difficulty breathing
• Severe pain
• Symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils)

Workers may also experience the following physical symptoms. If these symptoms occur over time or become severe, workers should seek medical attention. Additional physical symptoms include

• Fatigue
• Nausea or vomiting
• Dizziness
• Profuse sweating
• Thirst
• Headaches
• Visual difficulties
• Clenching of jaw
• Nonspecific aches and pains

Cognitive Symptoms

If these symptoms occur on the scene, workers may not be able to stay clearly focused to maintain their own safety or to rescue injured victims. Workers may experience momentary cognitive symptoms; however, if symptoms are chronic or interfere with daily activities, workers should seek medical attention. These symptoms include

• Confusion
• Disorientation
• Heightened or lowered alertness
• Poor concentration
• Poor problem-solving
• Difficulty identifying familiar objects or people
• Memory problems
• Nightmares

Emotional Symptoms

Strong emotions are ordinary reactions to a traumatic or extraordinary situation. Workers should seek support from a disaster mental-health professional if symptoms or distress continue for several weeks or if they interfere with daily activities. Emotional symptoms include

• Anxiety
• Guilt
• Denial
• Grief
• Fear
• Irritability
• Loss of emotional control
• Depression
• Sense of failure
• Feeling overwhelmed
• Blaming others or self
• Severe panic (rare)

Behavioral Symptoms

As a result of a traumatic incident, workers may notice the following behavioral changes in themselves or their coworkers:

• Intense anger
• Withdrawal
• Emotional outburst
• Temporary loss or increase of appetite
• Excessive alcohol consumption
• Inability to rest, pacing
• Change in sexual functioning

Recommendations to Monitor and Maintain Health On-Site

Responders need to take care of their own health to maintain the constant vigilance they need for their own safety. Responders must be able to stay focused on the job in the dynamic, changing emergency environment. Often responders do not recognize the need to take care of themselves and to monitor their own emotional and physical health. This is especially true if recovery efforts stretch into several weeks. The following guidelines contain simple methods for workers and their team leaders to help themselves and their team members. These guidelines should be read while at the site and again after workers return home.

Control the organization and pace of the rescue and recovery efforts.

• Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.
• Watch out for each other. Coworkers may be intently focused on a particular task and may not notice a hazard nearby or behind them.
• Be conscious of those around you. Responders who are exhausted, stressed, or even temporarily distracted may place themselves and others at risk.
• Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work environments. Mental fatigue, particularly over long shifts, can greatly increase emergency workers' risk of injury.

Maintain adequate nutrition and rest.

• Eat and sleep regularly. Maintain as normal a schedule as possible, and adhere to the team schedule and rotation.
• Drink plenty of fluids, such as water and juices.
• Try to eat a variety of foods, and increase your intake of complex carbohydrates (e.g. breads and muffins made with whole grains, granola bars).
• Whenever possible, take breaks away from the work area. Eat and drink in the cleanest area available.

Monitor mental and emotional health.

• Recognize and accept what you cannot change—the chain of command, organizational structure, waiting, equipment failures, and so forth.
• Talk to people when you feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it. Choose your own comfort level.
• If your organization provided you with formal, mental health support, use it!
• Give yourself permission to feel rotten: You are in a difficult situation.
• Recurring thoughts, dreams, or flashbacks are normal—do not try to fight them. They will decrease over time.
• Communicate with your loved ones at home as frequently as possible.

Recommendations to Maintain Health Following the Incident

Over time, workers' impressions and understanding of their experience will change. This process is different for everyone. No matter what the event or an individual's reaction to it, workers can follow some basic steps to help themselves adjust to the experience:

• Reach out—people really do care.
• Reconnect with family, social, and community supports.
• Consider keeping a journal.
• Do not make any big life decisions. However, make as many smaller, daily decisions as possible to give yourself a feeling of control over your life.
• Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.
• Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
• Remember that "getting back to normal" takes time. Gradually work back into your routine. Let others carry more weight for a while at home and work.
• Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress.
• Appreciate a sense of humor in yourself and others. It is okay to laugh again.
• Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication.
• Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem.
• Get plenty of rest and normal exercise. Eat well-balanced, regular meals.