Training & Education

Beyond Debriefing: How to Address Responders’ Emotional Health

First responders need time with colleagues to decompress after responding to an incident.

On Christmas Day 2011, a 9-year-old girl was killed when a tree fell through her family’s moving car on Whidbey Island in Washington state. Firefighter and EMT Rob Harrison was among the first on the scene. He knew the girl. He looked into her mother’s eyes. He said he did something a first responder will rarely admit to. “I broke down and cried on the scene.”

Despite professional training, traumatic events take their toll on first responders. Children’s deaths hit particularly hard, leaving psychological scars that can have a devastating impact in the short and long terms.

As many as 37 percent of firefighters meet criteria for a diagnosis of post-traumatic stress disorder (PTSD), according to the journal Fire Engineering. A decade after 9/11, about 1,000 of 5,000 Long Island first responders still showed symptoms of PTSD. After the Newtown, Conn., massacre, as many as seven police officers — more than 16 percent of the local 43-member force — were out at one time with PTSD issues, according to Police Chief Michael Kehoe.

The emergency management community has taken some steps to address the emotional needs of those who rush to a disaster scene. But experts say there’s much more that could (and should) be done.

Addressing Emotional Needs

The question of emotional health among first responders has been getting more attention lately. After the Boston Marathon bombings, for instance, Police Commissioner Ed Davis took the unusual step of calling for large-scale counseling efforts. “Officers that I have talked to have been extremely traumatized and saw things that you would see on a battlefield. We are extremely concerned about that,” Davis told The Wall Street Journal.

In recent years, the standard answer to first responders’ emotional needs has been the critical incident stress debriefing, an often mandatory gathering of those hit hardest by the trauma of disaster. Authoritative voices, however, say these interventions are insufficient.

The World Health Organization, for instance, says a psychological debriefing “should not be used for people exposed recently to a traumatic event,” and may do more harm than good.

While such debriefings have been common practice for first responders, the value hasn’t been scientifically demonstrated, said Kathleen Tierney, sociology professor and director of the Natural Hazards Center at the University of Colorado, Boulder. “This is something that doesn’t have much science behind it,” she said. The largest drawback: Debriefings are simply too generic. “One-size-fits-all debriefings are not appropriate.”

Yet the need for some intervention is indisputable.

“First responders in disaster situations and other kinds of major emergencies are confronted with things that can be psychologically very disturbing,” Tierney said. “The sight of dead bodies, people who lost limbs, people who are trapped, seeing children who have been killed or injured.”

The lasting effects of such exposure can include depression, anxiety and withdrawal. If generic debriefings aren’t the answer, what else can emergency managers do to ensure that responders
are properly cared for?

Lay the Groundwork

As with so many aspects of emergency management, post-trauma care often comes down to planning, said Jeff Upperman, director of the Trauma Program and the Pediatric Disaster Resources and Training Center at Children’s Hospital Los Angeles.

Adam Stone  |  Contributing Writer

Adam Stone is a contributing writer for Emergency Management magazine. Stone writes on business and technology from Annapolis, Md. He also contributes to Government Technology magazine.

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