TRAINING MODULES

Who are first responders

Who are first responders

 

First responders or Protective Service Workers  are those who respond to manmade and natural disasters. First responders are those professionals working within the following fields:

  • Firefighter servants
  • Law enforcement
  • Emergency medical services
  • Search and rescue
  • 112 operators and dispatchers
  • Emergency room staff (including doctors and nurses)
  • Psychotherapists, etc.

These groups of professionals experience daily career exposure to acute stress and trauma as well as direct or secondary trauma from the work environment.

 

Impact on people

The impact on people will be different and will involve a wide range of reactions and feelings: Confusion, insecurity, stress, fear, anxiety, insensitivity, indifference, or in severe cases, trauma.

Disasters psychological impact on persons can depend on different factors:

    • The type of the event
    • The environment and the circumstances
    • The personality characteristics and the individual vulnerability of the survivors/affected ones (personality and ability to cope with the catastrophic event).

In emergency situations everyone has psychological coping mechanisms, but some are especially vulnerable or might need additional help (children, teenagers, adults, parents/primary caregivers, interveners, other professionals with affected persons, etc.)

 

Preparing and organizing response to disasters

First responders train for many types of disasters, but the larger the event with the greater amount of individuals displaced and injured, the greater the exposure that can create response and management issues. Mental health professionals may be involved with preparing for and responding to traumatic incidents and disaster situations. These may include incidents limited to the department and/or larger community situations. In order to respond most effectively, it is important to consider several aspects, such as the type of disaster they face.

 

TYPES OF DISASTERS

  • Natural disasters: wildland and/or forest fires, earthquakes, a tsunami, hurricane, flood, epidemic, structural collapse, etc.
  • Man-made events: torture, acts of terrorism, war, drug cartel wars, school shootings, gang warfare, robbery, arson, bombs, etc.

 

Self-care in first respondents

ALERT SIGNS

  • Fatigue, tiredness, irritability, sleep problems, headaches, digestive problems
  • Anxiety, irritability, guilt, aggressiveness, pessimism
  • Focusing problems
  • Communication problems

SUPPORTING ACTIONS

  • Resting and allowing oneself time for disconnecting
  • Spending time with family and friends
  • Exercising regularly
  • Leisure, cultural activities & hobbies
  • Contact with nature,
  • Practising relaxation and meditation techniques
  • Sunbathing carefully about 30 minutes a day

 

Professional trauma

Professional trauma is responding to and witnessing an actual or perceived threat to the safety/integrity of self or others that may result in intense fear or helplessness in response to an event.

Compared to the general population, with an estimated 6.8% lifetime prevalence rate of PTSD for adults, first responders are at increased risk for developing PTSD

“Powerless in the face of an event” often is what causes the client to experience the event as traumatic. One of the examples of such critical incidents may include natural disasters and multiple fatalities or seriously injured survivors.

In addition to witnessing and experiencing horrific natural and manmade events as part of the career, targets of professional exposure include:

  • death notifications;
  • personal exposure, when professional colleagues are hurt or killed in the line of duty;
  • unique sensory flashbacks;
  • residual impact of habitual stoicism, depersonalization and derealization.

 

Stoicism, Depersonalization & Derealization

Stoicism, depersonalization, and derealization are three common psychological defense mechanisms used by first responders to deal with the wear and tear of the career.

    • Stoicism is a cultural expectation in that first responders are expected to not be impacted by the events to which they respond. This expectation manifests in a unique sense of humor, which can be interpreted as cold and/or disrespectful by others. The uniform and mask of first responders is used to cope with the career and is expected by the culture.
    • Depersonalization is experiencing an event, but feeling like it is happening to someone else.
    • Derealization is experiencing an event, but feeling like it isn’t real.

 

Post Incident Services: After Action Review (AAR)

An “After Action Review” is a common term used in military, law enforcement, and first responders. An AAR is a meeting of the professionals who responded to an event and later review the events in order to improve services and safety for professionals. An AAR often includes the following questions posed to the professionals who responded to the event.

  • What was expected to happen? What was our mission?
  • What actually occurred?
  • What went well and why?
  • What can be improved and how?
  • What could have gone better?
  • What might we have done differently?
  • Who needs to know?

 

Psychological Component of the AAR

Capitalizing on a known process for first responders, therapists may consider adding a psychological component to the AAR, using a CISD/CISM model of response, or a combination of the two. The following questions can expand the AAR to address the psychological impact of the event.

How did it impact me?

What do I need to do to care for myself?

How do I get closure?

Who else is struggling?

What if anything do I need/want to do for my brothers 

and sisters who also experienced this exposure?

How does this impact our next call? Our next shift?

By teaching first responders to consider these questions, an awareness of the impact of the exposure begins to grow.