PTSD with First Responders

It is difficult to give an exact percentage of the number of first responders who experience PTSD. Trauma is a worldwide event, affecting first responders in every country. Among first responders in the United States, the Substance Abuse and Mental Health Services Administration suggests that as many as one in three first responders develop PTSD, and this includes firefighters, law enforcement, emergency medical technicians and paramedics, search and rescue teams, and medical examiners. 

Overall, at least 400,000 first responders in the United States have at least some of the symptoms of PTSD. Our goal at UCF RESTORES is to change the way PTSD and other trauma-related concerns are understood, diagnosed and treated so we can help those impacted by trauma regain control of their lives. I’m proud to say that our approach to treatment has proven very successful with 76% of first responders no longer meeting the diagnostic criteria for PTSD following treatment.

First responders experience more traumatic events in one week, and sometimes in one day, than most civilians will experience in a lifetime. There is still a lot of stigma associated with seeking treatment for traumatic events and many say that what they had heard over the years was “Suck it up, buttercup.” There is now more recognition that “It’s ok to not be ok.” When we speak with first responders, we start out with the following statement: “Everyone reacts to a traumatic event differently and all responses to a traumatic event are valid.” 

It’s important to address the stigma about asking for help that often exists in the first responder culture, just as it exists among many in the military. Furthermore, when a first responder asks for help, therapists need to understand the culture of first responders and be able to listen to their traumatic experiences without becoming overly emotional. So often we hear from first responders that the clinician was unable to listen to their traumatic events, leading to the first responder feeling that they are 'broken' and no one can help them. Cultural competency is critical, which is why all our licensed mental health clinicians complete a clinician awareness program through our partners at the Florida Firefighters Safety & Health Collaborative and complete ride-along immersion with the Orlando Police Department.

An important part of our work is training first responders in mental health literacy and resilience. Although there are some events from which no-one is likely to walk away emotionally unscathed (such as mass violence), we work with agencies and individual first responders to give them tools that can help them mitigate the emotional distress that is often part of their work. First, we teach first responders (and everyone with whom we work) that there is a natural course to everyone’s response to a traumatic event. So, in the immediate aftermath of trauma, difficulty eating and sleeping, having flashbacks, and thinking about the event are common and normal reactions. It is only if these behaviors do not decrease over time that clinicians start to think about the development of PTSD.  

With respect to resilience, we teach skills such as sleep hygiene, anger management and mindfulness, which often are effective in decreasing emotional distress. Furthermore, we work with individual first responder agencies to develop peer support teams – other first responders who are often the first line of defense when an individual starts to experience emotional distress. Departmental peer support teams are readily available in the case of a critical traumatic incident and although they are not trained clinicians, they are trained to know when an individual is in need of professional support and can help get them there.

At UCF RESTORES, we leverage Trauma Management Therapy, an empirically supported, comprehensive treatment program for first responders, veterans, active-duty military, and other trauma survivors suffering from PTSD and trauma-related disorders. The core of Trauma Management Therapy is exposure therapy which brings patients 'face-to-face' with very specific elements of their traumatic memory (sometimes called cues or triggers), and through repeated contact, the individual learns to process the memory and make new neural connections in the brain so that they’re no longer associating that specific sensory cue as a threat or danger.

By combining individual exposure therapy with group therapy sessions that include sleep hygiene, social reintegration, anger management and behavioral activation for depression, our program addresses each person’s unique traumatic memory while teaching skills that address aspects of PTSD other than fear and teach resilience. We feel that teaching these skills is critically important as most first responders will be going back to their jobs, and therefore, will be exposed to more traumatic events.

This is a situation that we have not had to address. Through our research, we have found that the most common situation that results in the development of PTSD is a pediatric death. Witnessing the victims of murders or suicides is also a common catalyst for the development of PTSD. It is never a sign of weakness to talk about what you’ve seen and what you’ve been through. In fact, it’s a true sign of strength to raise your hand and ask for help when needed. First responders are heroes, but they’re also human. They experience horrific events, and so often, there comes a time when they are not able to process them alone.

For those who decide to seek treatment, the stigma surrounding mental health challenges, including PTSD, is no secret. In most cases, physical and mental injuries simply aren’t viewed in the same way. If you catch the flu, you take a sick day. If you dislocate your knee, you go to physical therapy. This type of consideration is not always made for those seeking treatment for PTSD and trauma-related disorders. If left untreated, PTSD can leave those suffering feeling helpless or like they’ll never be able to lead a 'normal' life. There’s no helmet you can put on to protect yourself from emotional trauma, but you can heal from it. 

Peer support helps individuals spot potential signs of struggle within themselves and others. Through peer support, stigma barriers can be broken and open dialogue can begin. Together, departments, stations or peer support providers can provide the first intervention for someone who is in distress.

First responders are often receptive to speaking to a peer as that person 'gets it.' When a first responder’s distress impairs their functioning and a higher level of care is needed, peers often facilitate the contact with mental health professionals, making that introduction.

We do not know if peer support can help prevent PTSD, but we do know that it is a very important piece of the overall strategy to overcome the stigma of asking for help.