Trauma
What is Trauma?
Trauma is the Greek word for “wound” and refers to the emotional injury suffered from terrible events (such as those involving death or injury). Traumatic exposure can occur directly (examples include being physically assaulted or nearly killed in a car accident) or indirectly (also referred to as vicarious trauma, such as when one is a first responder to the scene of a mass casualty event).
Types of Traumatic Events Faced by First Responders
First responders are frequently exposed to events that many people would consider to be extreme or traumatic in nature. Police psychologist Dr. John Nicoletti has noted that first responders are exposed to four types of trauma:
“Too Much, Too Ugly, Too Soon”
Traumatic experiences of this type occur suddenly. Witnessing a victim being suddenly killed is an example of this type of trauma.
The key feature of this type of trauma is that first responders have little or no time to prepare for the psychological impact of what they encounter.
“Too Much, Too Ugly, Too Long”
Sometimes first responders are faced with cumulative or prolonged exposure to trauma, such as when working long-term in special assignments that involve repeated exposure to disturbing imagery, victimization of children, or loss of life.
The key feature of this type of trauma is that managing the stressors becomes increasingly more difficult as one’s coping resources are diminished over time.
“Too Much, Too Ugly, Too Similar”
First responders sometimes encounter traumas that are either similar to other traumatic events they’ve previously endured, or in some way connect to others aspects of their lives (such as responding to the death of a child who is of similar age to one’s own child).
The key feature of this type of trauma is that the impact is heightened by the perceived relationship to one’s past or current circumstances.
“Too Much, Too Ugly, Too Different”
Some first responders encounter traumas that are particularly unusual, extreme, or different from what has been encountered in the past. Examples include bizarre violent crimes and mass casualty events.
The key feature of this type of trauma is that the unpredictability or unfamiliarity leaves the first responder without an anchor or reference point to help make sense of the event.
Types of Traumatic Events According to the DSM-V
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition), examples of traumatic events, some of which are much more common than others, include (but are not limited to):
- Threatened or actual physical assault
- Threatened or actual sexual assault
- Being kidnapped
- Being taken hostage
- Terrorist attack
- TortureIncarceration as a prisoner of war
- Natural or human-made disasters
- Severe motor vehicle accidents
- Sudden, catastrophic medical incidents
- Observing threatened or serious injury
- Witnessing the unnatural death or violent assault of another person
Responses to Traumatic Events
There are many different responses to crisis. Most survivors have intense feelings after a traumatic event but quickly recover; others have more difficulty — especially those who have had previous traumatic experiences, who are faced with ongoing stress, or who lack support from friends and family — and will need additional help.
Responses to traumatic events vary widely and can include a sense of shock or denial, intense or unpredictable feelings (which may include fear, anxiety, grief, anger, or sadness), vivid memories of the event, flashbacks, sensory intrusion (i.e., being reminded of the event through smells, sights, or sounds), physical symptoms (such as chest pain, nausea, or headaches), and disruptions to one’s normal life patterns (e.g., sleep patterns and eating patterns) and world view (i.e., undermining our beliefs about how the world is supposed to operate).
Professional Support is Available
Caring for Your Fellow First Responders Following a Critical Incident
When a first responder has been involved in a traumatic incident, support should be provided as soon as possible. As a fellow first responder, there are things you can do to help that do not require specialized training (these suggestions are adapted from a book entitled Preparing for the Unimaginable: How Chiefs Can Safeguard Officer Mental Health Before and After Mass Casualty Events).
Safety First: Ensure that the first responder is safe, that medical attention is provided if circumstances allow, and that reassurances of safety are communicated.
Practical Help: Ask what you can do to help. For example, they may be hungry, thirsty, or require assistance contacting their loved ones. Your genuine concern is important.
Do You Want to Talk?: Offer to talk, if they wish, but don’t insist on talking if they don’t wish to engage with you.
Listen Closely: If the first responder you’re assisting wishes to talk with you, listen attentively. You don’t need to feel pressured to ask detailed questions or solve problems; simply listening may be enough.
Provide Reassurance: If the first responder appears upset or distressed, provide reassurance that they are having a normal reaction to an abnormal circumstance.
Follow Through: Help ensure that your fellow first responder makes it home safely and and has access to necessary support resources.
Caring for Yourself Following a Critical Incident: The Post-Traumatic Incident Self-Care Checklist
Caring for yourself following a traumatic incident is of the utmost importance. Traumas test our resiliency, and it is unreasonable to expect that you should be able to absorb the impact of extremely stressful events without taking the necessary steps to care for yourself physically and emotionally. In addition to seeking out professional help, the following checklist outlines recommended self-care strategies that you may wish to implement following your exposure to a traumatic event.
- Avoid drugs and alcohol
- Be open to receiving support from those you trust
- Reach out to trusted family, friends, and co-workers who support you
- As much as possible, maintain a normal and active routine
- Exercise regularly
- Get plenty of sleep and rest
- Maintain a nourishing diet comprised of regularly scheduled healthy meals
- Consider writing down your thoughts and emotions to help organize your internal experience (it is recommended that you shred the writing if you wish to ensure your privacy)
- Avoid major life decisions that you may later regret (e.g., deciding whether or not to get married or buy a new house)
- Make many inconsequential decisions (e.g., selecting what to eat for lunch or what time to go for a run) to help reestablish a sense of control
- Understand that having strong feelings (including anxiety, anger, worry and fear) following a traumatic event is normal, and the “normal” range of personal responses following a traumatic incident varies widely from person to person
- Focus on what you can influence while letting go of what you cannot control
- Give yourself permission to feel however it is that you feel, while not imposing upon yourself any sense of obligation to maintain or preserve negative emotions
- Understand that emotional states are temporary and most people “bounce back” sooner or later following a traumatic event
- Keep in mind that you are only human, we are all prone to error, and even people who are the best in the world at what they do routinely make mistakes
- Be aware of “red flags” that signal you need help (e.g., frequent crying, excessive worry, anxiety, fearfulness, sadness, confusion, anger, sleep disturbance, or increased use of alcohol or other substances), and seek out support
- Consider reaching out to others who may be having difficulties; reassuring and helping others can be one of the most effective ways to recover as a team
- Communicate your needs to others in a clear and unambiguous manner
- Be patient and compassionate with yourself and others who may also be experiencing stress
Sources: (1) DSM-V; (2) National Alliance on Mental Illness. 2016. Preparing for the Unimaginable: How Chiefs Can Safeguard Officer Mental Health Before and After Mass Casualty Events. Washington, DC: Office of Community Oriented Policing Services; and (3) The National Institute of Mental Health.
© 2017 Cordico LLC. All Rights Reserved.
