First Responders and the Physiological Aspects of Trauma

First Responders at a Trauma Scene

By Victoria Delheimer, LMFT, LCMHC, CDWF, CCTP, Executive/Clinical Director for Journey Healing Centers, with Laurie Sue Brockway

In the course of the day there is a myriad of ways that average people are exposed to disturbing events, often simply by listening to the news or seeing the replay of graphic images on the internet. Hearing about awful things secondhand can make you sad, angry or afraid and can lead you to try to quell or avoid the feelings.

So just imagine the impact on first responders. Trauma is an occupational hazard with first responders, and an assumed part of the profession. These police officers, firefighters and EMTs are the individuals who run toward the scene of a catastrophe as others run from it. First responders are viewed as strong, stoic, helpful and brave. Most take their role very seriously. In fact, they are their jobs. They try not to take their work home and don’t talk about the things they experience with friends or family. It could be that they fear losing their jobs if it looks like they are not “handling things” or because being vulnerable and open is unfamiliar. What they don’t understand is that their continued exposure to trauma has a cumulative effect and can have lasting consequences if not addressed.    

How Trauma Manifests in the Body

To begin healing from traumatic events, it is important to understand how trauma impacts the brain and body. The autonomic nervous system plays a major role in how we react to trauma. It is a control system that acts largely unconsciously and regulates bodily functions such as respiration, cardiac regulation and vasomotor activity. It is made up of the sympathetic nervous system – the fight, flight or freeze reaction we all have when we are stunned or caught in an emergency situation – and the parasympathetic nervous system, which is sometimes referred to as “rest and digest” as it aims to conserve energy.

Every time a first responder heads to the scene of an accident, crime or catastrophe, the nervous system becomes activated. If a police officer, for example, goes to the scene of a car accident and witnesses a body in a horrific condition, there is a physiological response. Despite the body’s response, the first responder will do whatever necessary to get through the crisis. However, the body does not forget. After experiencing a significant traumatic event, the brain becomes hyper-sensitized which means it responds at the slightest trigger or reminder of a previous traumatic event even when there is no real immediate danger.

Everyone experiences this physiological process. For example, consider what happens to you immediately following a car accident. After the accident, you feel stunned, shaken. You may become nervous just getting into your car, your heart rate increases or your palms get sweaty. You might find reasons not to drive for a few days. You notice that every time you get into the car for the next few weeks you could swear every other driver is out to hit you.

This is what happens to first responders, but it happens over and over again. The brain, acting on past learning, is on alert for danger around every corner. And over time, the brain can get stuck in a tense fight, flight or freeze reaction because it’s accustomed to being in that state so often.

The Consequences of Untreated Trauma

Like military personnel, first responders are at high risk for PTSD if not addressed. Symptoms of PTSD can include intrusive thoughts, emotional distress, and nightmares or flashbacks. Physiological symptoms of PTSD can include:

  • Increased heart rate
  • Elevated blood pressure
  • Higher risk of coronary heart disease
  • Inflammation in the body
  • Compromised immune system

There is also a spectrum of trauma-related reactions, such as irritability or aggression, risky or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, and difficulty sleeping.

Of great concern is the increased risk of suicide for police officers, fire fighters and EMT workers, as well as members of the armed forces. The National Surveillance of Police Suicide study of 2012 showed a suicide rate for police officers of 14 per 100,000 and 20 per 100,000 for Army, as compared to 11 per 100,000 in the general population. The CDC reported in 2012 that among females, the highest suicide rates occurred among people in three occupational groups, including protective service occupations (e.g., law enforcement officers and firefighters). Police die more from suicide than from accidents on the job.

If not addressed, trauma can lead to severe depression, anxiety, behavioral issues and substance abuse. Those suffering from the impact of trauma may withdraw and stop communicating, wreaking havoc on trauma sufferers and their families.

‘I’m Just Doing My Job’

Many first responders don’t know they’re suffering the effects of cumulative trauma. Although they are doing their jobs, the mayhem that happens repeatedly over time can teach the body to feel and react as if it is always in danger. The mindset of service to others is so strong that even when a person in these professions recognizes they are experiencing problems, they get into the habit of just “getting through it.”

Even if they do take a moment to “debrief,” sometimes the message they receive is to “get over it and get back to work.” Perceived weakness is not allowed on the job. It is not uncommon to suffer in silence.

Get Familiar with Trauma to Heal It

It is crucial to identify trauma and its causes, and become knowledgeable about how it impacts everyday life. Once first responders understand the process, they can learn to self-regulate and develop tools and techniques to implement during stress to prevent the brain from being hijacked.

The driver who has been through an accident can learn to process their reactions: I’m not going to have a car accident. I’m okay. There’s nothing to indicate that I’m at risk right now. I can get through this. Same goes for the first responder whose trauma is intensified by countless tense moments and traumatic episodes. There is a way to normalize trauma: My breathing is fast, my heart is racing and I am sweating, but I can breathe through it. I don’t have to live in survival mode.

There are ways to desensitize and integrate trauma by going through the steps that led them there. Once first responders acknowledge and unpack the ways traumatic events have gripped their lives, they can loosen trauma’s hold.

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