First Responders and Trauma

Defining First Responders

The term first responder is used to describe the first person on the scene of an emergency who administers medical assistance. Hence, the person may be trained in first aid; may be military personnel, a police officer, or a firefighter; or may be a qualified paramedic, nurse, or doctor. Who the first responder is and that person's level of qualification depends on a number of things. For example, it may be coincidental that a person with medical response skills is present at the scene of an accident. Or alternatively, the person in attendance may have been called to assist. In some parts of the world, certification courses are run for first responders. Such courses involve training above the level of first aid, but not to the extent of the training health professionals, such as ambulance officers and nurses, undertake. Work roles for first responders also differ between countries. For example, being called to the scene of a medical emergency is the case for ambulance officers in the United Kingdom, Australia, and New Zealand, but is the role for firefighters in the United States and in France. In addition to professional first responders, an army of volunteers around the globe comes to the aid of those in need—for example, Red Cross or the plethora of community-based organizations such as community emergency service and fire-fighting groups. The types of events attended range from natural and human-made disasters to motor vehicle accidents and sudden medical emergencies (e.g., respiratory problems or chest pain).

Negative Consequences

The vast majority of psychological research conducted with first responders has been focused in a traditional pathogenic paradigm. Within this theoretical and applied approach, the interest is in determining what can go wrong for people whose role comprises relatively elevated levels of exposure to potentially traumatizing events, factors that may precipitate vulnerability, features of difficulties, and ways in which problems may be most successfully addressed. This valid approach has revealed much about mental health challenges in first respond-ers such as posttraumatic stress disorder (PTSD), depression, and suicidal ideation. Estimates of the prevalence of mental health challenges in this population vary enormously from less that 2% in a sample of Australian ambulance personnel to reporting significant issues for 40% of Canadian ambulance personnel. These variations result from a variety of factors such as the conceptual framework of the research and measurement tools used, but a variety of other factors clearly influences posttrauma outcomes. Some of these factors are discussed later in this entry.

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