Secondary Trauma among First Responders

Police officers, firefighters, and emergency medical technician (EMT) or paramedics, collectively referred to as first responders, are routinely called on to respond in situations involving car accidents, homicides, suicides, abuse, neglect, severely ill individuals, or families that are in crisis. First responders are duty bound to try to intervene in these emergencies. Even though the first responder may not experience a direct personal threat, simply being present at a traumatic event may cause the first responder to have a stress reaction. Responding to the injury or death of others, with no direct threat to the safety or well-being of the first responder is an indirect traumatic exposure. This indirect traumatic exposure can lead to a stress response known as secondary traumatization and has been referred to as vicarious traumatization. This entry discusses secondary trauma, including critical incidents and methods of coping with secondary trauma, as it relates to first responders.

Secondary trauma in first responders is a significant concern because of the nature of emergency work. In the emergency services, first responders are routinely exposed to violent, gruesome, tragic, or otherwise traumatic situations. In attempting to render assistance, first responders may react emotionally, feeling a sense of responsibility at the outcome or empathy for the patient or family. This emotional reaction may be strong enough to impede the responder's ability to perform his or her duties.

When a situation exceeds a responder's normal capacity for coping, it is known as a critical incident. An incident is considered a critical incident if it causes the first responder to have an abnormally strong emotional reaction that has the potential to interfere with functioning either at the scene or afterward. For first responders, common critical incidents may include calls involving the threat of violence toward the first responder, the injury or death of a coworker, the injury or death of a civilian as the result of emergency operations, the injury or death of an infant or child, a mass casualty incident (i.e., an incident with multiple victims), an event that attracts the attention of the news media, or response to an emergency involving a friend or family member.

Because of the nature of emergency response work, first responders have the potential for frequent and repeated exposure to critical incidents. Multiple exposures to critical incidents increase the potential for exposure to secondary trauma. First respond-ers may have a stress reaction because of exposure to one critical incident. However, responders may also have a stress reaction as the result of a series of events (for example, multiple deaths in a short period). Responders may also have an increased [Page 590]risk for a stress reaction if they are experiencing a high level of chronic stress. Chronic stressors include conflict with supervisors or colleagues, exhaustion because of long work hours, inadequate resources, or work-related health issues (e.g., back pain).

A significant majority of first responders are exposed to traumatic events as part of their work. However, exposure to a critical incident does not necessarily mean the responder will have a negative reaction to that event. If a first responder does develop a stress reaction, the symptoms may be similar to posttraumatic stress disorder. The responder may have problems with persistent reexperiencing of the event (for example, in dreams or flashbacks), avoidance of reminders of the traumatic event, or an increased level of arousal (such as difficulty sleeping or irritability). It is common for responders to have some of these symptoms at one point or another in their careers. However, symptoms may subside on their own. The responder should seek help if symptoms persist for more than one month or are interfering with the responder's home or professional life.

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