Guidelines for Working with
First Responders (Firefighters, Police, Emergency Medical Service
and Military) in the Aftermath of Disaster
Phillips Psy.D.,ABPP, CGP
As witnessed in response to the Oklahoma Bombing, 9/11, The
California Fires, The Tsunami, Hurricane Katrina, Hurricane Rita,
Firefighters, Emergency Medical Services, Law Enforcement and the
military (enlisted, reserve and National Guard) are the First
Responders in the face of natural and man-made disasters. Often
their response reflects a commitment to help in addition to the
on-going services they provide be it in another city or country. The
opportunity to support First Responders is facilitated by
understanding the following:
Characteristics of First Responders
Responders have a “Mission First” perspective. Any support or
response offered to these groups must recognize the importance of
and support is only viable if it is perceived as “added value”
toward achieving the goals of the mission.
Responders have a different perspective on traumatic events than
civilians. They enter into and expect to remain in dangerous, life
threatening situations to accomplish their mission. Their
threshold for the intense fear, horror or helplessness associated
with traumatic situations is different than civilians.
training, skills, personal and professional identities, First
Responders have considerable resilience to function despite
personal hardship. In most cases they return to and maintain prior
levels of functioning.
First Responders have a Band of
Brothers mentality. Their code of “ Leave
no man behind” is reflected in
courageous loyalty, as well as possible self-blame for the injury
or loss of others.
Responders expect not to get injured and not to feel stress. Their
attitude is – “Don’t get hurt, don’t feel and don’t get off the
line.” Personal injury is often experienced as personal failure.
Responders have an insider-outsider mentality. The expectation is
that outsiders will not understand and should not be told. This
often applies to partners who may feel the strain but at times
feel like outsiders.
It is difficult
for First Responders to recognize the cumulative stress associated
with their work as well as the fact that some catastrophes are so
great and disasters so extensive, that no one is spared the
hyperarousal, numbing and intrusive symptoms attendant to trauma.
( For example, it is beyond what could ever be imagined for FDNY
to lose 343 brothers in 9/11, for Reservists to look for bodies
in the aftermath of the Tsunami or for Police in New Orleans to be
caught between disaster and disorder.)
Responders come to understand that central to resilience is the
ability to manage stress and distress.
resilience of a firehouse, military unit, or
EMS team can often serve as a buffer for
cumulative stress. The shared experience of trauma often contains
and reduces the degree of traumatic impact- they are not alone
with the memory.
Responders there is often a “ functional” delay in symptoms (
anxiety, depression, PTSD) until the mission is over. Occurring
months even years later this can be alarming to them and their
In many of the
services, the major barrier to seeking care for mental health
issues is the stigma associated with mental health problems as a “
career killer. ” While this has lessened somewhat with
firefighters in New York, given the recognized traumatic grief and
need for help by so many, it remains a conflict for many who
identify themselves with their work and fear jeopardizing it in
and Chaplains are the most trusted resources used by most First
with First Responders
Support the Mission- Crucial to your overall support of the mission is your
understanding of the command structure and the role you are
assigned by the service you are identified with be it an Office
of Emergency Management , a medical unit, a volunteer agency, a
disaster team, one of the Uniformed Services etc. ) In the
aftermath of disaster, coordination of role and service is
Psychological First Aid (PFA)- This is considered “ best practice” for intervention
with First Responders in the aftermath of disaster ( Everly &
Flynn,2005; Institute of Medicine,2003;Litz, Gray & Adler, 2004)
The goal is the support of resiliency and continued functioning.
Psychological First Aid involves a variety of responses including
care for basic needs, empathic listening, normalizing of symptoms
and expected responses, psycho-education for stress reduction and
coping skills, on-going assessment and referrals for higher levels
of care. Given that First Responders have a strong sense of group
cohesion ( which command personnel seek to maintain and promote)
and often share similar trauma and loss, Group Psychological First
Aid( Group –PFA), which utilizes the elements of Psychological
First Aid in a group setting, may be particularly useful (Everly,
Phillips, Kane& Feldman, 2005).
Many of the following responses could be subsumed under the
heading of Psychological First Aid.
“ Self Care”
– Crucial to the functioning of First Responders is care of their
own basic needs. Reminders of and re-enforcement of self care (
sleep, eating, hydrating, down time- music, exercise, prayer etc.)
are important. Self-Care is generally underscored by officers in
the service who remind their personnel to take care of themselves,
but it is very difficult for First Responders to come off the line
in the face of disaster. Your role whether you are handing out
water, identifying a safe place for resting, or empathically
listening as you hand out blankets is to add value to their
functioning by being a support to their care.
The Walk Around-
Walking around during the acute and sub-acute stages of disaster
offers a non-intrusive supportive presence to assess self-care,
listen, normalize, provide information (if asked), and informally
assess the need for higher levels of care. The Walk Around brings
the support services to the First Responders. It was used by the
Military at the Pentagon after 9/11, in New York after 9/11 and
after the Oklahoma Bombing. The Walk Around should always be an
officially sanctioned intervention and is most effectively done
with a peer counselor from the service, a member of the service or
a Chaplain – If you are not part of the culture or already known
to the service, their presence lends you credibility.
“ Buddy Care”-
Given the Band of Brothers mentality, First Responders are more
likely to respond to an informal inquiry as to how their buddies
are doing than a focus on themselves. This often provides an
opportunity for sharing information on signs of stress,
normalizing of symptoms, coping skills, referrals for higher
levels of care etc. First Responders know each other. They know
when the talker stops talking or the joker is withdrawn.
– It is important to recognize the need and facilitate the use of
Chaplains when appropriate. In the military, chaplains are the
only members of the military with confidentiality. Their role is
important because disaster brings with it loss, grieving, burial
rites and an assault of belief systems.
Collaboration with Peers.
One of the lessons learned in the aftermath of previous disasters
is that close collaboration with peer counselors from within the
identified culture is a viable way to reduce barriers to mental
health care. Understanding their important contribution and
respecting the different skills that peers and professions bring
to those affected maximizes the help offered. Pre and post event
training of peers is essential and such training sessions in and
of themselves serve as an intervention that reduces the impact of
trauma of those being trained ( Castellano, 2005; Haley,2005).
Alone – Don’t Go it Alone.
First Responders is both a challenge and a privilege. Given that
First Responders are usually the front line of response in the
aftermath of disaster it is important for you to be part of an
identified group or agency in your response to them. This enhances
your credibility, effectiveness and support by others. In this
regard coordination with others, co-leadership, peer group and
supervision buffers the countertransference impact of disaster
work and restores resiliency.
Emergency Medical Services
The “ On site Academy”-residential
facility in Massachusetts open to Emergency Medical Services
recovering from PTSD. Phone 978 632-3518
“West Coast Post-Trauma Retreat”
Police Organization Providing Peer
Assistance (POPPA) Programs as the Police Organization Providing
Peer Assistance (POPPA) in NY and the Cop 2 Cop program in New
Jersey offer confidential counseling and/or 24/7 hot line support
that eliminates the fear of stigma or consequence. ( Poppa – About
Cop 2 Cop Program Confidential
Helpline for new Jersey Law Enforcement 1-866-Cop2Cop Helpline
Department of the City of New York- Counseling Service Unit
National Center for PTSD: Resources
for U.S. Soldiers Returning from Deployment ( Website offers
information and resources)
Examples of the type of information available:
This is a 24/7,365 days a year hotline
and online source for any personal or family issues. Privacy is
assured and there is no cost to the serviceperson
International toll free: 800-464-81077
This is the same as Army OneSource for
all military. It offers a 24/7 toll free information and referral
telephone service that is available worldwide to active duty,
Reserve and National Guard military members and their families.
(user id: military; password: onesource)
From the US : 1-800-342-9647
Outside the US: (country access code) 800-3429-6477 (dial all 11
Castellano, C. (2003). Large group crisis intervention for
law enforcement in response to the September 11
Center mass disaster. International Journal of Emergency Mental
Health, Vol. 5, No. 1.
Cozza, S., Huleatt,W., and James,L. (2002).Walter
Medical Center’s mental health response to the Pentagon attack.
Military Medicine, Vol. 167, Suppl. 4:12, pp. 12-14.
Department of Veterans’ Affairs, Department of Defense
(2004). VA/DoD Guidelines for the management of posttraumatic
Jr. & Flynn, B.W. (2005). Principles and practice of acute
psychological first aid after disasters. In G.S. Everly, Jr. & C.L.
Parkers (Eds). Mental health aspects of disasters: Public
health preparedness and response, Vol. I. Baltimore: Johns
Hopkins Center for Public Health Preparedness.
Everly,G.S., Phillips,S., Kane,D., and Feldman,D. (2005) “
Principles and practices of group psychological first aid ( Group-PFA).
Manuscript submitted for publication.
Haley, M. (2005, February 19).” An immunization against
stress…pre-incident education.” ICIF. 8th World
Congress on Stress, Trauma, and Coping,
Halloway, J. (2004). Psychologists help reduce stress in
the military. Monitor, APA, Vol. 35, No. 2, Feb. 2004.
Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D.
and Koffman, R. (2004). Combat duty in
Afghanistan, mental health problems, and barriers to care. The
Journal of Medicine,
Vol. 351, pp.
Medicine (2003). Preparing for the Psychological Consequences
of Terrorism. Washington D.C.: National Academy Press.
Karam, J. (2002). Into the breach: a year of life and
EMS. New York:
St. Martin’s Press.
Kates, A. R. (2001). Copshock: Surviving posttraumatic
stress disorder (PTSD). Tuscan: