Abstract
Traumatic events can disrupt the mental well-being, not only of the victim but also of those who are the first to respond in such situations. Studies have shown that many first responders have exhibited signs of PTSD at any given time during their active years, while others have committed suicide as a result of struggling with PTSD. Some of the first responders have reported that they have tried committing suicide at least once. Despite being trained to handle any form of traumatic situations, these first responders are human. The responders are still vulnerable to PTSD as a result of continuous exposure when dealing with graphic events such as tragic car and plane accidents, fire breakouts leaving scores of burnt bodies, and mass shootings. There has been relative neglect of these professionals in that little or no help has been advanced to them in terms of emotional support. This neglect has also facilitated the first responders' vulnerability to PTSD. The accumulation of negative and disruptive emotions makes these people even more vulnerable to PTSD. In order to devise measures to reduce first responders' susceptibility to PTSD, there is a need to identify the relationship between the dose of traumatic events and the first responders' vulnerability to PTSD. By determining this relationship, it will be easier to come up with recommendations that will subsequently curb this problem. This research paper aims to review the studies that have been conducted on the topic.
Keywords : Trauma, traumatic events, first responders, vulnerability, PTSD.
Introduction
The first responders are typically the first people to arrive in scenes involving extreme injuries and loss of lives. Despite the potential effects these graphic scenes may have on them, these people are expected to provide emotional and physical assistance to the accident victims without showing signs of being affected by the situation. These routine duties gradually affect first responders, and the possibility of them being susceptible to PTSD increases. Estimations show that about 30 percent of first responders have shown PTSD symptoms at one point in their lives due to continued exposure to traumatic events.
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To devise effective measures to curb vulnerability to PTSD, there is a need to determine whether the dose of the traumatic event affects a first responder's likelihood to show PTSD. The dose of a traumatic event refers to how extreme the traumatic event that the responder has to attend to is. Therefore, it is vital to assess the connection between the intensity of traumatic events and the vulnerability of the first responders to PTSD.
Research Findings
The dose-response model can explain the relationship between traumatic events and the first responders' vulnerability to PTSD. This model posits that the probability of developing PTSD after experiencing a traumatic event is reliant on the intensity of the traumatic event. It also hypothesizes that people's vulnerability to PTSD increases as they continue being exposed to traumatic events, and upon reaching a certain threshold, one that they can no longer handle emotionally, they experience full-blown PTSD. Neuner (2004) conducted a study to examine the Dose-response modeling hypothesis. The study comprised Sudanese citizens living in Southern Sudan and Ugandan citizens, and Sudanese refugees living in Northern Uganda. The study was to determine the impact of continued exposure to distressing events caused by the civil war in these areas. Study findings showed that out of the 3371 individuals who participated, 3179 showed PTSD symptoms due to continued exposure to traumatic war events. PTSD rates were highest among the Sudanese refugees in Northern Uganda (50.5%) due to intense war in that area. Therefore, Neuner (2004) concluded that PTSD vulnerability increases as a person is frequently exposed to traumatic events.
Another study was conducted by Bergen-Cico (2015) to assess the link between exposure to traumatic events and PTSD vulnerability. The research focused on two groups of first responders; those who responded to major natural and man-made disasters, which are not frequent, and those stationed in urban areas where the frequency of accidents is high. The results showed that 32% of the first group of responders exhibited PTSD, while 35% of those in group two showed PTSD traits. Natural and man-made disasters may be traumatic but are neither frequent nor long-lasting. Therefore, the first respondents to such events are not continuously exposed to traumatic events and are less vulnerable to PTSD. On the other hand, first respondents in urban areas have to regularly deal with traumatic cases, which can increase these individuals' vulnerability to PTSD.
More researchers have concurred with the hypothesis that there is a relationship between the dose of traumatic events and the vulnerability of exhibiting PTSD by first responders. Benedek (2007) focused his study on three groups of first responders; fire brigade, search-and-rescue team, and nurses. The group with the nurses had two subgroups. One subgroup had been deployed on a hospital ship during the Iraqi Freedom Operation while the other subgroup had not been deployed. Those who had been assigned to the ship encountered traumatic scenes ranging from badly injured soldiers to dead bodies, some of which had been destroyed beyond recognition. PTSD rates were higher among these nurses than those who had no experience of the hospital ship's events. Among the firefighters, Benedek (2007) found that increased exposure to traumatic events, coupled with perceived threat and proximity to death by fire, triggered PTSD symptoms among this group. Generally, the study put the vulnerability rate of firefighters to PTSD at 18%, at a continued exposure rate of 1-4 years. Likewise, in the search-and-rescue personnel group, there were two subgroups. One contained individuals who had responded to highly traumatic incidents such as 9/11, while another subgroup comprised individuals who were either not unassigned or their assignments were less traumatic. Findings showed high levels of PTSD symptoms among those who responded to extremely traumatic situations than those whose assignments were less traumatic.
In an effort to explain the link between doses of traumatic events and vulnerability of first responders to PTSD, Bezabh (2018) assessed the factors that may contribute to PTSD among first responders at Addis Ababa Fire and Emergency Control and Prevention Service authority. Out of the 603 participants, 18.1 percent reported perceived threats in the course of their operations. These participants also reported that some of these threats affected their emotional wellbeing negatively for a long time after the incident. 19.9 percent of the respondents were found to exhibit signs of PTSD. The prevalence was even higher among the search and rescue workers' group at 39 percent. The higher PTSD vulnerability rate among this group was the nature of their job, which comprised seeing badly mutilated bodies and hearing cries of people who need to be rescued, some of which gradually decline as the victims get weaker and die. Continued exposure to these events increases the vulnerability of the first responders to PTSD. If no social support is extended to them, they may find themselves overwhelmed by post-traumatic stress disorders.
The concept of vicarious traumatization can also explain first responders' vulnerability to PTSD. This concept defines the alteration of a worker's emotional cognition due to an empathetic engagement with a traumatized individual. First responders engage with traumatized victims every time they are called into a scene of accident. As they continue engaging with them over time, their vulnerability to PTSD increases. The frequent processes of hearing and witnessing graphic details of traumatic events contribute to the workers' gradual development of PTSD (Regher, 2005).
The intensity of the traumatic event has the propensity to increase the vulnerability of first responders to PTSD. Regher (2005) describes some of the statements by first responders. One interviewee narrated how they were responding to a collision between several vehicles and a transport truck. As they were removing two bodies from one vehicle, they found a dead baby in the back seat. Another firefighter narrated how two badly-burnt victims died as he helplessly watched. Both of these responders admitted that these incidents remained in their minds for a very long time and affected their mental health. The feelings described by the first respondents that were interviewed are similar to those explained in another study by Fjeldheim (2014), which found out that first responders that showed signs of PTSD stated that they had experienced highly traumatic incidents.
Conclusion
The studies that have been reviewed for this paper have affirmed a relationship between the dose of traumatic events and first responders' vulnerability to PTSD. One factor that has remained constant across all the studies is that exposure to traumatic events for a long time contributes to the responders' vulnerability to experiencing PTSD. There is a need to devise measures that will ensure their mental well-being is taken care of to reduce their vulnerability to PTSD. One effective way of helping first responders is to establish trauma response centers on a large-scale basis. In the communities that these centers have been established, they have helped the first responders effectively address any PTSD symptoms they may have.
Furthermore, personal accounts of first respondents have confirmed that exposure to traumatic events may trigger PTSD vulnerability. Thus, there is a need for the respondents to be aware of any symptoms which may show that they have PTSD. Experts and scholars need to develop a self-assessment toolkit that first responders can use to conduct a self-evaluation in order to determine their mental and emotional welfare. If the self-evaluation shows that they may be showing PTSD symptoms, then consulting trained professionals would help address this problem. These recommendations would go a long way in helping reduce these professionals' vulnerability to PTSD despite being exposed to traumatic incidents frequently.
References
Benedek, D. (2007). First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers. Annual Review Of Public Health , 28 (1), 55-68. https://doi: 10.1146/annurev.publhealth.28.021406.144037
Bergen-Cico, D. (2015). The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain. International Paramedic Practice , 5 (3). https://doi: 10.12968/ippr.2015.5.3.78
Bezabh, Y. (2018). Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study. BMJ Open , 8 (7), e020705. https://doi: 10.1136/bmjopen-2017-020705
Regehr, C., & Bober, T. (2005). In the line of fire . New York: Oxford University Press.
Fjeldheim, C. (2014). Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emergency Medicine , 14 (1). doi: 10.1186/1471-227x-14-11
Neuner. (2004). Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC psychiatry , 4 (1), 1-7.
