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PTSD and First Responders

  • R. Nicholas Carleton
| Aug 05, 2014
Nicholas Carleton
Dr. R. Nicholas Carleton
Associate Professor of Psychology
University of Regina

Recently, the media have highlighted the extraordinarily destructive potential of post-traumatic stress disorder (PTSD) for first responders—EMS, Fire, and Police. The Global News headline “13 first responders, 13 suicides, 10 weeks” (July 17, 2014) has raised concerns about PTSD and our first responder community, with Labour Minister Kevin Flynn astutely supporting the urgent need for education and prevention. I could not agree more.

Let us start with some brief education. PTSD results from exposure to the risk of harm or death to oneself or others.1 The clinical presentation of PTSD varies, but always includes the following symptoms:

  • re-experiencing (e.g., recurrent distressing memories and nightmares);
  • persistent avoidance of trauma-related stimuli (e.g., avoiding people, places, objects, or thoughts that are reminders of the trauma);
  • negative alterations in thought and mood (e.g., negative beliefs about oneself, others, the world, or the causes and consequences of the traumatic event—depressive symptoms);
  • marked alterations in physical arousal and reactivity (e.g., irritability, hyper vigilance, difficulty concentrating).

PTSD can increase suicide risk, challenging physical symptoms like chronic pain, difficulties with substance abuse, and substantial interpersonal and familial problems.

That said, education is relatively easier than prevention and it is important to understand the four factors working against prevention of PTSD and other operational stress injuries (OSIs) for our first responders—for example, depression.

1. Education about mental health and available resources is a critically important improvement. However, that education must begin with the unequivocal removal of the stigma that still exists for mental health. Removing it is a process that will take time because it requires a real shift— grassroots and up—in how we all think about mental health.

2. Our first responders will necessarily be exposed to situations that are traumatic. PTSD begins with “exposure to actual or threatened death, serious injury, or sexual violence.”2 Consider for a moment the unfortunate frequency with which such events occur in our society. Then consider what we do when those events occur. We call 911 and people in white, red, and blue uniforms —I want to emphasize that they are regular people—rush in to help while others rush for safety.

3. First responders are “deployed” very differently than others whom we expect to be exposed to trauma (e.g., soldiers). For one, most first responders live in the same place they are deployed, with many deployed alone to remote areas. The nature of such deployments blurs the boundaries between areas perceived as safe and dangerous. Most first responders are deployed continuously for many years. Moreover, threats are highly inconsistent (e.g., any person or situation may become traumatic and require intervention), creating unreliable distinctions between safe and threatening people and environments. As such, being a first responder involves a perpetual state of potential threat and uncertainty, which facilitates vulnerability to mental health problems, particularly PTSD.

4. A great deal of research remains to be done regarding the development and maintenance of PTSD. We know that, although most people will be exposed to a traumatic event during their lives, the majority of people will not develop PTSD. Similarly, we know that first responders will be repeatedly exposed to traumatic events, but not all will develop PTSD. The rates for first responders are difficult to calculate because of the stigma, but estimates range up to 35 per cent. We already know that developing PTSD is not about a person being mentally or physical weak. Everyone is vulnerable to develop PTSD under certain conditions. Sometimes, it is just a case of the right person being exposed to the wrong event at the wrong time.

What we do not yet know for certain is what individual factors contribute to the complex combination of risk and resiliency variables that influence the development and maintenance of PTSD. If we did know, we could design programs to reduce risk and increase resiliency, thereby preventing PTSD. However, that information requires research over time (i.e., longitudinal studies), which is more expensive and challenging to conduct, but ultimately forms the only real answer to this complex problem. We have research teams ready, willing, and able to conduct those projects and start fixing this problem, but what we need is the support and will of the public to do so.

First responders are human first and everything else second. Too often we see the uniform and forget the person—mother, father, son, daughter, brother, sister—who must not only bear witness, but be responsible for and engage with the trauma.

When we need them, they are there: thin white, red, and blue lines standing between us and our nightmares. Surely we can, and indeed we must, do more to support those heroes —heroes who are nonetheless just as human as you and I.

About the Author
Dr. Nicholas Carleton is a faculty member at the University of Regina’s Department of Psychology. His research is supported by the Canadian Institutes of Health Research.

1    Details of the symptoms are available in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). APA, 2013, 271.

2    Ibid.

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