“Trauma creates change you don’t choose. Healing is about creating change you do choose.” –Michelle Rosenthal

By Amelia Buckley and Kristy Jansen

As we move in to a second spring colored by coronavirus, we all feel the toll.  For those of us who have been working from home and living in various levels of lock-down depending on our jurisdiction or seasonal virus levels, time has become slippery.  What even is a weekend when a Sunday is pretty much the same as any Wednesday?  Many of us have lost jobs, businesses and other forms of stability.  Many have lost loved ones. Many are suffering. 

Then there are the people who have been called into service over this last year who have seen things, experienced things that are unimaginable to anyone not involved.  Many hospitals were challenged by the Covid-19 pandemic, and in in some cases even overwhelmed by patients, as emergency rooms were under siege and ICUs exceeded capacity.  Health-care workers have continued to give care throughout the year, despite many personal tolls including exhaustion, personal risk of infection, fear of bringing it home to family members, the illness or death of many co-workers, and the tragic loss of patients.  

Think of the nurse arranging a final video call for his patient, alone in the hospital, so that the family could say a socially distant goodbye.  Once the call was over, and the person under care took their last breath, all he can do is move on to the next patient who needs attention.  But who cares for the caregiver?  What happens when the nurse goes home to an empty house, or to his own family who has no frame of reference to understand what he’s just been through?    

And medical professionals on the front lines of this pandemic are not the only professionals who have endured tremendous strain in this last year.  The spiritual advisors who are counseling the families who have lost loved ones are wrestling with their own grief. Countless essential workers have kept going to work, exposing themselves to the dangers of an unknown, unseen virus, and even more frightening, to the risk of bringing it home to sicken the people closest to their hearts. They still get up every day and go back out there.   

The studies on the emotional and mental health costs of this pandemic have yet to be written, but even before this unprecedented year, healthcare workers, like firefighters, emergency service professionals and police officers, have been found to be at high risk of anxiety, depression, burnout, insomnia, moral quandary, post traumatic stress disorder, and other signs of emotional turmoil.  

According to the Centre for Suicide Prevention, first responders are at greater risk for Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD), but are simultaneously expected to have a heightened ability to cope with these traumatic situations. Unfortunately, this is not always the case. Exposure to trauma without adequate support has lead to higher rates of suicide among first responders, a crisis that has only intensified this past year. 

The crisis of stigma

One of the biggest hurdles when it comes to supporting the mental health of first responders is destigmatizing trauma. In jobs like nursing, firefighting, counseling, policing, and emergency services, where employees face danger, injury, violence, disease, and even death on a daily basis, many first responders do not feel comfortable discussing how these events affect their mental health and wellbeing. 

A 2017 study of over 2,000 first responders, including nurses, firefighters, and police officers, found that 50 percent of first responders think their supervisor will treat them differently if they seek help for their mental health.

This plague of unaddressed trauma not only creates the previously mentioned tragic high rates of suicide and depression among first responders, but it also leeches out into our society and impacts first responders’ ability to do exactly what they joined the profession to do: help those in crisis.  

One solution that has been gaining traction is the creation of peer to peer support networks, so that others who have the lived experience of the uncommon types of stress of first responders know how to effectively help their fellows. 

In California, a bill introduced in 2018 extends confidentiality laws to peer supporters and increases training for peer support programs at all levels of the fire service to encourage firefighters to have open conversations with their peers and offer trained aid to coworkers. 

For nurses, organizations like the American Holistic Nurses Association (AHNA) and American Psychiatric Nurses Association offer similar programs while The Code Green Campaign and NAEMT EMS Mental Health serve all emergency medical service providers. 

The good news is that the severity of the pandemic crisis has accelerated a societal wide conversation on the need to destigmatize mental health needs for first responders.  For example, police and firefighters in New Hampshire are speaking out about the emotional and mental health stress this year has wrought.  A recent article in the Lancet highlights the glimmers of hope that in the aftermath of Covid, there will be systemic changes with how the medical field approaches the human toll among its professionals, with increased investment in proactive training and programs to help.  

A report issued from the Joint Commission in 2018 encourages hospitals and medical facilities to create a culture where nurses, doctors, and support staff have open discussions about the traumatic events they experience. It also encourages staff members who have experienced trauma to share the personal strategies they employed to process and heal from the event. 

In hospitals, many of these initiatives, called “second victim” programs, aim to normalize the reality that healthcare professionals often experience second hand trauma from the experiences their patients undergo. 

One example of this practice in action is at John Hopkins. The university hospital launched their Rise program in 2011 which employs 30 clinicians to run a 24/7 call center trained in psychological aid to help victims debrief soon after a traumatic patient event. 

Psychological First Aid

One primary strategy employed by Rise and other resource programs is psychological first aid (PFA). Developed by Dr. Robert Macey, the founder of the International Trauma Center in Boston, PFA is designed to offer support and help to individuals of all ages in the immediate aftermath of a traumatic event. PFA is designed for anyone who has experienced trauma, but for organizations, leaders, and local officials looking to bolster support for first responders, the program serves as a template for addressing and processing trauma. 

To create the program, Dr. Macey worked with numerous local, state, and federal programs to develop customized somatic-focused protocols for reducing suicide, depression, PTSD and vicarious trauma among first responders. 

The program is based upon eight core principles: 

• Contact and engagement. Contact following trauma should be done in a helpful and compassionate manner. Those helping trauma victims should approach in a clear, but comforting way, introduce themselves, explain their role, and discuss how they are there to help in any way that the individual feels will be constructive for managing their traumatic experience. 
• Safety and comfort.  After a traumatic event, it’s important to be in a place where you feel safe and comfortable both in your physical setting and in the people you surround yourself with. This includes initially removing potential triggers from someone’s immediate vicinity that could remind them of the traumatic event. Safety and comfort also includes providing the individual with critical information regarding the event and ensuring them that others who were involved are also receiving care. 
• Stabilization. If needed, stabilization aims to address shock or panic. Physically, it can be helpful to practice “grounding.” This process involves having the person sit in a comfortable position and focus on deep breaths while increasing awareness of their surroundings. While they breathe, have them list the stable and present things they can see around them such as “I see a chair” and “I see a woman talking to her child.” These serve to calm the individual and reconnect them to their safe immediate surroundings. 
• Information gathering on current needs. Once the individual is physically and emotionally stable, inquire about direct services that could help them such as referrals to a professional to speak to, community resources, or medical advice.
• Practical assistance.  Once emotional and physical health have been assessed, offer to provide practical assistance. Ask the individual what their most pressing concerns are. This could be the safety of a loved one, the care of a child, or legal resources. Identify these needs and help the individual make a plan of action to address them. 
• Connection with social supports.  Individuals who are well connected to their community and those around them are more likely to engage in supportive and healing activities. Encourage the individual to reach out to their support networks which can offer help and advice as well as reassure them of their self-worth. Ask them about individuals or groups they would turn towards in times of crisis or to list people they believe could be beneficial in helping them process the traumatic event. 
• Information on coping.  Brief the individual on the common outcomes of trauma and potential coping mechanisms they experience, both emotional and physical, such as physical pain, anxiety, withdrawal, anger, or guilt. Discuss negative coping mechanisms and signs to be on the lookout for. 
• Linkage with collaborative Services.  Trauma often takes a lot of time to recover from. Provide the individual with a list of resources that can help them process the event both in the near and distant future. This can be online guides, support groups, therapy resources, medical consultation, or community programs. 

PFA for a pandemic

This is a brief outline of the steps of PFA as it is practiced by outreach professionals, but it’s a practice anyone can learn to help others and to also practice healing in your own life. For example, in Santa Barbara, CA the Santa Barbara Response Network, a nonprofit grassroots network of volunteers trained at PFA, has made tremendous contributions toward healing in the aftermath of multiple natural disasters, gang violence, and teenage suicides clusters over the past decade. These strategies are not only for first responders, but can be immensely helpful for anyone who has experienced trauma of any kind. If you are interested in getting training, visit the National Child Traumatic Stress Network and explore their programs.

For many, the nearing end of the pandemic may even bring up traumatic feelings that have been suppressed as we live in a perpetual state of self-defense. Our bodies and minds can push aside feelings of anxiety or fear in periods of stress which we only realize the magnitude of when we perceive our surroundings to be safe once again. These emotions can even surface as physical pain or discomfort lodged in our bodies for years to come. 

Domestic violence has also increased during the pandemic with limited resources for individuals trapped at home with their abusers. The city of New Orleans reports that from January to April of 2020, domestic aggravated assaults jumped 37 percent.

After a year of managing intense medical anxiety while also being separated from friends and family, there is a high probability that we as a society will be dealing with the trauma-based fallout from the pandemic long after the actual disease is under control. 

The first step of managing trauma, before PFA can be implemented, is recognizing the signs of trauma. These can look different for every person, but some symptoms are common signs of trauma. 

Emotionally, shock, sadness, anger, guilt, or shame are common feelings surrounding trauma while physical symptoms like dizziness, shaking, racing thoughts, loss of appetite, disrupted sleep, and aches and pains are also common. 

If you are experiencing a traumatic response to an event, the strategies such as re-establishing routine, prioritizing self-care, and ensuring you’re in a safe physical environment can all help overcome the trauma. 

Talking to friends and family or a professional resource can also be immensely beneficial. When it comes to community shocks, like a pandemic, many other people are likely experiencing the same feelings you are. 

Trauma is widely experienced, but not widely addressed. This is in part due to the many forms it takes and many ways in which it expresses itself. We may not experience the physical and emotional fallout from trauma until years after the event. Regardless of the source of trauma, these awareness and action steps can help us support not only first responders, but everyone in our community, especially following a collective crisis like a global pandemic.  By bringing the pain into the open and processing it in healing ways, we can turn the trauma and stress of this pandemic into an opportunity for post traumatic growth. 

As Fred Rodgers of Mr. Rodgers fame once said, “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.”  

It just that we need safe spaces to talk and trained people to listen.  That’s what PFA can offer.    

To explore PFA further, we encourage you to check out this series of free webinars from PsychAlive and The Glendon Association. The four part series, which will occur every Wednesday in April starting on April 7th, is led by first responders and mental health experts who will provide self-care and psychological support strategies to those facing this crisis head on. The target audience will be the first responder community, but anyone with interest is welcome to attend.