Tag: First Responders

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Forewarned is forearmed: First Responders and Traumatic stress

The ancient Latin saying, ” Praemonitus, praemunitus,” later in 16th century England became “Forewarned is forearmed” can apply to a wide variety of situations. For this post I’ll be discussing the importance for first responders to learn about the potential dangers of their work to their mental health.

Before I begin it is important to note that each individual will process their experiences differently. Not everyone who is exposed to a traumatic event will end up with a traumatic stress related injury. Advance knowledge of Post Traumatic Stress Disorder (PTSD) and related disorders can help first responders help themselves and their co-workers.

Post Traumatic Stress Disorder (PTSD) is fully explained on the website of the National Institutes of Mental Health. I encourage all first responders to read the information on their site.

For the purpose of this entry I share the criteria the NIMH list on their site for a diagnosis of PTSD below. In the last paragraph the BOLD type was added by me for emphasis:

“To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.”

It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.“

I added the bold type above to emphasize the fact that feeling off or experiencing any of the reactions listed above immediately after a traumatic event is normal. The phrase often used is, “It is normal to feel abnormal .” If the reactions do not lessen after a month or so, that is a sign to seek additional support from a therapist or doctor.

First responders, like service members, often hesitate asking for help. No one wants to be taken off of active duty, or to say they are struggling. Fortunately in the military great strides are being made in de-stigmatizing asking for and seeking help. Due to increased awareness of suicide rates among first responders, steps are now being taken by public safety administrators to increase peer support programs and enhance employee assistance programs. More work need to be done in this area.

Administrators of public safety departments need to lead in the realm of education on mental healthcare for their department.

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Anger Management and First Responders

My daughter and I had the opportunity to shoot the cannon at half time of a football game at The Citadel.
Anger can feel like your insides will explode.
Photo by Michael Givens

Anger management. Yes, it’s the title of a movie starring Adam Sadler and Jack Nicholson, but it is also a big problem in our society. Do a Google search for “Anger Management” and you’ll get over 262,000,000 hits. Most of these sites don’t have anything to do with the movie.

Anger is a natural emotion. It can be a healthy emotion to express. In the work environment however it is a hard emotion to process. Working in a time sensitive and at times dangerous industry only increases the likelihood of anger increasing on the job. Emergencies, equipment failures, and a variety of personalities on a scene can combine to make for one very frustrating and anger-filled environment.

Left unexpressed, anger can internalize and cause physical problems. Repressed anger can come out in passive aggressive behavior, depression, or in a negative outlook of life in general.

The key is to express anger in a constructive manner. Too many individuals channel their anger in destructive ways. When I was growing up we referred to it as the “kick the dog theory.” This theory basically said a person who gets in trouble with a boss in the work place can’t voice their anger at the boss. Instead they go home and for no reason kick the dog – definitely not the way to handle anger and frustration!

If you have an encounter in the work place and feel yourself getting angry you do have options in how you respond. We can’t always control what is happening around us, but we can control our reactions to what is happening.

Your options include learning how to express your anger in a manner that does not harm yourself or another person. These options take practice.

  • Count to ten. It sounds like a cliché, but there are studies to back this practice up. When we’re angry, we use the emotional side of our brain. This is where the “four letter words” reside. Taking a minute to count to ten before you speak will bring you back into the rational side of your brain. The counting method also gives us sometime to calm down and is a distraction from what we reacted to.
  • Sleep on it. While related to the first suggestion, this advice applies to situations when a decision is announced and your first reaction is anger. Allowing a little time between the announcement and your reaction can help by allowing all the facts to be presented. We often get angry first and discover later our fears never materialize.
  • Write out your response. Sometimes it helps to write everything down. All the things you want to say but don’t feel you can. This is the version you keep in a private place or shred later. Write down all your thoughts, including the things you’d never say out loud to someone, then move to a more rational approach. Write down why or what upset you. Then write down how you can resolve the problem (remember you can’t harm yourself or others!)
  • Exercise – We often feel an an adrenaline rush along with the feeling of anger. This is related to the fight or flight response. Taking a walk, or more strenuous exercise, can help your body process the rush you felt during the encounter,

In some cases the pattern of anger has gone on for so long, outside counseling is needed to help you live a healthier life. Your friends and family will also give you clues that you need help. Taking that first step can be scary, but well worth the rewards.

If you are a member of a faith community the clergy person may be a good resource for referrals. They can also offer practices within the framework of your faith system of how to work through anger. The American Psychological Association has a very helpful information on their web site about anger management, what it is, how to deal with it and when to seek outside help.

Additional reading:

What your Anger May be Hiding

Anger Management: Understanding Anger

Science of Anger: How Gender, Age and Personality Shape This Emotion

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Dealing with the Stress of COVID-19

The old dock behind the old boathouse on the campus of The Citadel, in Charleston, SC. My favorite spot on campus. I have a copy of this tranquil place by my desk.

We seem to be stuck in some strange combination of the movies Pandemic and Ground Hog Day. If you are like me, days of the week don’t mean anything any more. While I like my quiet time, I am really ready to get out and be social again.

I know quite a few people who are feeling very unsettled with what has become our new normal in the time of COVID-19 self-isolation. There are very good reasons to feel anxious and stressed right now. My friends and family in New Jersey have many friends who are very ill or who have died. Our news and social media feeds are filled with updates on confirmed cases and death tolls.

There was a time in my life where I experienced a lot of loss and change in a very short period of time. I began to show signs of heart trouble. My left arm would go numb and I had chest pains. After being thoroughly checked out by a cardiologist, the determination was I was experiencing a stress reaction to the events in my life. I began my quest to learn all I could about stress, anxiety and the affect on our bodies. If you find it hard to get out of a loop of worry and anxiety I am going to share a few coping strategies I learned that you may find helpful.

Our minds are amazing things. Our thoughts are very powerful. Have you ever had someone describe the taste of a lemon? The thought of the very sour taste of a lemon can lead you to pucker your lips. Have you noticed that after watching a commercial about a certain food or beverage you suddenly have a craving for that food or drink? You end up with a physical craving for something that started with your thoughts.

When we hold a concern or a worry in our mind we often experience a physical reaction. Unfortunately most of us do this and aren’t aware of where we are holding stress in our body. We go from one activity to another holding a worry in our mind and having a physical reaction in our body that we just ignore. For me I held a lot of stress in my gut, but also in my shoulders. To combat this stress I had to become more aware of when I felt it. Like many people, I would worry or get upset about things I had absolutely no control over. I had to slowly learn to control what I could and let go of what I couldn’t. I called this state of being stressed my “What if” side of my brain. My self dialogue would go something like this:

“What if my husband gets that job in Texas he is looking at? We would have to move. The kids would have to change schools. Will I fit in there? What if I can’t find a job?”

I would get worked up over something that may or may not happen. As it turned out my husband didn’t apply for the position. That was a lot of emotional energy spent on something that never happened. Most of our worries are that way. We get worked up over something that we have little control over.

So how to you live with ambiguity? Learn to live more in the moment and not in the “What if” side of your brain. Using a grounding exercise can help you learn how to live in the present. The following exercises help you get from the abstract “what if” the present situation using your senses to bring you into the present moment. So much of our anxiety and stress comes from how we think of something. Slowing down those abstract thoughts with concrete tactile exercises helps us realize we are actually OK.

A popular grounding exercise is the 54321 grounding exercise. You can find several methods online. The exercise involves using your 5 senses. The Mayo Clinic Health System website suggests the following method. Visit their website for additional tips:

Everyone feels anxious now and then. But there are things you can do to minimize those feelings. Mayo Clinic Health System staff suggest trying the exercise below the next time your mind is stuck on the worry setting.

Sit quietly. Look around you and notice:

  • 5 things you can see: Your hands, the sky, a plant on your colleague’s desk.
  • 4 things you can physically feel: Your feet on the ground, a ball, your friend’s hand.
  • 3 things you can hear: The wind blowing, children’s laughter, your breath.
  • 2 things you can smell: Fresh-cut grass, coffee, soap.
  • 1 thing you can taste: A mint, gum, the fresh air.

This exercise helps you shift your focus to your surroundings in the present moment and away from what is causing you to feel anxious. It can help interrupt unhealthy thought patterns.

See the blog post, “Stress Relief: The four A’s” by Alan Conway, MD for another helpful list of ideas to help you ease and reduce stress.

Most stress relief and anxiety relief methods involve being present in the moment. In moments of stress really helps me to take a quick safety inventory. I ask these questions, Am I physically safe? Am I getting the nutrition I need? Am I getting the sleep I need?If the answer is no to any of these questions, that is what needs to be addressed in the moment.

Some simple things you can do in your work space whether it is at home or at an office:

  • Keep a pretty landscape photo in your work area
  • Have a simple rhyming verse or poem nearby to read. See this link for a few options
  • If possible listen to calming music. My current favorite is Bach for the Brain!
  • Listening to the sound of water, like a fountain, river, ocean are shown to have a calming affect. If you don’t have natural water running near you, taking a shower can be helpful. To see this calming affect in action watch small children by an outdoor fountain. They are naturally drawn to them while their parents would walk right by.
  • Unless you are required to wear one, take off your watch. We often stress ourselves over the passage of time. If you want to know the time our phones, computers, and office space usually have clock functions. Glancing at your wrist every few minutes is not helpful. (I stopped wearing a watch in my early thirties.)

If sleep is hard for you, try keeping a journal. Each night before you go to bed, take out your notebook and write down everything you are thinking about. If you find you are caught in the same thought “loop” and can’t move on, write down what you are thinking about in detail. There is great relief in writing down your worries then tearing up the paper and throwing it away. If you have a safe way to do it going outside and burning the paper offers another great release. In the past I’ve had to do that a few times before my thoughts would no longer linger on a negative topic.

Physical exercise is a great release of tension. It can be as simple as talking a walk, outside if possible. Being outside in the sun is also very therapeutic. There is a very helpful organization called Yoga for First Responders. Yoga can help you physically and mentally. Practicing yoga can also help you sleep better.

Social nutrition is a term I learned from Dr. Jonathan Shay, a renown scholar and mental health practitioner. We were attending a conference and I heard him explain how one heals from a traumatic event is determined by the social nutrition a person has around them. He went on to say if a soldier has a mortar wound a big factor in healing that would is the nutrition that person takes into their body. He continued by saying when a person has a psychological wound a big factor in their healing is the social nutrition they have around them. Do they have a supportive family? A group of friend they can talk to? When we talk about our stressors it actually helps us heal the wounds, like intrusive thoughts, that we carry.

I hope you find this information helpful. If I may be of service to you or your organization by leading a workshop/didactic on stress relief, compassion fatigue, or self-care, please send an email to dorie (at) dorielgriggs (dot) com

For further study:

Basics of Compassion Fatigue – A helpful guide to teaching/learning about Compassion Fatigue. Available on the website for the Figley Institute

Gift From Within webcasts and resources on a variety of related issues.

Disclaimer: This website is for information purposes only. By providing the information contained herein we are not diagnosing, treating, curing, mitigating, or preventing any type of disease or medical condition. Before beginning any type of natural, integrative or conventional treatment regimen, it is advisable to seek the advice of a licensed healthcare professional.

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What is Traumatic Stress

Thanks to the public information campaigns of a number of organizations supporting veterans the term PTSD, or Post Traumatic Stress Disorder is now widely known. After almost 20 years of learning and lecturing about PTSD I have learned that while the name is well known there is still very little general understanding of the criteria a person has to meet to be given the diagnosis of PTSD.

Several years ago a chaplain friend of mine asked me to speak to the oncology department at his hospital. The topic was traumatic stress and self care. The nurses attended the didactic thinking they were there to learn how to care for their patients who may be traumatized. What my friend guessed and what I learned after this experience is that some of the nurses experience and struggle with the traumatic events they deal with in the course of their work.

What I wrongly assumed is that medical professionals would know and understand the toll their work takes on them personally, they did not. That lecture led to an invitation to another conference of medical professionals. In the three years I’ve served as a chaplain for the Roswell Fire Department I’ve had conversations about traumatic stress with our public safety employees in the fire, police and 911 dispatch areas. Many know their jobs expose them to trauma, but few know what it takes to meet the criteria for a PTSD diagnosis.

For a comprehensive explanation of PTSD you should read through the National Institute of Mental Health web page on Post Traumatic Stress Disorder. In summary there is a list of conditions that must be present to meet the criteria for a diagnosis. After experiencing or witnessing a traumatic event it is normal to feel unsettled, upset and have trouble processing the experience. If after a month or two after an event, or after responding to a number of disturbing events in the case of public safety personnel, you are struggling with symptoms that interrupt your normal ability to function, you should seek help from a professional trained to diagnose and help people who experience traumatic events.

Much has been done in this field the past 20 years. Therapies have shown to greatly reduce the symptoms of traumatic stress and allow the person with the diagnosis to function at a very high level. There is such a high success rate that professional in the field are working to change the name from Post Traumatic Stress Disorder to Post Traumatic Stress Injury. The word disorder has a connotation that it is a pre-existing condition where as the word injury more correctly fits the symptoms since we now know people can recover and heal from their experiences. In a letter to the American Psychiatric Association, Drs. Frank Ochberg and Jonathan Shay outline their reasoning for the change from disorder to injury. I encourage you to go to the website, Post Traumatic Stress Injury, and read through the various links.

I do need to mention that I look to Dr. Ochberg and Dr. Shay as mentors in the field of traumatic stress. I had the opportunity to meet both in 2003 at the International Society of Traumatic Stress Studies. Both are very generous with their time and knowledge and helped me learn early after I graduated from seminary about traumatic stress and related diagnosis. I have had the opportunity to attend a few other meetings over the years with both doctors, and others like Dr. Charles Figley who wrote the book on Compassion Fatique. You will note several resources on the Resources for First Responders entry are related to these three doctors.

For an easy to understand, and listen to, webcasts about PTSD and related topics, see this webpage from Gift From Within .

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Resource List for First Responders

This list will be updated as I learn of other reputable resources for first responders and others interested in learning more about PTSD, traumatic stress, and related topics. Since the major research area for PTSD is the military many of the resources are under the VA, but the information is applicable to most people with a traumatic stress diagnosis.

NOTE: I receive no compensation from the following organizations. They are listed as a resource only. The information here is not meant to replace a diagnosis from a licensed mental health professional.

  • Helplines:
  • Fire/EMS Helpline: 1-888-731-3473
  • Safe Call Now: 1-206-459-3020
  • FBHA: 847-209-8208
  • COPLINE: 1-800-267-5463
  • Nat’l Suicide Hotline: 1-800-273-8255

National Center for PTSD – “The National Center for PTSD conducts research and provides education on the prevention, understanding and treatment of PTSD.”

On Facebook: National Center for PTSD – U.S. Department of Veterans Affairs

PTSD Decision Aid from the National Center for PTSD

VA screening tools (confidential) for PTSD, Depression, Substance Abuse, Alcohol Use

National Institute of Mental Health – Post -Traumatic Stress Disorder read the information on this link for a listing of signs and symptoms, risk factors, treatment and therapies.

Firefighter Behavioral Health Alliance – Self Assessment – a self-screening for suicide ideations for firefighters/EMT

International Association of Firefighters – IAFF Behavioral Health Program

Next Rung Website – “We are a nonprofit with a mission to combat mental health issues in First Responders by offering peer support and scholarships for licensed counseling.” Next Rung on Facebook

PTSD in Paramedics, EMTs, First Responders on Facebook – “You no longer have to suffer in silence, you are not alone. We are here to help.” Website: Project Hope: EMS

Compassion Fatigue: Figley Institute

Trauma support: Gift From Within – An international nonprofit organization for survivors of trauma and victimization. Gift From Within Free webcasts

Confidential online screening for mental health issues – from, The Summit Counseling Center, North Fulton County, GA

Mission FISH USA – “The Purpose of Mission FISH., FISHING, INTERACTING SHARING & HEALING  is to organize and plan fishing day trips and provide FISH therapy for PTSD and TBI for Veterans, Active duty service members, 1st responders and Gold Star families.”

Reboot Recovery – “REBOOT is different. Our courses are led by people who have been there, lived through it, learned from it, and want to help lead others out of it. We are a community of people committed to helping each other heal from the spiritual and emotional impact of daily stress and trauma. You won’t find shortcuts or easy answers but rather solutions that last. Families just like yours are experiencing healing at this very moment. Your healing can start today.”

Save a Warrior – Save A Warrior™ has changed countless lives through our “War Detox” program, which supports the healing from Post-Traumatic Stress (PTS). We specialize in connecting Active Duty Military, Returning Veterans, and First Responders experiencing psychological trauma. 

Suicide prevention:

Suicide Prevention Lifeline

Suicide Prevention Resource Center

Suicide prevention workshops:

Soul Shop Movement

Armed Forces Mission – 911

Books:

Achilles in Vietnam: Combat Trauma and the Undoing of Character

Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized

Odysseus in America: Combat Trauma and the Trials of Homecoming

Resilience: The Science of Mastering Life’s Greatest Challenges

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Welcome to my updated site

Since 2011 I have maintained a blog. At first the entries dealt with topics of interest to parents of cadets at The Citadel, then they were my reflections as the mom of an Army officer. With this entry the focus is changing to reflections and essays of interest to first responders and others who, in the course of their work, are exposed to traumatic events.

I am entering my 4th year as the Chaplain for the Roswell (GA) Fire Department. It is a consulting position, but one I feel particularly called to. My study of traumatic stress began in the late 1990′ while I was a master of divinity student at Columbia Theological Seminary. While taking pastoral care classes learning about self-care for pastors, I realized my journalist friends could use the same advice.

My early professional career was spent in the press rooms/boxes of college sports. I worked in sports information which is the public relations office for college athletics. At the various games I’d hear stories, mainly from the photographers and videographers, about scenes they had covered before arriving to the game. Scenes that involved violence and sometimes death. A videographer for a local television station told me a stat that stayed with me. When the lists of most dangerous careers are published photographers and videographers are toward the top of the list. To do their jobs well they have to get close to the event. This fact stayed with me a propelled me on a course that gave me a purpose, supporting people who in the course of their work are exposed to traumatic experiences.

Since 2000 I have studied traumatic stress, attended several meetings of the International Society of Traumatic Stress Studies, and The Dart Center for Journalism and Trauma where I met world renown experts in the field whom I now consider mentors and friends. You can read more about my background and training on my LinkedIn profile.

In the months and years to come I hope this site will be a source of information and support to first responders of all types. If you’d like to follow the blog, please submit your email through the link on this page. Please share any entries you find helpful.

If you began to follow my blog for information on The Citadel and you no longer want to follow the blog you can unsubscribe from the notices through the email notice you receive.