First responder's common sense after trauma

First responder's common sense after trauma
by Kathie Costos
Wounded Times Blog
April 7, 2013

Aside from other training I have taken over the years, in 2009 it was Disaster and Extreme Event Preparedness that really should apply to what the military needs to do right now. Why? Because while they have been giving the wrong training and increasing the number of suicides, they have to move fast.

My certification was on Safety Function Action for Disaster Responders I was already certified as a Chaplain and in Crisis Intervention but this training really helped because it was more about taking care of responders than "victims" after traumatic events, usually on a mass scale.

For the sake of this article I'll be addressing first responders with common sense, well vetted steps to take to save a life and start someone on the road to recovery. Civilians have been using this for police, firefighters and other emergency responders for decades.

Event-explosion.
Fire-bodies ripped apart-chaos-wounded-screams-bullets from sniper.
Duty, stop sniper, secure area, put out fire, treat wounded, recover bodies.

What happens afterwards when everyone is safe and out of danger is what determines what happens tomorrow.

Encourage talking. Don't let everyone just sit there stunned. Don't let them just go off by themselves, play a game, listen to music or sulk. Watch them. Watch their eyes. Listen to their voice. Hear the tone. Notice their facial expression. Their hands. Eye contact. If any of these are "out of the ordinary" for them, they need to talk and you need to listen. Really listen. First you have to get them into a safe place so they can talk freely without having to fear someone else hearing them.

You can start them talking but once you open the door to it, you need to back off and take your cues from them. If they seem like they are trying to find the right words, just sit there and wait. They are trying to make sense out of what is in their heads before they pick what words to use.

If they talk way too fast, calmly tell them to take their time and let them know you are in no hurry. They may feel as if you are a busy person and there is so much to say they need to get it all out at once so they don't bother you too much. Yes, that happens more times than you would think it does but you also have to remember responders are used to doing for others not having others do for them.

Do not try to fix them. Do not roll your eyes. Do not say something stupid like "God only gives us what we can handle" because that tells them God did it to them and that only makes it worse when they may already have that thought in the back of their head. People walk away from traumatic events one of two ways. Either they are a lucky SOB and God saved them or God judged them and did it to them. Don't tell them to suck it up or remind them they had been through worse before because most of the time they haven't dealt with those times either. Do not tell them much at all until they start talking.

Be quiet. Listen to what they are telling you and let them lead the conversation. If they talk about what happened and toss in something strange like "she was just walking down the street and picked up an orange when the bomb went off" then you need to stop them and ask them about the woman. There have been times when responders are putting two separate events together because an event from the past has not been addressed. They can switch subjects in mid sentence and confuse the hell out of you, so you need to be clear on what you are hearing. Do not do it forcefully. Calmly get them to help you understand what they are talking about.

They need to make sense out of everything that happened in the "horror moments" while in the "normal moments" where they are safe. It helps them let go of the power it has over them and puts the power back into the "now" where it isn't still happening.

If they stop talking but seem to have not found peace with it, then you can let them know you understand. It is not a contest. Do not tell them you had it much worse or tell them about how you just got over it and forgot about it. If you can relate to them, then do it for real. Otherwise just tell them it is ok and you'll wait until they want to talk again. If you've been through the same thing twenty times before then you need to remember what it was like for you after your first time and how hard it hit you. That will help them to hear it knowing it did not destroy you. You will give them hope they can get to where you are as well.

Do not look at your watch, check your phone or talk to others. That tells them they do not really matter and they are taking up your time.

If they cry, let them. Don't try to stop them. Crying is not a sign of weakness. It is the beginning of healing. You will know if they are out of control and need more help then you can give them.

What is important is this is done soon after the event. These steps also work for times when it it well past the event but no one has talked to them before. Do the same thing but in this case you'll have to get a bit more involved.

You need to know if they have been having nightmares or flashbacks, eating differently, drinking or smoking more, nervous, angry or having mood swings. If they are it is likely they need professional help above and beyond your support. If it is 30 days past the event and the symptoms they are experiencing have not eased up, they really need to see someone in the mental health field. If they don't want to, try your best to encourage them to. If that fails, then recommend a Chaplain. If that fails then you need to ask your CO. Don't give up on them because they are giving up on themselves.

Do not let them change the subject to what else is going on like trouble at home because they are trying to avoid what is really bothering them. Get them back to the event they were talking about. It is easier for them to deal with something ordinary than the bomb killing people they know. Most of the time they want to change the subject because of the fear they are facing knowing it not only could have been them but they are very aware of the fact the next time it may be their turn and they are afraid. They need to sort that out as well.

Listen until they are done talking and let them know you do not think any less of them for opening up. Let them know you are there for them whenever they need to talk. Do not tell others what you talked about or you will erode any trust you just gained and will shut the door to them leaving them feeling worse for having talked to you in the first place.

Learn what PTSD is and what it does as much as why it does it to some but not to others. It is their ability to feel things more deeply and has nothing to do with courage or dedication. Once you know the facts then you are in a better position to really do some good for the other responders. The guys you have to watch out the most for are not the most obvious. The ones everyone seems to go to for help and advice are the last ones able to ask for help for themselves. They take on a lot from others and take care of themselves last. When they get hit by all of it, it hits them harder. Again watch for signs of change.

This last part is where it gets really tricky and will take a lot of courage on your part. If you know what PTSD is then you will be able to judge a bit better who is in danger or thinking about suicide. Suicide is committed because the person has lost all hope of a better day coming for them. Ask them if they are thinking about it, then listen. Thinking of it doesn't always mean they will. Ask them how they would do it or if they have a plan. If you are concerned, then you need to act. If you are right, then you may have saved a life. If you are wrong, they will be pissed off but they will be alive to be angry. If you worry about that more than you worry about them and end up making the wrong decision, they will be dead and you will blame yourself for the rest of your life. If you are wrong then let them know you cared enough about them to have their back.

This may help as well. It is one of my older videos for National Guardsmen.


also of interest
Sheriff's Office Receives PTSD Training from Fort Campbell
Lee Erwin Reporting


CLARKSVILLE, Tenn. - The Montgomery County Sheriff’s Office and Fort Campbell’s Warrior Transition Battalion teamed up Friday, April 5 to offer Sheriff’s Deputies a training session. The training covered the challenges Soldiers and Sheriff’s Deputies may face when dealing with individuals diagnosed with a behavioral health condition.

The training was conducted by Command Sergeant Major James Smith who has served as Fort Campbell’s Warrior Transition Battalion’s Command Sergeant Major for close to two years. As a member of the National Guard, he was called back to active duty while serving as a Captain with the Clarksville Police Department.

Since his assignment to Fort Campbell’s Warrior Transition Battalion, Smith has taken a special interest in developing partnerships with local area law enforcement at Fort Campbell as well as Clarksville, Hopkinsville and Oak Grove.

The relationships are being developed to help both law enforcement agencies and Warrior Transition Battalion Soldiers improve communications and outcomes, especially when an individual is involved who may be suffering from a behavioral health diagnosis like Post Traumatic Stress Disorder or PTSD.
read more here