Emergency Responding to the Emergency Responder

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Emergency Responding to the Emergency Responder
Stress, Coping and Surviving in the Emergency
Services
Officer Joel Fay Psy.D(415) 720-6653
Joel.Fay_at_SRPD.0rg
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Post Traumatic Stress Disorder An Assault on
the Mind, Body and Spirit
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PTSD

• PTSD is a total person experience
• Symptoms effect
• Mental Health
• Physical Health
• Family and Friends
• Work
• Spirit

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PTSD Diagnostic Criteria

• Must be exposed to a traumatic event

Person's response to the event must involve
intense fear, helplessness, or horror
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The event must be re-experienced by distressing
recollections, dreams, flashbacks, etc.
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Avoidance of locations, persons, etc
Sense of isolation No one else knows what I am
going through I cant burden other people with
this.
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Persistent Problems With Increased Arousal

• Withdrawal
• Irritability
• Insomnia
• Hyper-vigilant

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Symptoms of the Spirit

• Hopelessness
• Helplessness(Locus of Control)
• Meaning of life
• Questioning faith

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How The Brain Processes Threats
And why its NOT our Fault
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How It Works

• Thalamus is a routing station for all incoming
  sensory impulses except smell

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How It Works

• Thalamus Routes information from eyes and ears
  to the brain

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Amygdala

• Small almond shaped structure near the middle of
  the brain.
• Attaches meaning to memory
• Places the experience into the context of an
  emotion.

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• The Amygdala is the command center of the
  brains fear system.

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• A rat lacking an Amygdala will not respond to
  a threat.

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Brains Response

• Works with Hippocampus by evaluating threats and
  placing them in the context of a previous
  experience.
• Prefrontal Cortex Reins in the Amygdala if the
  threat is deemed to be insignificant.

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What Happens Next?

• Amygdala If threat is sufficient the body shuts
  down non-emergency services (I.e., digestion and
  immunity)
• Triggers body wide emergency response within
  seconds

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Hypothalamic-Pituitary-Adrenal System (HPA)

• Release of Cortisol to activate the bodies
  defense systems
• Release of Catecholamines - dopamine,
  norepinephrine, and epinephrine

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Catecholamines

• Suppress activity in areas at the front of the
  brain concerned with short-term memory,
  concentration, inhibition, and rational thought.
  
• This allows a quick reaction to the threat

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What is Memory?

• The use of past experiences to affect future
  behavior.

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• Heightened alertness in the brain which in
  effect tells the memory centers,
• Remember what occurred.

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• Although cognitively you know that the event is
  over, part of you (your nervous system) still
  feels that the event is happening. This constant
  state of alertness taxes your body and spirit.

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What makes an incident Critical?

• Perceived threat / trauma
• Your bodys reaction
• What else is happening in your life
• The meaning you attribute to an event

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EVENT
Once you crossed over that line there is no
going back.
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Coping
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Stress vs. Critical Incident Stress

• Daily stress
• Stress v. Distress

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• Organizational/ Personal Betrayal

Its about the system
How a person recovers from trauma depends on
the support system available after an event.
Dont punish the victim.
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How Do We React to Trauma

• I think I am going crazy
• There is something wrong with me.
• My inability to control my symptoms shows how
  weak I am
• Fearing Fear The anticipation of experiencing
  the symptoms can be almost as debilitating as the
  symptoms themselves.

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How Do We React to Trauma

• We have trouble controlling emotions because
  reminders lead to sudden anxiety, anger, or upset
• We feel anger or aggressive feelings and feel the
  need to defend ourselves
• We get upset when we are reminded about the
  trauma (by something the person sees, hears,
  feels, smells, or tastes)

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• You cannot predict and you cannot control your
  life to the extent that would make you feel
  comfortable and safe.
• To adjust to this lack of control you check
  out, numb yourself become unavailable.

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The Cost of Denying Emotions

• In 2002, 437 paramedics were tested to look at
  long term effects of suppressing emotions.
• The greater the emotional suppression the
  greater the physical and psychological stress
  symptoms.
• Wastell, 2002

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• Our strengths are the other side of our
  weaknesses

Self- Control Physical and Psychological
Not affected by what we experience
Command presence
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Commonly Used Maladaptive Coping Techniques

• Harder, Faster, Better
• Hyper-Activity
• Counter Phobic Behavior
• Impulsive and Reckless Behavior w/o Thought

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Commonly Used Maladaptive Coping Techniques

• Multiple Romantic Relationship
• To obtain positive mirroring
• I cant be bad, look how much she loves me

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More

• Overcompensation
• Token attempts seeking professional help.
• Alcohol / Substance Use

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What These Coping Strategies Have in Common

• An attempt to recapture the ability for denial
• They work for a while for some
• They are avoidance techniques
• They do not include conscious grappling with the
  issues and fears generated by Cognitive Dissonance

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• Often the symptoms of a stress reaction are
  misdiagnosed by supervisors, families, doctors
  and the individual.

Anger, Somatic Reactions, Frustration, Burn Out
Person
Self-Blame
Guilt
Second Guessing
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The Aftermath of Failed Repaired Efforts

• Each failed attempt at restoring the Self-Concept
  further proves fraudulence
• Isolation
• From work, friends, family and prior activities.
• Occurs because there are fewer and fewer people
  you can reveal ones self to.
• There is a fear of being found fraudulent

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What Do We Do?

• Alcohol/ Drugs
• Thought Suppression
• Risky Behavior
• Excess Work

• AVOIDANCE

This works until it doesnt
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The Aftermath of Failed Repair Efforts

• Panic Attacks
• Fear of Fear
• Self-Blame and Self- Guilt
• Depression
• Psychic Exhaustion
• Global Negative Self Appraisal
• Job Site Becomes Toxic
• Emergency Responder Exhaustion Syndrome

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Survival
What Can You Do?
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Peer Goals

• Provide acceptance, validation and empowerment
  
• Breaks the fallacy of uniqueness by
  demonstrating that they are not alone and that
  what they are experiencing is normal

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Peer Goals

• Help clients cope with the myth of
  invulnerability which has been shattered
• Provides hope

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Police Chaplains
International Conference of Police Chaplains
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EAP

• Are they culturally competent?
• Do you have a list of clinicians you could call
  on in case of an emergency?
• Create a program where local clinicians go on
  ride-a-longs, do FATS, etc

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Who Attends WCPR

• Police, fire and emergency services personnel are
  the typical residents.
• People affected by the CI for whom a debriefing
  or individual therapy has not been sufficient to
  reduce symptoms.
• Most clients come because they are in crisis and
  not coming was not an alternative.

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Why Residential Treatment ?

• Program must be of sufficient impact / relevance
  to effectively challenge long held faulty
  self-concepts.
• Robust peer-support network.
• VERY culturally competent mental health
  professionals.
• A true collaboration which is peer driven and
  clinically informed.

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Primary Goals

• Keep the person alive / Do no harm
• Restore psychological and emotional functioning
• Reduction of physical symptoms
• Restore ability to participate in their own
  recovery
• Link client to appropriate resources

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Program Components

• Initial Phone Intake
• Intake First, Worst and Last, DAPS
• 5 CISD Phases
• Education Modules
• Family/Relationship Debriefings
• Individual / Group
• EMDR
• Chaplain
• AA
• 90 Day Relapse Prevention Plan

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Some Data

• Gender 75 male
• Substance Abuse Issue 43.7 Yes
• How They Came
• 29 Workers Comp
• 13 Department Training Funds
• 28 - Self Pay
• 20 - Scholarships
• 6 - Donations (Police Associations)

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Where They Come From

• Northern California 63
• Central California 14.1
• Southern California 2.3
• Arizona 5.5
• Military 6.3
• Others International and other states

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Work Status on Arrival

• Working 51.5
• Not Working 40
• Retired - 10

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Follow-Up

• 95.7 of those who were working were still
  working.
• A small percentage of those not working were able
  to return to work.
• Early intervention works best
• Often is it about saving a life.

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• Officer Joel Fay Psy.D.
• San Rafael Police Department
• 1400 Fifth Avenue
• San Rafael, CA 94901
• [phone] ex 111366
• Joel.Fay_at_srpd.org