Trauma such as Sept. 11 takes a toll on our first responders
by Mark C. Johnston, Ph.D.



With the 10th anniversary of 9/11 upon us, consider this: Critical incidents and traumatic events, large and small, have been occurring forever. Their singular and cumulative impact has challenged many a first-responder (police, fire and emergency medical.

Thirty years ago, this was critical incident stress management: Lots of talk, a written report and some slaps on the back. The next stop was a tavern for a few cold ones. And then, “just one more,” which turned into a few more, and who knows how many brain cells vanished in a wash of alcohol. Later we would help him stumble up his back stairs.

That’s how we consoled a fellow officer who had been working a walking post, responded to a nearby bank-robbery call and got involved in an exchange of gunfire. It was the same years later, when a fellow squad member of our FBI office in New York was shot and killed. Taking in the scene of his murder — he was still sitting behind the wheel with a couple of holes in his head and his blood turned to Jell-O on the car’s upholstery — sickened us. And day after day, the news kept showing the scene.

Once, on a cold December evening, while driving to a police department party, I encountered a crazed, pistol-firing doper shooting at some apparent associates. A shot was fired in my direction; there was a subsequent chase with more shots, some tense moments and a successful ending. Upon arrival at the scene, a supervisor, observing blood on the ground nearby, asked: “Are you all right?” My reply was: “Yeah, I think so.” To which he responded: “OK, see you at the Christmas party.”

None of that is considered appropriate critical-incident stress management today. We have learned an awful lot in the last few years in responding to and supporting those involved in critical incidents — like the terrorist attacks of Sept. 11, 2001.

This is particularly true when it comes to the potential “second injury.” For many, the more devastating, insidious and longer lasting injury is the emotional/psychological reaction. Sort of like insult to injury. Often, the “second injury” is exacerbated by the employee’s fear of sharing his or her experience — fears that the department or other agency may pursue adverse action in a use-of-force incident, fear of civil action, of blame, of appearing weak, of second-guessing by peers, superiors and the public, etc.

The hypothalamic-pituitary-adrenal axis and the release of stress hormones, more commonly referred to as the “fight or flight response,” is a natural process that helps us react and make the quick association between a threat and negative consequences. But it may be so repeatedly, drastically and/or indelibly seared into the memory as to drive us to dysfunction.

The stress hormones entrench the memories of the emotionally significant event via the amygdala (part of our brain that regulates fear and other emotions) and the factual content in the hippocampus. An officer operating with a predominantly competent cognitive process before a critical incident may end up with an emotionally dominant process during and after the incident. The horrifying memories may have been stored with such intensity that the mechanism that normally regulates this may be overridden, and emotion can dominate.

This is not good for most people and extremely precarious for a law-enforcement officer or other first responder. Post traumatic stress may sometimes become a career- and life-disabling emotional hangover. And trying to stoically stop the process is tantamount to telling someone with dysentery to just use will power.

In fact, the “image armor” that some first responders wear may even impede healthy recovery, sort of like some of the less-than-healthy, age-old law enforcement remedies like alcohol, promiscuity and isolation. Climbing into a bottle or the wrong bed doesn’t help anyone.

Think of the hundreds of smaller traumatic events occurring in communities daily. Who is always there? That’s right, our first responders. There are, of course, the big ones: 9/11, TWA Flight 800, Hurricane Katrina or Virginia Tech. But each additional trauma, small or large, adds another brick to your psyche’s baggage and can literally wear new pathways in our brains. Some begin to react as if everything were a tragedy, others as if nothing is. Either way, it all adds to anxiety.

So the next time you see a first responder who may appear to be at less than their absolute professional best, think that it may not have been 9/11, Katrina, or even the last smart-mouthed teenager encountered, but rather an accumulation of hurts. Think again, too, that notwithstanding the stress, chaos or pain, we always respond.

Mark C. Johnston, Ph.D., recently retired from 30 years of law enforcement and as the FBI’s Northeastern U.S. employee-assistance program manager. He is now the police in-service training program manager for Atlantic County’s Anthony Canale Law Enforcement Training Center.