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Post-Traumatic Stress in Disaster First Responders

Published online by Cambridge University Press:  15 February 2016

Joshua C. Morganstein ,
David M. Benedek  and
Robert J. Ursano
Joshua C. Morganstein*
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
David M. Benedek
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
Robert J. Ursano
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
*
Joshua.morganstein@usuhs.edu
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Abstract

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On the Cover
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 1 , February 2016 , pp. 1 - 2
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

Disasters have significant psychological effects on individuals and communities. Public health and safety first responders such as community workers, fire and rescue, police, health care and mortuary affairs workers, and others play a critical role in disaster response and planning. Owing to their unique roles, responsibilities, and exposures, first responders are vulnerable to the adverse psychological effects of disasters.Reference Fullerton, McKibben and Reissman 1 Ongoing and unique exposures, secondary traumatization, and the potential to be both victim and service provider in the wake of disasters create unique stressors for this population.Reference Skogstad, Fjetland and Ekeberg 2

First responders exposed to disasters experience distress reactions, engage in health risk behaviors, and develop mental health disorders often at high rates.Reference Benedek, Fullerton and Ursano 3 First responders frequently have increased rates of alcohol use and intimate partner conflict as well as major depression and post-traumatic stress disorder (PTSD).Reference Osofsky, Osofsky and Arey 4 In addition, first responders may be particularly vulnerable to the stigma associated with the use of mental health care and other help-seeking behaviors.

The article by Loo and colleaguesReference Loo, DiMaggio and Gershon 5 in this issue of the journal identifies the association of avoidant coping and risk for PTSD in first responders. Identifying responders at greatest risk for adverse effects and maladjustment can allow interventions to be more effectively tailored with the goals of enhancing performance and reducing the adverse effects of traumatic stress exposure. Expert guidelines have been offered as a means to standardize interventions in the treatment of PTSD in first responders.Reference Harvey, Devilly and Forbes 6 First responders also benefit from pre-disaster training that reduces the risk of injury and decreases fear associated with novelty. In addition, resilience training to increase comfort with their roles, improve understanding of the psychological effects of stress, and enhance help-seeking behaviors may benefit health and early care seeking.Reference Benedek 7 Consistently, research suggests that social support is important to health protection and recovery from the stress of disasters. Recently, findings suggest that the cohesion and strength of community in which disaster workers live may also reduce the frequency of major depression and post-traumatic stress for first responders.Reference Ursano, McKibben and Reissman 8 , Reference Fullerton, Ursano and Liu 9

Future research will improve our ability to predict which first responders are at greatest risk for developing adverse outcomes and provide interventions in the preparation and response disaster phases that minimize exposures, decrease the impact of traumatic stress, and optimize treatment for those requiring interventions.

Courtesy of Dana Swift, RN.

Courtesy of Dana Swift, RN.

Moore, OK, May 21, 2013 rescue workers continue search and rescue operations at Plaza Tower Elementary School after a tornado destroyed many parts of the community on May 20, 2013. Jocelyn Augustino/FEMA.

New Orleans, LA, September 3, 2005 Rescue crews help survivors of Hurricane Katrina. Michael Rieger/FEMA.

References

1. Fullerton, CS, McKibben, JB, Reissman, DB, et al. Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes. Disaster Med Public Health Prep. 2013;7(1):89-95. doi: 10.1017/dmp.2013.6.CrossRefGoogle ScholarPubMed
2. Skogstad, L, Fjetland, AM, Ekeberg, O. Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 – a cross-sectional study. Scand J Trauma Resusc Emerg Med. 2015;23(1):23.CrossRefGoogle Scholar
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5. Loo, GT, DiMaggio, CJ, Gershon, RR, et al. Coping behavior and risk of post-traumatic stress disorder among federal disaster responders [published online ahead of print Dec 23, 2015]. Disaster Med Public Health Prep. doi: 10.1017/dmp.2015.141.CrossRefGoogle Scholar
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