Events Inducing PTSD

Law Enforcement Officers

banner image of law enforcement officers

Photos by Jim Macmillan, Philadelphia Daily News

"The only thing necessary for evil to triumph is for good men to do nothing." - Edmund Burke

In the United States, there are over 14,169 separate law enforcement agencies with at least 708,000 sworn officers serving in varying roles.  There are an average of 154 line-of duty deaths each year.  In 2013, 106 officers died in the line of duty; 49 of these officers were feloniously slain.  Law enforcement officers experience an average of 57,892 assaults and 15,483 injuries per year.  (National Law Enforcement Officers Memorial Fund, Inc., 2014; Uniform Crime Reports, 2013).

Researchers have found between 3% - 17% of police officers to have Post Traumatic Stress Disorder (PTSD) at any given time.  (Boyd, 1994; Harvey-Lintz & Tidwell, 1997; Robinson, Sigman & Wilson, 1997). Some of these researchers have estimated that 30% of all police officers suffer from PTSD at some point in their career.

Officers working in assignments that rarely deal with violent death, automobile accidents, domestic violence calls and traffic stops will clearly not have the same rates of PTSD as do officers dealing with the most violent, evil and horrific aspects of the job.  For example, college campus police were found to have levels of PTSD similar to the general public (Lambert, 1997).  However officers in some other countries have been found to have high levels of PTSD; Australia, 8.3% (Higgins, 1996); Germany, 5%, with 39% experiencing intrusive memories (Teegen, Domnick & Heerdegen, 1997).

For the law enforcement officer who often works alone, where violent attacks can come from anywhere and where split-second decisions can result in death of a citizen, a perpetrator or oneself, the job stressors and potential to be traumatized are tremendous. 

Unlike fire department personnel, where a group of fire fighters  generally respond, with a supervisor on the scene, a law enforcement officer is frequently on his/her own during a traumatic incident.  Further, when a law enforcement officer is involved in an action that injures or kills a citizen or a perpetrator, there is invariably an investigation.  Supervisors or members of a “Shooting Board” or Internal Affairs Office commonly investigate the incident.   These investigators can second-guess decisions that were made in a split second during situations of extreme threat.  Research has consistently found that a positive level of support following a critical incident can decrease the likelihood of the development of PTSD.  However, for many law enforcement officers, the reaction of their own department following their involvement in a traumatic incident is not experienced as supportive and, in some cases, may become even more traumatic than the actual incident (Horn, 1991).  Comments by the news media, reviews by citizen boards, and legal actions in the courts can compound the impact of a job-related trauma.  In addition, officers incur additional stress from compulsory annual physical exams, frequent need to re-qualify with weapons, and often-required disclosure of finances and personal relationships.

In many departments, officers who seek psychological help can be sent for a fit-for-duty examination to evaluate whether he or she has emotional or physical problems.  The results of these examinations can lead to being assigned to the “rubber gun squad”, having their weapon confiscated, being placed on disability, or even fired.  In other words, in many police departments, seeking assistance after being traumatized by job-related experiences may lead management to order restricted duty or dismissal from the job.  Fear of being sent for a fitness-for-duty exam keeps many officers from seeking the professional help  that would improve their job performance.  

“The worst part of a critical incident sometimes is not the critical incident but what happens afterwardBbecause they feel like they’ve done the best they possibly could under the set of circumstances that existed at the point they made the decision.  Yet, they are second guessed, maybe all the way to the Supreme Court for a decision they made in a split second.”  Horn, 1991 page 143.

Additional stress comes from an increasing tendency of criminals and citizens to file civil suits against police officers for their actions.  Studies have shown a dramatic increase of lawsuits alleging police misconduct.  Even such tasks as investigating traffic accidents, which are routinely handled on a daily basis by officers, have the potential to give rise to significant levels of PTSD (Mitchell, 2000). 

Rescue Workers

banner image of rescue workers

Photos by Jim Macmillan, Philadelphia Daily News. The photo to the right is an award winning
picture of dawn breaking over the ruins of the World Trade Center on 9/12/01.

"Courage is not the absence of fear, but rather the judgment that something else is more important than fear." - Ambrose Redmoon

 

For the purpose of this article, rescue workers are defined as emergency service professionals (law enforcement, fire fighters, paramedics and EMTs, health care professionals and search and rescue teams) who respond to disasters. The traumatic incidents involved in rescue work can be similar to some found in the fire service or law enforcement.  However, the way in which rescue workers are being used seems to have dramatically changed in that they respond to many more man-made disasters and remain on site for longer periods of time than those caused by nature.  

Thirty years ago, the debris from a disaster or plane crash would probably have been bulldozed, after it was clear that there were no survivors (those in the ocean would have remained there). However, as advances have been made in evidence collection and identification of human remains, so has the response required of rescue workers. In major disasters, following the immediate stages of removing the injured and easily accessible bodies, rescue workers often remain at the scene for months. As they painstakingly search through rubble for evidence and body parts, rescue workers are exposed for extended periods to the most vile and horrific of scenes, smells, etc.

Zettl (1998) found that one of the ways rescue workers balance the traumatic incidents involved in their jobs is through saving and rescuing citizens.  In contrast, as rescue workers act as evidence technicians, searchers for body parts, and what may seem at times like garbage collectors, there are few, if any, rescues of survivors.  Furthermore, when working disasters, shifts of twelve or more hours, with no weekend breaks, are common.  Working a disaster site may also involve travel far from home, which deprives workers of the social support typically available from family and friends.  Warning signs that a rescue worker is becoming traumatized by their work include: inability to disengage from the rescue work, irritability, inability to relax and difficulties communicating with others” (NCPTSD, 2002).  The reaction of rescue workers during this time have been compared to those of peacekeepers  in hostile situations  of foreign countries, i.e., increased use of alcohol, problems in sleeping, and increases in anxiety (Mehlum, 1999).

Incidents most likely to traumatize Rescue Workers:

Rescue workers often become very traumatized through working bomb scenes and other disaster sites. Nineteen percent of Rescue Workers serving at sites following the 9-11 attacks have been diagnosed with PTSD in the two years following this tragedy. The following events and quotes have been taken from traumatized Rescue Workers who had worked in numerous rescue efforts. These events, commonly and predictably induce symptoms of PTSD in Rescue Workers.

Witnessing a Death:

  • If the death was violent/body torn apart
  • “I had just gotten to the hotel; it was in flames.  The hotel management had locked the doors because of the casino. I found out later there were over 500 people locked inside.  They were crawling out the windows, they were running, they were screaming.  Suddenly, a giant fireball exploded.  I watched it burn the people in the windows into black distorted forms.  The people who were running inside were stopped in their tracks. The screaming coming from inside stopped.  When I saw the bodies later, they didn’t look human.   It was horrible.”

    “We were outside the building, when it started to collapse.  People started jumping out the windows to their deaths.  One fell right in front of me.  I saw his face right before he hit the ground.  I’ll never forget it.”

Emergency Service Workers - Firefighters

image of emergency service workers

Photos by Jim Macmillan, Philadelphia Daily News

"Many people have the wrong idea of what constitutes true happiness. It is not obtained through self-gratification but through fidelity to a worthy purpose." - Helen Keller

 

  • When a dead victim becomes personalized, rather than just an unknown body, through interaction with grieving family members or friends, or from information gained in numerous ways from the scene, news reports, and so on.  Continued association with the pain of survivors through investigations (and often long after) also can personalize the dead victims.  When a victim dies in the arms of a fire fighter or EMT/paramedic, or on route to the hospital, particularly when the victim is a child or adolescent.
  • The terror of being caught in a violent riot and feeling trapped, particularly when the crowd is focused on killing or injuring the fire fighter or EMT/paramedic.
  • Particularly bloody or gruesome scenes and the length of exposure to these scenes.  Viewing victims with severe burns, the suffering and/or grief of victims or their loved ones.
  • Observing an event involving violence or murder, but not being able to intervene (i.e., “I watched him kill her. She was screaming for my help but there was nothing I could do.”)
  • Feeling personally responsible for someone’s life, such as those administered by an EMT/paramedic at the scene or on route.  When a victim dies on route to the hospital.  Symptoms may occur even when victims are rescued or survive, as a result of the stress hormones released during long rescue operations.
  • When citizens at the scene threaten to kill or critically injure a fire fighter or EMT/paramedic unless some condition is met (For example; “If my father dies, you die.  You had better save him.”)
  • Lack of support by management following their involvement in a very traumatic incident.
  • Being referred to as a “Hero” after being involved in an incident where other fire and rescue service professionals died or were critically wounded; their sense of guilt at living or not saving their peer and/or friend can dramatically increase PTSD symptoms.
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    © 2007-2013 Dr. Davis gives permission for this article to be duplicated and used for training and/or educational purposes provided she is acknowledged as the author.

    *These incidents have primarily from the stories she heard as she treated traumatized fire and rescue service personnel and from research in this area. 

Combat Veterans