The trouble with trauma in emergency services

Many emergency service and health-care workers who serve the public are routinely exposed to the of their patients and clients. These workers include police officers, firefighters, emergency medical services staff, hospital emergency department staff, funeral home workers, 911 operators and many others. These unsung heroes enter into burning buildings, pull crash survivors to safety, carry out life-saving procedures, and deal with the aftermath of horrible tragedies. In their work, these professionals need to be incredibly strong and resourceful, and share a culture of courage and resilience. The downside of these strengths can be an unspoken code of silence which can lead to hiding personal fears, pain, and trauma from others and reluctance to access counseling and psychological treatment for post-traumatic stress symptoms.

When I first began my practice as a clinical psychologist and established the Traumatology Institute in Canada in 1998, I immediately offered services to emergency service professionals. As a result of this work, I recognized that emergency service workers needed to be incredibly courageous, resourceful, strong and resilient by nature. I noticed that individuals going into these fields were often very good at being caring and compassionate with others but not necessarily for themselves. They did not easily tolerate emotional discomfort as this was perceived as weakness in their own response to their work. They revealed a lack of self-compassion when reflecting on their own emotional pain.

To give an example, several years ago I coordinated a Psychological First Aid response after a plane crash in a rural community (details have been changed to protect the privacy of those involved). The pilot and all 24 passengers in the plane lost their lives resulting in a community-wide sense of grief and loss. Two days after the crash, John, an RCMP member who was managing the response to the incident spoke with me in the hallway of the Emergency Operations Centre (EOC). Almost everyone on the plane was a member of John’s small community. He was personally devastated but did not feel that he could express his feelings with friends or colleagues because of his role in the aftermath of the event.

John explained quietly and away from his peers that he felt “burnt.” I asked him to explain what he meant. He listed a series of symptoms consistent with Post-Traumatic Stress Disorder (PTSD) including memories of work traumas intruding into his dreams and daily activities, feelings of anxiety that had become intolerable at times, and a tendency to avoid work situations that reminded him of past traumatic events. He told me that he had begun to feel very badly the previous fall where he was on scene when a young child (the same age as his own son) who had drowned and was pulled from the water after a boating accident. He said he tried to shut-out his feelings and just “get over” his discomfort. He admitted that this approach wasn’t working anymore and every day was a struggle. I called him a “good coper”, a person who experiences emotional pain but who continues to make every effort to carry on despite daily demands. He agreed and said that he never talks about his own feelings. I said I wasn’t surprised as it is very common to focus on the needs of others in a field where the work is really about helping others cope rather than concerning oneself with the personal impact of the job.

John continued to confide in me, expressing his concern about the stigma of being personally affected. He said that his peers would lose all respect for him if he told them the truth about his distress. He was convinced that he was the only one suffering from his close contact with daily trauma. I told him about a book called Cop Shock (Kates, 2008) in which the fallacy of emergency workers’ invincibility is exposed. The foreword, written by retired Detective Martin is an incredible eye-opener in which he publicly discloses his struggle:

“For most of my police years, I was addicted to alcohol and prescription drugs. I often had suicidal thoughts and once tried to kill myself. I didn’t realize that my exposure to frequent trauma was causing PTSD. Fortunately, I have benefited from counseling and am now in recovery.”

Experiencing PTSD after exposure to workplace trauma is not unusual and occurs to 15-25 per cent of emergency workers depending on the severity of incidents they are exposed to. Certain high impact traumatic events like terrorist acts such as the Oklahoma City Bombing and The World Trader Center attack in New York City can result in even higher rates of PTSD among emergency responders or hospital workers.

Seeking trauma therapy can mean the difference between years of suffering and the ability to work through unresolved memories, symptoms and limiting or troubling behaviours. In my experience, those who seem to recover the best seek help early, are open to trying a variety of therapeutic approaches, and take the time to care for themselves through lifestyle factors such as eating well, exercising regularly, getting enough sleep, and relying on family, friends, co-workers, and counseling professionals for support.

Those who want to start with a self-help approach may wish to listen to a self-guided audio recording I developed titled “Recovery Now Trauma” (Baranowsky, 2010). This recording provides information about trauma exposure, and assists the listener with guided exercises in a Tri-Phasic post-trauma care approach. The audio recording covers three essential phases in trauma therapy which include Stabilization (deep breathing, relaxation), Trauma Memory Processing (working through trauma memories), and Reconnection (re-establishing meaningful activities and connections with others after trauma). “Recovery Now Trauma” is not meant to replace direct counseling services but does provide a starting place or adjunct for those who want to work on their own between therapy sessions.

The true cost of untreated PTSD goes far beyond diminished work performance and can result in extreme personal distress, relationship issues, reduced ability to function in all areas of life, potential job loss, financial difficulties, addiction and reduced ability to take pleasure in even the simple joys of life. We cannot afford to lose those who do so much good in our society to the impact of trauma. We all need to watch out for our peers, colleagues, friends and family members in the aftermath of trauma and do everything within our ability to encourage those in need to seek service as well as to release the stigma of seeking treatment.

The road to recovery from trauma is challenging but worth every step of the journey.

Dr. Baranowsky is the CEO and founding director of The Traumatology Institute (Canada). She runs a private practice in Toronto, Ontario with a specialization in Trauma Therapy. She is preparing to launch a new web based service to assist trauma survivors find skilled trauma therapists anywhere in Canada or the U.S. For more information visit

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