Trauma and first responders

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incident, occupational stressors, neuroticism, introversion, and poor coping skills.” Firefighters who display high levels of “hostility, low self-esteem, neuroticism, previous trauma, and a lack of social support” are more at risk for developing PTSD. Location may serve as a risk factor, as urban police are more likely to be deployed in pairs and have structural support compared with rural police who are often deployed alone without access to the same support systems. Additionally, there is an increased risk for unmarried paramedics, canine handlers with insufficient training, and firefighters who experience an increased number of distressing missions.

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difficulty scheduling appointments, not knowing where to go to get help, difficulty taking time off work, leaders discouraging getting treatment, not having transportation, fear of a negative impact on their career and fear that the services are not confidential. Stigma-related concerns create a significant barrier for first responders to seek treatment. Offering psychiatric assessment in general health care sites, making assessment and care routine rather than waiting for symptoms to present, offering assessment, feedback, and treatment that is easily accessible have been found to effectively decrease barriers to care and stigmas.

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into either moral distress or moral injury Moral distress entails experiencing pain and mental health issues that affect the individual in situations during which they are expected to make the correct decision but they are unable to do so due to an external barrier. They may also experience moral injury, which causes individuals to lose perception of the world as a safe place and other human beings as individuals they can trust. Furthermore, Police Complex Spiral Trauma (PCST) addresses the cumulative effect of trauma experienced by police officers over the course of their career due to the frequency of their exposure to trauma.

263: 199:(AED). These positions entail high levels of work related stress and repeated exposure to physical and psychological stressors. In addition to traditional first responders (e.g., police officers, firefighters, EMTs, and hospital providers), there are non-traditional first responders, including laborers and equipment operators. These individuals are also exposed to the aftermath of disaster scenes during their jobs, and face an increased risk for encountering physical injuries and developing psychological distress. 585: 312:

sooner rather than later. The idea of this is how much can someone carry, is the load heavy or light? First responders tend to not seek help, they carry and carry until they can no longer carry the weight/stress. Some first responders suffer from severe-critical incident stress. The rock metaphor describes the weight and load each first responder carries through the length of their careers. Some loads are heavier than others but nonetheless they all carry weight.

359:(AUD) There has been little research on the health risks of first responders because getting help from psychologist have been voluntary and many first responders decline the help. Individuals who experience repeated traumatic events have an increased risk of developing PTSD. Additionally, the type of trauma, the first responder's personality traits, and their level of social support play an important role in the development of post-traumatic stress symptoms. 355:(MDD) are the two most prevalent disorders among first responders. These disorders can begin from the stress of the job or a preexisting stress that comes from the job the first responder is doing now. This type of stress can lead to alcohol drinking which is widespread among first responders. Drinking often helps manage, or soften job-related stress and the exposure to the distressing incidents. This puts first responders at a higher risk of developing 234:

death of a patient while in their care, the death of a child, and violence. In addition to this, the same study reported that 70% had been assaulted on the job and 56% reported experiencing events which could have resulted in their own death. Often small scale triggers (in combination with larger events), such as the lonely death of an elderly person or a death by suicide which can trigger emotional responses.

25: 347:, nightmares, and recurring thoughts, emotional numbness, avoidance of people or places trauma has taken place. “Nearly 400,000 first responders in the United States, and 10% worldwide are suffering from PTSD symptoms.” This would also include U.S. soldiers being linked to PTSD as many are first responders when they come back to the United States after 562:

gives easy access to specialist services, saves time by not going to the doctor's office, cost effective, better continuity of care, and allows for a private form treatment, protecting your information. Other effective uses included help in managing your medications, EEG based neuro-feedback, and additional possible treatments.

483:(PE) is on learning how to gradually address traumatic memories. The goal of PE is to help the individual facing the trauma to stop avoiding the memories. The American Psychological Association (APA) strongly recommends PE for treating PTSD. In a study of police officers, treatment of PTSD using PE led to PTSD remission. 415:

their psychiatric history, trauma exposure, neuroticism, perceived resilience to stress, and depressive attributions. During this two-year study, it was determined that first responders who were at risk for developing PTSD or major depression could be identified within the first week of their training.

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Hoffman, Leon (February 2014). "Book Essay on Diagnostic and Statistical Manual of Mental Disorders; Desk Reference to the Diagnostic Criteria from DSM-5Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC: American Psychiatric Association, 2013, 991 pp.Desk Reference to

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It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone. Eye movement desensitization and reprocessing (EMDR) is a relatively new

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The types of trauma experienced by first responders often vary depending on the emergency service. Police officers handle domestic violence and serious crimes; paramedics encounter gruesome injuries and dead bodies; firefighters rescue burn victims and trapped car crash victims; and search and rescue

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The demand to care for and interact with all members of the community often results in compassion fatigue among police officers. Additionally, the need to care for each individual, and specifically any victims, on a crime scene can create a feeling of moral suffering, which can be further broken down

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New forms of treatment are being introduced as through technology in order to treat PTSD. One of them is called Biometric TeleHealth which has been introduced to the health worker category of first responders. It helps healthcare workers with post-traumatic stress symptoms or chronic pain.It further

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As Emergency Responders progress through their careers, each incident, each experience goes into their backpacks as a rock. A good example is that if a first responder is wearing a backpack, after each traumatic experience they add a rock. Eventually, the back pack will start to get incredibly heavy

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Eighty percent of first responders report experiencing traumatic events on the job. As of 2012, the prevalence rates of PTSD were “14.6% for emergency personnel, 7.3% for firefighters, 4.7% for police officers, and 13.5% for other rescue teams." “Nearly 400,000 first responders in the United States,

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Education at the academy on signs and symptoms of depressive behavior and resources available to first responders shows others are feeling the same way. The federal government is looking into promoting mental health training for each occupation. There is a stigma that comes from asking for help and

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EMTs and paramedics, amongst other first responders, can suffer from posttraumatic stress symptoms and depressive symptoms as a result of repeated exposure to human pain and suffering on a daily basis. A study of paramedics reported more than 80% of paramedics in a large urban area experienced: the

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Research has largely focused on trauma among more stereotypical first responders such as firefighters or police officers, however, there is an increasing amount of research investigating the biometric stress parameters such as heart rate among emergency dispatchers. One study found dispatchers had

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Barriers to receiving mental health care are not uncommon, however first responders face unique challenges. In a review of studies assessing barriers to care among first responders, 33.1% of participants reported experiencing some barrier to receiving treatment for PTSD. Common barriers included:

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During orientation, training, or an academy, first responders should be told about any job-related resources available to them. This include Critical Incident Stress Teams, Peer Support Teams, or Employee Assistance Programs. It is worth noting that social support has shown a decreased stress and

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Suicide is considered high risk in law enforcement officers, but is not solely related to the exposure to a traumatic event. Lack of social support is significantly associated with an increase of feelings of hopelessness and suicide. Additionally, an increase in stress of administrative practices

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Paramedics have the highest prevalence of PTSD while police officers have the lowest. Paramedics respond to more emergencies than police and firefighters and do not undergo the same intense screening like police and firefighters. Since police officers carry weapons (firearms, batons, electroshock

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PTSD is characterized by, "exposure to actual or threatened death, serious injury, or sexual violence" either directly or indirectly, intrusion, persistent avoidance of stimuli associated with the event, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity

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Psychological therapies are usually recommended first in people who have PTSD that require treatment. A mixture of a medication and psychological therapy may be recommended if the individual has chronic, severe or persistent PTSD. A doctor may refer the individual to a clinic that specializes in

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Prior to entering a first responder career, there is some evidence that screening can occur to help predict and train certain people who may have predictors of developing PTSD. During this study, new paramedic students were evaluated based on multiple factors. These factors included things like:

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Emotional stress is an intrinsic part of emergency dispatchers’ occupational health; they work in critical situations, with an irregular work load, and no feedback regarding patient outcome. Acute stress is a fundamental adaptive response, but psychological stress at work can lead to illness and

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Search and Rescue personnel are also repeatedly exposed to direct and indirect stressors as they are always putting their own safety at risk in order to come to the aid of others. Search and Rescue personnel share similar occupational experiences with firefighters, and the severity and degree of

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Critical Incident Debriefing (CISD) is a type of group debriefing that takes place following exposure to a potentially traumatic event. CISD follows a seven-stage protocol (Introduction, Facts, Thoughts, Reactions, Symptoms, Education, and Re-entry). CISD was developed as part of program called

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Around 5.9-22% of first responders end up being diagnosed with psychological trauma. Side effects and impacts from this can be physical, mental, or behavioral. The first responder field is high risk, with the daily exposure of severe incidents. First responders have a high emotional impact when

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Firefighters may experience Repeated Exposure Trauma, as they are often faced with recurrent severe stress when responding to life-threatening incidents during which their goal is oftentimes to save lives. The severity of the incidents that firefighters are involved in, and the emotional skills

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also increased feelings of hopelessness in this particular occupation. In 2017, 103 firefighters and 140 police officers committed suicide, compared to 93 firefighters and 129 officers died in the line of duty (being fatally shot, stabbed, drowning or dying in a car accident while on the job).

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Klimley et al. found that Canadian female police and firefighters were more likely to test positive for any mental disorder. Other types of first responders did not show a significant difference based on sex. Risk factors presented for law enforcement include “proximity to the event, type of

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Due to the stigma associated with having a mental health disorder among first responders, individuals at these jobs tend to under report symptoms to avoid judgment by peers and supervisors, demotion, or a decrease in responsibilities at work. On average, "about one in three first responders

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Those with a history of mental disorders are 6-times more likely to develop PTSD. It is important that providers receive adequate education on signs and symptoms of developing PTSD and know what resources are available to them because they are at a higher risk of experiencing a PTSD event.

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with PTSD. Similarly, firefighters experience “cardiovascular disease, respiratory problems, depression, acute stress disorder, interpersonal difficulties, substance abuse, and suicide.” Lastly, dispatchers can present with high cortisol and higher burnout rates with a PTSD diagnosis.

148:(GAD). Exposure to multiple traumatic stressors could also exacerbate other pre-existing conditions. The presence of any mental health disorders in these individuals can also be associated with diminished ability to work efficiently, early retirement, substance abuse, and suicide. 278:

personnel encounter missing people, some of whom may be seriously injured or dead. Dispatchers, who may not see or experience these themselves, may receive panicked emergency calls or first responder transmissions, and may find themselves unable to help despite hearing trouble.

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Brief Eclectic Psychotherapy (BEP) is a combination of cognitive behavioral therapy (CBT) and psychodynamic approaches. The focus of BEP is specifically on feelings of guilt and shame. Following treatment of BEP, 86% of first responders with PTSD return to work.

553:. However, benzodiazepines are not recommended as a treatment method for PTSD on their own as they have been observed to increase early incidence of PTSD after treatment, have worsening symptoms during withdrawal and have a high likelihood of developing dependence. 129:, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed. 282:

dealing with trauma due to the fact they don't allow their feelings to interfere with their jobs. First responders must keep their emotions under control so that they can help victims; this type of behavior eventually has a toll on the responder.

471:(CBT) focuses on the relationship between thoughts, feelings and behaviors. The American Psychological Association (APA) strongly recommends CBT for treating PTSD. Current evidence supports the use of CBT for first responders experiencing PTSD. 536:

Although CISD is commonly practiced with police officers, firefighters, and paramedics, this treatment has been associated with an increased risk of PTSD and alteration of memories of the traumatic event, therefore is not recommended.

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In many states, there are no regulations regarding the protection or treatment for first responders after experiencing a traumatic event. The following states have enacted some type of legislation regarding PTSD and first responders:

241:, the process by which an individual shares or experiences the feelings of another, paramedics move beyond a cognitive understanding of loss or suffering in stressful situations to experiencing emotional empathy in these situations. 396:

Prior to a PTSD event, a first responder should be given the resources or be aware of what resources are available to them in the event of a traumatic experience. A list of resources can be found on the Code Green Campaign website.

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trauma of events that these teams must respond to might have an impact upon these individual's emotional and mental health. Both Firefighters and Search and Rescue personnel are also at great risk for developing compassion fatigue.

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reduced productivity. Being at the beginning of the rescue chain, it is important that dispatchers are in good health to communicate vital information during critical phases of operations; errors can have serious consequences.

2439:"Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study" 1234:"Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study" 160:, defines the term as "those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property evidence, and the environment, including emergency response providers". 774:

Haugen, Peter T.; McCrillis, Aileen M.; Smid, Geert E.; Nijdam, Mirjam J. (November 2017). "Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis".

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following a traumatic experience. Symptoms must last longer than one month, cause clinically significant distress in social or occupational functioning, and not be attributed to other conditions or substances.

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elevated heart rates and reduced heart rate variability at the beginning and throughout a shift; additionally dispatchers showed a significant increased risk of work disability as compared to a control group.

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experiences stigma regarding mental health." Other barriers associated with under reporting are a lack of knowledge of where to receive treatment, scheduling concerns, and fear regarding confidentiality.

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Berger, William; Coutinho, Evandro Silva Freire; Figueira, Ivan; Marques-Portella, Carla; Luz, Mariana Pires; Neylan, Thomas C.; Marmar, Charles R.; Mendlowicz, Mauro Vitor (18 June 2011).

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Wittchen, Hans-Ulrich; Schönfeld, Sabine; Kirschbaum, Clemens; Thurau, Christin; Trautmann, Sebastian; Steudte, Susann; Klotsche, Jens; Höfler, Michael; Hauffa, Robin (3 September 2012).

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Wild, J., Smith, K. V., Thompson, E., Béar, F., Lommen, M. J., & Ehlers, A. (2016). A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression.

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Jeong, Hyeonseok S.; Park, Shinwon; Lim, Soo Mee; Ma, Jiyoung; Kang, Ilhyang; Kim, Jungyoon; Kim, Eui-Jung; Choi, Yejee J.; Lim, Jae-ho; Chung, Yong-An; Lyoo, In Kyoon (3 July 2017).

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Following a traumatic event, there are multiple treatments for post-traumatic symptoms used for individuals in these populations. Common treatment for first responders with PTSD are

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This screening tool should only be used to help a provider with the awareness of developing PTSD. It is illegal for an employer to screen or deny a provider based on these findings.

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Torchalla, Iris; Strehlau, Verena (17 August 2017). "The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations".

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treatment that's been found to reduce the symptoms of PTSD. EMDR was found to be more effective at treating PTSD among first responders than a stress management program.

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Klimley, Kristin E.; Van Hasselt, Vincent B.; Stripling, Ashley M. (November 2018). "Posttraumatic stress disorder in police, firefighters, and emergency dispatchers".

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Tuckey, Michelle R.; Scott, Jill E. (25 June 2013). "Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial".

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Paterson, Helen M.; Whittle, Keenan; Kemp, Richard I. (16 January 2014). "Detrimental Effects of Post-Incident Debriefing on Memory and Psychological Responses".

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Paterson, Helen M.; Whittle, Keenan; Kemp, Richard I. (16 January 2014). "Detrimental Effects of Post-Incident Debriefing on Memory and Psychological Responses".

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weapons, etc.), the hiring process is designed to find individuals with personality traits related to psychological resilience through psychological assessment.

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Weiss, Daniel S.; Brunet, Alain; Best, Suzanne R.; Metzler, Thomas J.; Liberman, Akiva; Pole, Nnamdi; Fagan, Jeffrey A.; Marmar, Charles R. (15 November 2010).

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Critical Incident Stress Management (CISM) which includes individual counseling, pre-exposure interventions, family support and referral for further therapy.

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In a study conducted by Regehr et al., researchers aimed to better understand by what processes do lasting effects take hold. Researchers found that through

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Understanding and acknowledging that first responders are exposed to traumatic events is critical in the health and safety of a first responders career.

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lowered PTSD symptoms in first responders When first responders can come together and talk about similar situations they showed resilience with the

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Weibel, Laurence; Gabrion, Isabelle; Aussedat, Michel; Kreutz, Gerard (April 2003). "Work-related stress in an emergency medical dispatch center".

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Kim, Jieun E.; Dager, Stephen R.; Jeong, Hyeonseok S.; Ma, Jiyoung; Park, Shinwon; Kim, Jungyoon; Choi, Yera; Lee, Suji L.; Kang, Ilhyang (2018).

1791:"Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers" 2391:

Haugen, Peter T.; Evces, Mark; Weiss, Daniel S. (July 2012). "Treating posttraumatic stress disorder in first responders: A systematic review".

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Haugen, Peter T.; Evces, Mark; Weiss, Daniel S. (July 2012). "Treating posttraumatic stress disorder in first responders: A systematic review".

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First responders risk for developing stress-related health problems is greater than the general population. This could include such things as

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Among law enforcement officers, “chronic pain, cardiovascular problems, arthritis, substance use, depression, anxiety, and suicide” present

49: 2703:"PUBLIC Law, Chapter 294, An Act To Support Law Enforcement Officers and First Responders Diagnosed with Post-traumatic Stress Disorder" 2052:

Violanti, John M.; Andrew, Michael E.; Mnatsakanova, Anna; Hartley, Tara A.; Fekedulegn, Desta; Burchfiel, Cecil M. (27 February 2015).

1912:"The Effectiveness of Interventions Aimed at Improving Well-Being and Resilience to Stress in First Responders: A Systematic Review" 1291:"Frequency and severity approaches to indexing exposure to trauma: The Critical Incident History Questionnaire for police officers" 1351:

Regehr, Cheryl; Goldberg, Gerald; Hughes, Judy (2002). "Exposure to Human Tragedy, Empathy, and Trauma in Ambulance Paramedics".

1582:"Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders" 546: 993:"First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers" 2494: 2802: 1994:"Psychometric Properties of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) in Public First Responders" 1164:"Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey" 1120:

Papazoglou, Konstantinos (2013). "Conceptualizing Police Complex Spiral Trauma and its applications in the police field".

1042:"The Role of Moral Suffering (Moral Distress and Moral Injury) in Police Compassion Fatigue and PTSD: An Unexplored Topic" 673:

Vermont: Created true occupational presumption for PTSD, recognizes PTSD under workers’ compensation for first responders

448: 2777: 1873:"The relation of perceived and received social support to mental health among first responders: a meta-analytic review" 82: 545:

There are a number of medications that have been found to be beneficial in the treatment of PTSD. The most common are

2908: 2586:"Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis" 1712: 629: 67: 132:

These occupations subject individuals to a great deal of traumatic events, resulting in a higher risk of developing

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Massachusetts: Ensures that first responders have access to mental health resources after a traumatic event.

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South Carolina: $ 500,000 fund to assist first responders with costs associated with the treatment of PTSD

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Bezabh, Yodit Habtamu; Abebe, Solomon Mekonnen; Fanta, Tolesa; Tadese, Agitu; Tulu, Mikiyas (July 2018).

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Bezabh, Yodit Habtamu; Abebe, Solomon Mekonnen; Fanta, Tolesa; Tadese, Agitu; Tulu, Mikiyas (July 2018).

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the Diagnostic Criteria from DSM-5. Washington, DC: American Psychiatric Association, 2013, 443 pp".

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New York: Allows first responders to claim for mental injury after extraordinary work-related stress

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Lyra, Renan Lopes de; McKenzie, Sarah K.; Every-Palmer, Susanna; Jenkin, Gabrielle (30 April 2021).

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Oldenburg, Marcus; Wilken, Dennis; Wegner, Ralf; Poschadel, Bernd; Baur, Xaver (30 September 2014).

2877: 2827: 611: 2727: 503:(EMDR) focuses on the memory of a traumatic event. EMDR follows a structured eight phase process: 2267:"Traumatic Experiences and Posttraumatic Stress Disorder in Soldiers Following Deployment Abroad" 262: 164: 2852: 2110:"Study: Police Officers and Firefighters Are More Likely to Die by Suicide than in Line of Duty" 1009: 992: 685: 344: 91: 1527: 1911: 218: 2323:"Depression, PTSD, & Other Mental Health Conditions in the Workplace: Your Legal Rights" 2584:

Haugen, Peter T.; McCrillis, Aileen M.; Smid, Geert E.; Nijdam, Mirjam J. (November 2017).

2322: 1593: 1175: 110: 2161:"First responder mental healthcare: Evidence-based prevention, postvention, and treatment" 8: 348: 1597: 1179: 2570:“Biometric Telehealth for PTSD in Frontline Healthcare Workers.” Institutes of Health, 2553: 2471: 2438: 2373: 2299: 2266: 2188: 2160: 2086: 2053: 2029: 1939: 1823: 1790: 1764: 1681: 1637: 1624: 1581: 1555: 1422: 1323: 1290: 1266: 1233: 1206: 1163: 1076: 1041: 973: 922: 887: 868: 328: 2585: 1487:"Job-related stress and work ability of dispatchers in a metropolitan fire department" 1397:

REGEHR, CHERYL (16 February 2005). "Bringing the Trauma Home: Spouses of Paramedics".

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Loftus, Elizabeth F. (1999). "A step backward in the recovered memory debate".

1364: 550: 141: 118: 2404: 2361: 2282: 1806: 1543: 1503: 1486: 1410: 961: 888:"The Current Crisis in Emergency Care and the Impact on Disaster Preparedness" 856: 729: 2902: 2609: 2541: 2462: 2412: 2369: 2290: 2231: 2184: 2077: 2017: 1978: 1935: 1896: 1814: 1752: 1744: 1677: 1669: 1615: 1512: 1418: 1372: 1314: 1257: 1197: 1141: 1133: 1067: 1058: 1018: 969: 913: 864: 796: 737: 676:

Washington: Recognizes PTSD under workers’ compensation for first responders

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Firefighters and paramedics extract a patient from their vehicle following a

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or have training in the field can typically provide advanced first aid care,

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Minnesota: Recognizes PTSD under workers’ compensation for first responders

2631: 2617: 2549: 2480: 2420: 2308: 2208:"Inaugural federal committee meeting confirms HHS's efforts to address SMI" 2134: 2095: 2025: 1832: 1760: 1633: 1551: 1528:"Treating Psychological Trauma in First Responders: A Multi-Modal Paradigm" 1466: 1380: 1332: 1275: 1215: 1085: 1026: 931: 804: 745: 646:

Colorado: Recognizes PTSD under workers’ compensation for first responders

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Wild, Jennifer; El-Salahi, Shama; Esposti, Michelle Degli (October 2020).

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Florida: Recognizes PTSD under workers’ compensation for first responders

2632:"Workers' Compensation For Mental Impairment | Colorado General Assembly" 1458: 376: 168: 122: 87: 1872: 991:

Benedek, David M.; Fullerton, Carol; Ursano, Robert J. (16 March 2007).

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Texas: Recognizes PTSD under workers’ compensation for first responders

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Idaho: Recognizes PTSD under workers’ compensation for first responders

2207: 2176: 2054:"Correlates of hopelessness in the high suicide risk police occupation" 1888: 495: 356: 336: 2223: 1788: 1306: 332: 176: 126: 2572:

https://institutesofhealth.org/ptsd-in-frontline-healthcare-workers/

2778:"New York State Assembly | Bill Search and Legislative Information" 2657:"Statutes & Constitution :View Statutes : Online Sunshine" 1702: 2264: 2159:

Lanza, Allyssa; Roysircar, Gargi; Rodgers, Sarajane (June 2018).

2051: 271: 2803:"South Carolina Legislature Online - Bill Search by Bill Number" 1579: 1484: 406:

this could be why the research on first responders is so low.

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National Security and Homeland Security Presidential Directive

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deal primarily with the United States and do not represent a

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odd capitalization, repeated information, awkward formatting.

1444: 842: 1848:"Helping First Responders Withstand Traumatic Experiences" 2583: 773: 1707:(5th ed.). American Psychiatric Association. 2013. 516:

Phases 4-7: Processing the memory to adaptive resolution

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Maine: Created true occupational presumption for PTSD

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Diagnostic and Statistical Manual of Mental Disorders

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and 10% worldwide are suffering from PTSD symptoms.”

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These can consist of fully trained positions such as

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Eye Movement Desensitization and Reprocessing (EMDR)

2347: 947: 391: 156:The term "first responder", as defined in the U.S. 1658:Journal of the American Psychoanalytic Association 474: 460:treating PTSD, depending on the proximity of one. 2432: 2430: 1871:Prati, Gabriele; Pietrantoni, Luca (April 2010). 1730: 886:Cherry, Robert A.; Trainer, Marcia (1 May 2008). 2900: 2828:"85(R) HB 1983 - Introduced version - Bill Text" 2390: 1870: 1040:Papazoglou, Konstantinos; Chopko, Brian (2017). 1039: 715: 1491:Journal of Occupational Medicine and Toxicology 1161: 2427: 2255:(12), 2571–2582. doi:10.1017/S0033291716000532 2165:Professional Psychology: Research and Practice 1991: 1959:Professional Psychology: Research and Practice 1795:Social Psychiatry and Psychiatric Epidemiology 885: 592:The examples and perspective in this article 501:Eye Movement Desensitization and Reprocessing 445:eye movement desensitization and reprocessing 2495:"Treatment - Post-traumatic stress disorder" 430: 351:. Post-traumatic stress disorder (PTSD) and 302: 217:needed to cope with this stress can lead to 151: 2519: 1010:10.1146/annurev.publhealth.28.021406.144037 556: 2682:"HOUSE BILL 585 – Idaho State Legislature" 1119: 454: 443:(PE), brief eclectic psychotherapy (BEP), 98:part of the training exercise, playing an 94:training exercise in 2014. The woman is a 2470: 2350:Journal of Police and Criminal Psychology 2298: 2085: 1822: 1623: 1605: 1502: 1322: 1265: 1205: 1187: 1075: 1057: 1008: 950:Journal of Police and Criminal Psychology 921: 903: 630:Learn how and when to remove this message 68:Learn how and when to remove this message 2728:"Session Law - Acts of 2018 Chapter 329" 2206:Canady, Valerie A. (11 September 2017). 1525: 565: 319: 261: 81: 1654: 547:Selective Serotonin Reuptake Inhibitors 383: 2901: 2243: 2241: 2205: 1956: 1480: 1478: 1476: 1440: 1438: 1436: 1396: 1227: 1225: 1115: 16:Trauma experienced by first responders 2047: 2045: 2043: 1784: 1782: 1780: 1778: 1726: 1724: 1697: 1695: 1392: 1390: 1346: 1344: 1342: 1157: 1155: 1153: 1151: 1113: 1111: 1109: 1107: 1105: 1103: 1101: 1099: 1097: 1095: 838: 836: 834: 519:Phase 8: Evaluating treatment results 370: 285: 1526:Flannery, Raymond B. (1 June 2015). 943: 941: 832: 830: 828: 826: 824: 822: 820: 818: 816: 814: 769: 767: 765: 763: 761: 759: 757: 755: 711: 709: 707: 705: 703: 701: 578: 513:Phase 3: Assessing the target memory 18: 2238: 1845: 1473: 1433: 1353:American Journal of Orthopsychiatry 1222: 574: 528:Critical Incident Debriefing (CISD) 449:Critical Incident Stress Debriefing 13: 2040: 1775: 1721: 1692: 1387: 1339: 1148: 1092: 540: 487:Brief Eclectic Psychotherapy (BEP) 464:Cognitive Behavioral Therapy (CBT) 257: 212:Firefighters and search and rescue 202: 14: 2920: 938: 811: 752: 698: 2602:10.1016/j.jpsychires.2017.08.001 789:10.1016/j.jpsychires.2017.08.001 583: 439:(CBT), CBT as exposure therapy, 392:Awareness of available resources 228: 197:automated external defibrillator 23: 2870: 2845: 2820: 2795: 2770: 2745: 2720: 2695: 2674: 2649: 2624: 2590:Journal of Psychiatric Research 2577: 2564: 2513: 2487: 2384: 2341: 2315: 2258: 2199: 2152: 2127: 2102: 1985: 1950: 1903: 1877:Journal of Community Psychology 1864: 1839: 1648: 1573: 1519: 1282: 845:Aggression and Violent Behavior 777:Journal of Psychiatric Research 475:Prolonged Exposure Therapy (PE) 315: 2878:"Washington State Legislature" 1033: 997:Annual Review of Public Health 984: 879: 244: 134:post-traumatic stress disorder 1: 2522:Anxiety, Stress, & Coping 2070:10.1080/15614263.2015.1015125 2010:10.1080/10826084.2016.1271986 691: 510:Phase 2: Preparing the client 221:(ASD) and, eventually, PTSD. 185:emergency medical dispatchers 181:emergency medical technicians 2534:10.1080/10615806.2013.809421 2058:Police Practice and Research 1971:10.1037/0735-7028.30.6.623.b 1607:10.1371/journal.pone.0251038 1447:Annals of Emergency Medicine 1189:10.1371/journal.pone.0190630 469:Cognitive Behavioral Therapy 437:cognitive behavioral therapy 425: 409: 146:generalized anxiety disorder 7: 2455:10.1136/bmjopen-2017-020705 2271:Deutsches Ärzteblatt Online 1295:Journal of Traumatic Stress 1250:10.1136/bmjopen-2017-020705 679: 606:, discuss the issue on the 173:search and rescue personnel 43:. The specific problem is: 10: 2925: 2393:Clinical Psychology Review 2114:Ruderman Family Foundation 1998:Substance Use & Misuse 1399:Journal of Loss and Trauma 1365:10.1037/0002-9432.72.4.505 718:Clinical Psychology Review 481:Prolonged Exposure Therapy 441:prolonged exposure therapy 107:Trauma in first responders 2753:"2018 Minnesota Statutes" 2405:10.1016/j.cpr.2012.04.001 2362:10.1007/s11896-014-9141-6 2283:10.3238/arztebl.2012.0559 1928:10.1027/1016-9040/a000402 1807:10.1007/s00127-011-0408-2 1544:10.1007/s11126-014-9329-z 1504:10.1186/s12995-014-0031-8 1411:10.1080/15325020590908812 962:10.1007/s11896-014-9141-6 857:10.1016/j.avb.2018.08.005 730:10.1016/j.cpr.2012.04.001 431:Post-crisis interventions 353:major depressive disorder 303:Stigma and underreporting 152:Types of first responders 138:major depressive disorder 2909:Stress-related disorders 2707:www.mainelegislature.org 1745:10.1177/0145445517725048 1670:10.1177/0003065114524985 1134:10.1177/1534765612466151 1059:10.3389/fpsyg.2017.01999 557:Technological Treatments 165:law enforcement officers 90:treats a woman during a 2857:legislature.vermont.gov 2139:The Code Green Campaign 1046:Frontiers in Psychology 507:Phase 1: History-taking 455:Psychological Therapies 2249:Psychological medicine 892:BMC Emergency Medicine 686:Combat stress reaction 340: 274: 103: 92:mass-casualty incident 1916:European Psychologist 1733:Behavior Modification 1532:Psychiatric Quarterly 905:10.1186/1471-227X-8-7 566:Barriers to treatment 357:alcohol use disorders 323: 265: 219:acute stress disorder 85: 2807:www.scstatehouse.gov 2782:assembly.state.ny.us 2212:Mental Health Weekly 2135:"Help and Resources" 1459:10.1067/mem.2003.109 612:create a new article 604:improve this article 384:Pre-crisis education 111:psychological trauma 50:improve this article 39:to meet Knowledge's 2661:www.leg.state.fl.us 1598:2021PLoSO..1651038L 1180:2018PLoSO..1390630K 2757:www.revisor.mn.gov 2501:. 17 February 2021 2329:. 12 December 2016 2177:10.1037/pro0000192 1889:10.1002/jcop.20371 371:Comorbid disorders 341: 329:funeral procession 286:Prevalence of PTSD 275: 104: 2832:capitol.texas.gov 2732:malegislature.gov 2277:(35–36): 559–68. 2224:10.1002/mhw.31179 1307:10.1002/jts.20576 640: 639: 632: 614:, as appropriate. 325:Australian police 239:emotional empathy 78: 77: 70: 41:quality standards 32:This article may 2916: 2893: 2892: 2890: 2888: 2874: 2868: 2867: 2865: 2863: 2849: 2843: 2842: 2840: 2838: 2824: 2818: 2817: 2815: 2813: 2799: 2793: 2792: 2790: 2788: 2774: 2768: 2767: 2765: 2763: 2749: 2743: 2742: 2740: 2738: 2724: 2718: 2717: 2715: 2713: 2699: 2693: 2692: 2690: 2688: 2678: 2672: 2671: 2669: 2667: 2653: 2647: 2646: 2644: 2642: 2636:leg.colorado.gov 2628: 2622: 2621: 2581: 2575: 2568: 2562: 2561: 2517: 2511: 2510: 2508: 2506: 2491: 2485: 2484: 2474: 2434: 2425: 2424: 2388: 2382: 2381: 2345: 2339: 2338: 2336: 2334: 2319: 2313: 2312: 2302: 2262: 2256: 2245: 2236: 2235: 2203: 2197: 2196: 2156: 2150: 2149: 2147: 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477: 466: 457: 433: 428: 412: 394: 386: 373: 318: 305: 288: 260: 258:Types of trauma 247: 231: 214: 205: 203:Law enforcement 154: 119:police officers 113:experienced by 74: 63: 57: 54: 47: 28: 24: 17: 12: 11: 5: 2922: 2912: 2911: 2895: 2894: 2882:app.leg.wa.gov 2869: 2853:"Vermont Laws" 2844: 2819: 2794: 2769: 2744: 2719: 2694: 2673: 2648: 2623: 2576: 2563: 2512: 2486: 2449:(7): e020705. 2426: 2399:(5): 370–380. 2383: 2340: 2314: 2257: 2237: 2198: 2171:(3): 193–204. 2151: 2126: 2101: 2064:(5): 408–419. 2039: 1984: 1949: 1922:(4): 252–271. 1902: 1883:(3): 403–417. 1863: 1846:Heglund, Jan. 1838: 1774: 1739:(2): 273–303. 1720: 1713: 1691: 1664:(1): 125–147. 1647: 1572: 1538:(2): 261–267. 1518: 1472: 1453:(4): 500–506. 1432: 1386: 1359:(4): 505–513. 1338: 1301:(6): 734–743. 1281: 1244:(7): e020705. 1221: 1147: 1128:(3): 196–209. 1091: 1032: 983: 937: 878: 810: 751: 724:(5): 370–380. 696: 695: 693: 690: 689: 688: 681: 678: 638: 637: 598:of the subject 596:worldwide view 591: 589: 582: 576: 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and 127:paramedics 117:, such as 2610:0022-3956 2542:1061-5806 2463:2044-6055 2413:0272-7358 2378:145132669 2370:0882-0783 2291:1866-0452 2232:1058-1103 2193:149731930 2185:1939-1323 2078:1561-4263 2034:205748996 2018:1082-6084 1979:0735-7028 1944:226194988 1936:1016-9040 1897:0090-4392 1815:0933-7954 1753:0145-4455 1686:146680876 1678:0003-0651 1642:233471457 1616:1932-6203 1513:1745-6673 1497:(1): 31. 1419:1532-5024 1373:1939-0025 1315:0894-9867 1258:2044-6055 1198:1932-6203 1142:1085-9373 1068:1664-1078 1019:0163-7525 978:145132669 970:0882-0783 914:1471-227X 873:149632078 865:1359-1789 851:: 33–44. 797:0022-3956 738:0272-7358 608:talk page 426:Treatment 410:Screening 189:certified 102:survivor. 2903:Category 2887:29 March 2862:29 March 2837:29 March 2812:29 March 2787:29 March 2762:29 March 2737:29 March 2712:29 March 2687:29 March 2666:29 March 2641:29 March 2618:28800529 2558:27769659 2550:23799773 2505:13 March 2481:30049692 2443:BMJ Open 2421:22561967 2333:29 March 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