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

There are approximately 266,300 professional (paid) fire fighters in the U.S. and 815,500 volunteers, and the number of volunteers is declining. Fire fighters and paramedics are continually exposed to high levels of job-related trauma. In 2001, 438 fire fighters and paramedics died on the scene of fire incidents (344 responding to the attack of the World Trade Center on 9-11). Of those who died, 83% were professional fire fighters, 71 deaths were of volunteers, part-time or wild land fire fighters. In 2005 there were 115 line-of-duty deaths and 41, 950 injuries. Surprisingly, in the past 20 years, heart attacks have accounted for about 50% of on-the-job fire fighter fatalities. Motor vehicle crashes have accounted for about 21% of deaths; gunshot wounds for 5.3% (www.usfa.dhs.gov/fireservice/fatalities/statistics/casualties.shtm; Fire Headquarters; 2002)

Although the high rate of on-the-job deaths of fire fighters as a result of heart attacks may initially be interpreted as being the result of the combination of the exertion involved in the use and wearing of heavy equipment and poor physical condition of some fire fighters, recent research is suggesting that the response of a body and brain to threatening and traumatic experiences and how this impacts on heart rate, blood pressure and immune reactions is also a contributing factor.

In a study by Corneil, Beaton, Murphy, Johnson & Pike (1999), which compared 203 U.S. fire fighters in urban departments with 625 Canadian fire fighters, 22% of the U.S. fire fighters and 17% of the Canadians were found to be in PTSD. (The U.S. sample had 9% women and 13% paramedics, not found in the Canadian sample). Other researchers have found 33-41 % of fire fighters were experiencing emotional distress; 21% of ambulance service workers were found to have PTSD (Clohessy & Ehlers, 1999). Rates of PTSD in U.S. fire fighters are similar to those found in a study of German fire fighters, 18.2% (Wagner, Heinrichs & Ehlert, 1998) and are higher than those generally found in wounded combat veterans, i.e., 20%. These researchers concluded that the high level of PTSD suggests that this is a serious mental health problem of epidemic proportions in urban professional firefighters in the U.S.”.

U.S. fire fighters were found more likely to be injured on-the-job and to have multiple exposures to traumatic job-related incidents than their Canadian counterparts.  Furthermore, high levels of social support from both family and the job were associated with a significantly lower odds ratio of developing PTSD.  In fact, being married (regardless of previous divorce) was a protective factor in U.S. fire fighters.  The social support that develops in the firehouse as a result of the significant periods of time where fire fighters live together can help to insulate fire fighters from the impact of traumatic experiences, particularly if the fire fighter fits into and is accepted by his/her peers.  However, withdrawal from social relationships is common in fire fighters who develop PTSD.  High levels of work stress (problems with supervisors, and other work-related problems) was associated with a 3 to 4 fold increase in the odds of a fire fighter developing PTSD (Corneil, Beaton, Murphy, Johnson & Pike, 1999).

Combat Veterans

banner image soldiers in combat

Photos by Jim Macmillan, Philadelphia Daily News

 

Individuals in the military who have served in combat and war have the highest rates of PTSD of any group studied. Thirty percent of combat veterans returning from service in Vietnam were suffering from PTSD; forty years after the Vietnam War, many of those who served in that war continue to have flashbacks, sleep problems and other symptoms. Between 12 – 20% of US combat veterans returning from service in Iraq and Afghanistan (often having multiple deployments) are experiencing post traumatic stress symptoms. (2010 Expedition Balance). The suicide rate among the nation's active-duty military personnel now is higher than those dying in combat, averaging over one a day (Williams, The New York Times, 6/8/12)

This high level of PTSD is predictable: combat veterans tend to be young; away from home and social support (although e-mail and Face time with family members is now acceptable); often serving in a culture and environment that is foreign to them and conditions which are often quite primitive.  Many of them report that upon awakening each day they say to themselves; “Today may be the day I die.”  Given that veterans are being deployed for months and often again and again, being exposed daily to situations which often lead to death or permanent handicaps is accompanied by a number of emotions, the most intense of which is typically fear.

Buddies, solders and/or Marines serving in their unit may be killed or injured in their presence, often in a very violent manner.  The common use of bombs by the enemy leaves only bloody pieces of a body…someone they may have laughed with only hours before.  They may be assigned to clean up the body parts of these friends---a horrific assignment that would give nightmares to all but the coldest of men or women.

These veterans may communicate with the relatives of friends who were killed or attend the funeral of their friend in full dress uniform, thus expected to show no emotion.  When friends and peers are killed and/or mutilated day after day, survivor guilt is common.

Lack of control plays an important role in the development of PTSD symptoms.  Soldiers and Marines typically have little control over where they are deployed and being re-deployed.  Experiencing a lack of control and feeling trapped may be a companion to their fear.

Soldiers and Marines may kill an enemy and view the enemy dying; some kill children, either by accident or because the child has a weapon and would kill them if given the chance.  Under any circumstances, killing a child is abhorrent and life altering to many of these men and women.  Exposure to the bodies of both enemy soldiers and innocent civilians is common.  Some soldiers and Marines have been mistaken for the enemy and attacked by friendly fire.  Sleeping conditions may be such that little sleep is achieved; food may be strange and unfulfilling.

Humans are designed with a number of systems that activate when survival is threatened.  These systems make muscles stronger; re-direct blood flow to muscles and change heart rate, perception and brain function to deal with the threat.  A number of hormones are released to activate these systems, such as adrenaline.  Because the men and women assigned to combat zones are at constant risk of attack which could result in injury, permanent handicaps or death, their survival systems usually remain “on” during the entire length of their service in the combat zone.

When the combat veteran returns to a non-combat situation, it is somehow expected that his or her body will immediately and completely turn these systems off automatically …the systems that for months was activated as a survival mechanism. However, the changes in the body that assist a veteran to survive combat are difficult to extinguish when the soldier returns home.  Family problems are not uncommon for veterans returning from combat.  Veterans may volunteer for redeployment because being home feels out of place given the survival symptoms they are experiencing.