First Responders

See Lauren Goldbach talking with P.I.S.T.L.E. about the physiology of PTSD in first responders:

First Responders are: Police officers, Firefighters, EMTs, 911 dispatchers, Emergency room personnel, and any one who provides on-site care to someone in need during an emergency.

 

A first responder commits suicide every 18 hours in the United States.

GETTING HELP WITH COSTS

Table of Contents:

If you are in crisis:

  • CopLine is an international, confidential hotline answered by experienced, retired police officers who know what it’s like to be in the line of duty. If you’re an officer struggling with work, or life, call us. You aren’t alone. You have someone to talk to.Call 1-800-COPLINE
  • Contact P.I.S.T.L.E. at https://www.pistle.org/
  • Contact Blue Help at https://bluehelp.org/ or

Who We Are:

Lauren and Sarah both have experience working alongside Police and Firefighters on crisis teams with Phoenix (Lauren and Sarah) and Chandler (Lauren). Lauren and Sarah are able to take HB2502 (Craig Tiger Act) funding, so there is no out of pocket cost to you. 

Lauren was honored to share her skills in trauma work in 2018 and 2019  by volunteering with West Coast Post Trauma Retreat  (click for more info). 

When selecting a counselor, look for someone who has been trained specifically in the treatment of trauma in First Responders. We have extensive training in the special needs of this population and how these jobs impact physical, emotional and psychological functioning, as well family systems. 

EMDR and other approaches will look different for first responders than for the civilian population. Someone who understands the culture, stressors of the job, and how it can impact your families is a critical part of successful therapy.

National studies have found that 37% (or higher) of firefighters and 30% (or higher) of Police officers meet criteria for PTSD, as compared to 3% of the civilian average.

First responders regularly suppress the brain’s automatic response system of fight/ flight or freeze/collapse. They literally “run in” while everyone else is “running out” of a dangerous situation. Shift work, being awakened by “tones,” and repeated first-hand exposure to dangerous, stressful, and traumatic events can cause cumulative damage to the nervous system and create thousands of unprocessed memories. This can result in “flashbacks” that look very different for a first responder than a civilian.

First responders “have to minimize the psychological and physical dangers of the job in order to be able to do it” (Adler-Tapia). This is done with defense mechanisms like compartmentalization and dissociation, which work great on the job, but not so well in personal lives. A counselor who understands the balance is important.

East Valley Trauma counseling does NOT do Fit For Duty Evals, Return to Work Evals, Independent Medical Examinations (IMEs), Medical Retirement Evaluations, or any other assessments your department may request of you that would create a conflict of interest between helping YOU versus helping your CITY/ DEPARTMENT. 

What Will Therapy Look Like?

We are not doctors, we do not prescribe medications or do assessments of any kind. We are not here to diagnose you, and we do not share your information, progress notes, or our treatment information with anyone.

When you come to session, we will teach you about First Responder Exhaustion Syndrome, how to care for your nervous system, skills for calming your body and mind, and how to communicate with friends and family who may not understand the things you’ve experienced. Traumatic memories (sounds, smells, sensations in the body) are like cookies backed up in a computer that require “dumping” and interventions we’ve been trained in help you do exactly this. These are the things that make you feel “irritable” or on edge, even if you are not experiencing flashbacks.

We don’t have to talk extensively about childhood, describe the critical calls, or spend months/ years “on the couch.” In fact, you don’t really even have to talk. Your brain knows how to heal and we can help. If you’re coming in for a bi-annual wellness session, we can have an informal chat- nothing goes back to your department except confirmation of the date and time you came in.

We work for YOU. To this end, we do not perform:
  • Fit for duty evaluations
  • Return to work evaluations
  • Independent Medical Examinations (IMEs)
  • Medical Disability / Retirement evaluations
  • Any other assessments your department may request of you that would create a conflict of interest between helping you versus helping your city or department.

WEAPONS

Our office is 2A friendly. You will NEVER be asked to leave your weapons at home or in your car. Please be advised that several of our counselors in the suite have CCWs and carry at all times.

YOUR PRIVACY

Your privacy is important to us. For this reason, we strive to ensure that you are not scheduled at a time when you will see other first responders who work in your city. However, because many people schedule online on their own, this cannot be guaranteed.
Many of you refer your friends and coworkers to us. We appreciate the trust. However, even if we see you interacting in the lobby with one another, we cannot (by law) acknowledge that we know your friends and co-workers and we will never mention you or your sessions to them. We are prohibited by privacy laws to ever discuss or disclose information, or even acknowledgement of seeing you to anyone not directly involved in your care. 
Your records cannot be accessed or viewed by anyone without your express written permission, unless you are using insurance (insurance requires a diagnosis for treatment to be covered and has a right to access all your records). Your diagnosis will be shared with you in this case. 
Your departments will only receive an invoice with the dates you attended sessions. Nothing else. 
HB2502 (Craig Tiger Act), no records or diagnosis will ever be shared without your express written permission. No diagnosis will be given to you during treatment, unless it is deemed necessary and you will be informed of any diagnosis you receive. All measures to protect your privacy and career are taken at all times with regard to diagnoses.
Instances when your records will be shared (with your signature on a release of information):
  •  If you pursue a medical retirement or workman’s comp claim. In most instances, your records are requested and become part of your case.
  • If you are investigated by IA or another entity regarding your performance on the job, we are required to turn over your records under the Patriot Act IF asked to do so, and are also required by law to not tell you this request was made.
  • If we receive a subpoena from a judge, we will fight to keep your records private. However, if a judge court orders your records, we are compelled to comply.
We make every effort to protect your career and privacy. If you have any questions about your records or the above, please feel free to ask your counselor.

What is Emergency Responder Exhaustion Syndrome? 

The following is quoted from “Emergency Responder Exhaustion Syndrome (ERES): A perspective on stress, coping and treatment in the emergency responder milieu” by Fay, J. PsyD, Kamena, M. D PhD, Benner, A. PhD, Buscho, A. PhD & Nagle, D.
The WCPR program is for first responders whose lives have been affected by their work experience. The WCPR residential program provides an educational experience designed to help current and retired first responders recognize the signs and symptoms of work-related stress including post traumatic stress disorder (PTSD) in themselves and in others. FRSN prefers to identify PTSD as a post traumatic stress injury.
Information on West Coast Post-Trauma Retreat can be found here: 
https://www.frsn.org/west-coast-post-trauma-retreat.html

Key Characteristics of ERES

The key characteristics of ERES are depression, isolation, and physical and emotional exhaustion.

Depression
Although the level of depression varies for each responder (Breslau, 2002), it is not uncommon for responders to report suicidal ideation, planning and suicide attempts. Situational events, critical incidents and life stressors are not responsible for police officer suicide; however, depression, stemming from them, does (Hackett & Violanti, 2003). It is important for a responder to understand that depression is a chemical imbalance that can create feelings of helplessness and hopelessness and when combined with poor judgment, difficulty concentrating and making decisions, poor impulse control and substance abuse, suicide may appear to be a viable option (Hackett & Violanti, 2003). Responders who are influenced by depression utilize selective perception to “prove” their insufficiency (Furr & Funder, 1998; Moffitt, K. 1994). Depression frequently blocks a responder’s ability to perceive positive outcomes (e.g., “I survived”) and fosters a negative belief (e.g., “I failed to save that person; therefore I am a bad person”). This cycle of depression, negative self-appraisal and a reluctance to accept positive outcomes further isolates and exhaust the responder.

Isolation
There is a strong need to conform and be a part of the team in the emergency services. Emergency responders rely on each other for emotional and physical survival, and peers motivate one another to confront and handle danger. Responders may also develop a sense of separation, isolation, secrecy and resistance to outside criticism (Brown & Campbell, 1994). At times, responders may believe that they are not worthy of the respect and trust of fellow peers. Simply leaving the job will not alleviate symptoms. In fact, separation from police duties increases vulnerability to symptoms (Paton, Violanti, & Schmuckler, 1999). Yet, they may isolate from the very people who could help them recover out of fear of being discovered as frauds. As an example, one responder experienced an intense negative reaction after receiving an award recognizing her investigative abilities. She explained, “No one knew how badly I felt inside (as a result of my experience investigating the case) and receiving that award just proved that I was a fraud.” Social support from colleagues may reduce the effects of critical incidents. However, when peer support does not enhance coping skills, a reverse effect can occur which may be retraumatizing (Lowery & Stokes, 2005) and cause them to avoid certain thoughts or feelings and to further isolate themselves. Avoidance involves attempts to escape or minimize heightened emotionality (Asmundson, Stapleton, & Taylor, 2004). Emotional distancing by emergency responders makes it unlikely that they will receive the help needed. For example, student paramedics had significantly greater trauma-related symptomology when they expressed negative attitudes regarding emotional expression (Lowery & Stokes, 2005). Thus, emotional distancing is a maladaptive coping strategy.
Exhaustion
Exhaustion, as used here, means a depletion of the ability to cope. As a responder exhausts these coping abilities, symptoms such as insomnia, suspiciousness, hypervigilance, chronic fear, panic attacks, disengagement, emotional constriction, depersonalization, derealization, memory disturbance, exaggerated startle response, agoraphobia and others may appear (Briere, Weathers, & Runtz, 2005). As coping resources are depleted, failed attempts at recovery (insufficient psychotherapy, excessive overtime, etc.) reinforce a sense of personal failure, which enhances depression and isolation. As a result, adaptive coping (e.g., physical exercise, peer support, hobbies, spirituality, relaxation and family support) decreases, while maladaptive coping (e.g., engaging in high-risk activities, substance abuse and multiple sexual relationships) increases. While the responder’s capacity to recover is slipping away and while support is dwindling, families and bosses become more demanding. Stress from the job can carryover to the home, making it difficult to recover from the demands of the job at home (Peeters, Montgomery, Bakker, & Schaufeli, 2005). Increasing stress at both home and work may lead to burnout. Burnout has been defined as stress arising from the interaction between the responder and recipient (e.g., distressed citizen) (Alexander, 1999) with the failure to find meaning and growth in life (Van Dierendonck, Gaarssen, & Visser, 2005) and has exhaustion and cynicism as its core issues (Peeters et al., 2005). However, exhaustion is closely associated with core maladaptive assumptions, negative beliefs, demands and unmet expectations (Van Dierendonck et al., 2005).

What is HB 2502 / Craig Tiger Act? 

https://www.azleg.gov/ars/38/00672.htm

https://www.azleg.gov/ars/38/00673.htm

Peace officers and firefighters who are exposed to any one of the following events while in the course of duty (must be provided with) up to twelve visits of licensed counseling, which may be provided through telehealth, paid for by the employer:

  1. Visually witnessing the death or maiming or visually witnessing the immediate aftermath of such a death or maiming of one or more human beings.
  2. Responding to or being directly involved in a criminal investigation of an offense involving a dangerous crime against children as defined in section 13-705.
  3. Requiring rescue in the line of duty where one’s life was endangered.
  4. Using deadly force or being subjected to deadly force in the line of duty, regardless of whether the peace officer or firefighter was physically injured.
  5.  Witnessing the death of another peace officer or firefighter while engaged in the line of duty.
  6. Responding to or being directly involved in an investigation regarding the drowning or near drowning of a child.

In addition to providing paid time off and counseling services, peace officers and firefighters may also take up to 30 paid calendar days off to engage in treatment.

Common Psychological Defense Mechanisms used by 1st Responders include:

STOICISM 

First Responders are expected to not be impacted by events. This results in humor that may seem cold/disrespectful to others.

DEPERSONALIZATION 

First responders may experience an event, but feel like it is happening to someone else. It is a sense of detachment from others.

DEREALIZATION 

First responders may experience an event, but feel like it isn’t real.

For many, symptoms can be undetectable – sometimes presenting as only recurring headaches and sleep disturbance, a sense of irritability, or feeling detached.

Habitual use of these defenses can result in delayed PTSD (Adler-Tapia), which can lie dormant for years until any trigger (overt or innocuous) is encountered and suddenly, symptoms are noticed.

Betrayal trauma describes a situation in which the city, department, fellow workers, or family members did not support the individual who is exhibiting symptoms.

Due to the ongoing nature of a first responder’s job, “pinpointing” the exact traumatic even that “caused PTSD” can be difficult, if not impossible. Working with somebody who understands this and the cumulative effects of daily exposure to shootings, fire, deaths, accidents, domestic violence, and other disruptions is important in choosing a counselor.

Data from the University of Phoenix shows that only 39 percent of first responders with PTSD sought help because many fear negative repercussions. Your information is confidential. 

We encourage (but do not require) family sessions in our work to help spouses and/ or children understand the nature of the injury to the nervous system and how they can be supportive.

For peer support, resources, advocacy and training for LEO, please visit P.I.S.T.L.E. : A peer support group run by cops for cops.

Spouses of First Responders may benefit from reading the following books:

“I Love a Cop: What Police families need to know” by Ellen Kirschman

“I Love a Fire Fighter: What the family needs to know” by Ellen Kirschman

“Emotional survival for law enforcement: A guide for officers and their families” by Kevin M. Gilmartin

SESSIONS MAY BE COVERED AT NO COST THROUGH THE FOLLOWING RESOURCES:

100 Club: 602-485-0100 https://www.100club.org/

For HB2502 Services:

City of Gilbert Police Peer Support:

Ed Morales (Edward.Morales@gilbertaz.gov)

McKay Lauritzen (McKay.Lauritzen@gilbertaz.gov)

Fire: Dan Brady  dan.brady@mesaaz.gov

City of Mesa Fire and Police Peer Support:

Police: Jonathan Appel   Jonathon.Appel@mesaaz.gov

City of Tempe Police Peer Support: 

Please contact Lauren for more information

City of Phoenix: 

Call Compsych with the date of your critical incident to get an authorization for 36 sessions (no cost to you) under Craig Tiger Act (HB2502).

Public Safety Crisis Solutions:

Brian French 602-466-9456, Brian@pscrisissolutions.com or visit www.pscrisissolutions