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= Trauma and First Responders =            The nature of a first responder’s occupation continuously puts them in harm’s way and gives great opportunity to see others harmed (Haugen, McCrillis, Smid, & Nijdam, 2017; Haugen, Evces, & Weiss, 2012). Because these positions put this population through a great deal of traumatic events, they are at a higher risk of developing Post-Traumatic Stress Disorder (PTSD) or related symptoms (Haugen, Evces, & Weiss, 2012). The exposure to the multiple traumatic stressors could also exacerbate other pre-existing disorders (Haugen, McCrillis, Smid, & Nijdam, 2017). The presence of any mental health disorders in these populations can also be associated with diminished ability to work efficiently, early retirement, divorce, substance abuse, and suicide (Haugen, McCrillis, Smid, & Nijdam, 2017).

Types of first responders
           First responders consist of law enforcement officers, firefighters, search and rescue personnel, paramedics, and emergency dispatchers (Haugen, McCrillis, Smid & Nijdam, 2017; Paterson, Whittle, & Kemp, 2014). All of these positions entail high levels of work related stress and repeated exposure to physical stressors and psychological stressors (Haugen, Evces, & Weiss, 2012).

Types of trauma
           The types of trauma first responders endure are based on their specific field. Generally, they are directly experiencing a threat to their own life, or witnessing someone else’s life in danger (Haugen, Evces, &Weiss, 2012).

Police officers are often needed to save others from being attacked by weapons, accidents, fires, bombings, floods, earthquakes (Berger et al., 2012; Haugen, Evces, & Weiss, 2012). However, first responders often tend to rate injuries to or death of a colleague as most distressing. Other possible scenarios for law enforcement involve being taken hostage, loved ones being threatened, being shot at, learning of a badly beaten or sexually assaulted child, being seriously beaten, killing or injuring someone else in the line of duty, being threatened with a gun or other weapon, watching someone die, making a death notification, a life threatening high speed chase, or seeing mutilated remains (Weiss et al., 2010).

Prevalence of PTSD
           PTSD is characterized by intrusion, avoidance of distressing trauma related stimuli, negative alterations in cognitions and mood, and alterations in arousal and reactivity following a traumatic experience (American Psychiatric Association, 2013).

           Of all the first responders, ambulance personnel have the highest prevalence of PTSD and police officers have the lowest (Berger et al. 2012). As of 2012, the worldwide 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” (Torchalla & Strehlau, 2018).

Ambulance personnel not only respond to more emergencies than law enforcement and firefighters, they are not subjected to the intense selection criteria that police officers are. Since police officers carry weapons (firearms, batons, electroshock weapons, etc.), the hiring process is designed to find individuals with personality traits related to psychological resilience through psychological assessment (Berger et al., 2012).

Stigma and Under Reporting
Due to the stigma associated with having a mental health disorder amongst 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 (Berger et al. 2012; Haugen, McCrillis, Smid, & Nijdam, 2017). Other barriers associated with under reporting are a lack of knowledge of where to receive treatment, scheduling concerns, and fear regarding confidentiality (Haugen, McCrillis, Smid, & Nijdam, 2017).

Risk Factors
           The more traumatic events a person experiences, the higher risk someone is for developing PTSD. Therefore, the most obvious risk factor among these populations is their repeated exposure to traumatic events (Berger et al. 2012).

Additionally, there is an increased risk for unmarried paramedics, lack of training amongst canine handlers, and increased number of distressing missions among firefighters (Berger, 2012).

Suicide is considered high risk in law enforcement officers, but is not solely related to the exposure to a traumatic event (Violanti et al.). Lack of social support is significantly associated with an increase of feelings of hopelessness and suicide (Violanti et al., 2016). Additionally, an increase in stress of administrative practices increased hopelessness (Violanti et al., 2016). 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).

Post-Crisis Interventions
Following a traumatic event, there are multiple treatments for post-traumatic symptoms used for these populations. Common treatment for first responders with PTSD are cognitive behavioral therapy (CBT), CBT as exposure therapy, prolonged exposure therapy (PE), brief eclectic psychotherapy (BEP), eye movement desensitization reprocessing (EMDR), and Critical Incident Stress Debriefing (CISD) (Torchalla & Strehlau, 2018; Haugen, Evces, & Weiss, 2012; Paterson, Whittle, & Kemp, 2014). Following treatment of BEP, 86% of first responders with PTSD return to work (Torchalla & Strehlau, 2018). EMDR has shown significant symptom improvement among first responders (Torchalla & Strehlau, 2018; Haugen, Evces, & Weiss, 2012). 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 (Paterson, Whittle, & Kemp, 2014).