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First Responders, Secondary Trauma and Suicide

I have spent my adult life as a responder, a fixer. People call us because they are sick, hurt, bored and sometimes even in real trouble. I have received a great deal of training and education learning how to help people. In all of that training no one ever taught me anything about how to help myself or take care of myself.

It turns out that the career field I chose - firefighter, paramedic, rescuer can have a significant impact. Not just a physical impact, although I have had my share of that. I am speaking about emotional and psychological impact.

First Responder suicides are on the rise. I am going to a funeral today for a brother firefighter that took his life. To have an understanding of this subject we have to understand some terminology:

• Secondary Trauma (ST) is defined as "the stress resulting from helping or wanting to help a traumatized or suffering person". That definition is OK. It is not enough of an explanation. Secondary trauma is what you suffer by being a part of someone else's trauma. A person can only take so much of that suffering (theirs and yours) and it begins to take a toll. Especially if you are not aware of the impact ST has and you are not prepared with tools to cope.

• Vicarious Trauma (VT) is defined as "bearing witness to another's trauma". Very similar to secondary trauma. Many people use these terms interchangeably. In My Opinion secondary trauma is more applicable when you are participating in an event but you are not a victim. i.e. a paramedic caring for a dying child. Vicarious trauma would apply more to someone that was aware of or present for the trauma. This is my definition and not from the Diagnostic & Statistics Manual of Mental Disorders (DSM).

• Post Traumatic Stress Disorder (PTSD) is defined as:

Posttraumatic Stress Disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stress­or-Related Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among several changes approved for this condition that is increasingly at the center of public as well as profes­sional discussion.

The diagnostic criteria for the manual's next edition identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:

• Directly experiences the traumatic event
• Witnesses the traumatic event in person
• Learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental)
• Experiences first-hand repeated or extreme exposure to the details of the traumatic event (not through media, pictures, television or movies unless work-related)
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the indi­vidual's social interactions, capacity to work or other important areas of functioning. It is not the physi­ological result of another medical condition, medication, drugs or alcohol.

As you just read the definition does not require that you are a victim of a significant or a horrific event. Just being a witness can have serious consequences. As a First Responder you are more than a witness. We become active participants. Even when there is a good outcome your personal stability cab be seriously impacted. Believe me. I know.

How can you tell if you are suffering from Secondary Trauma? Here are some things that you should be aware of:

· Sleep disturbance (I spent the better part of six years not sleeping)
· Drug and/or alcohol use and abuse

o You don't have to be a heroin addict prescription drugs work just fine

o Drinking is just something we did (and still do) to deal with bad calls, loss of friends etc.

· Relationship troubles
· Isolation

o When you don't want to do anything or be with anyone

· Anger
· Intrusive thoughts
· Chronic fatigue
· Sadness
· Poor concentration
· Second guessing
· Detachment
· Emotional exhaustion
· Fearfulness
· Shame
· Physical illness
· Absenteeism

For a First Responder Secondary Trauma is inevitable. We need to spread the word and increase awareness. Even though secondary trauma is inevitable it need not be fatal. Indeed it is possible to live with secondary trauma. It is absolutely critical that we learn to live with our trauma.

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