PTSD: Understanding the Injury & Keys to Successful Debriefing

The brain’s ability to manage stimuli during traumatic events is uncanny, and to a large extent, unexplored. While researchers don’t fully understand why tragic circumstances may be processed constructively by one first responder and overload the coping mechanisms of another, the aftermath of unaddressed Post Traumatic Stress Disorder (PTSD) more accurately known as Post Traumatic Stress Injury (PTSI) in police, fire/EMS and dispatchers is starkly evident.

Identifying the Problem

Whether originating from single events or a series of unaddressed micro-trauma, chronically elevated cortisol levels associated with PTSI can result in anger control issues, weight gain, poor sleep and a general feeling of being mired in fight or flight response. Public safety employees get divorced at a rate 10-20% higher than the national average of 50%, and first responder suicides have eclipsed line-of-duty deaths in recent years as well.

But the results of unaddressed PTSI transcend societal assumptions of who’s most at risk. Women first responders, for instance, are more likely to abuse alcohol than their male counterparts, and retirees accounted for a third of over 150 first responder suicides in 2019. Examining the details at such a granular level provides a dire outlook, but it’s critical to accurately frame the issue.

Beating PTSI to the Punch

Attempting to address PTSI prior to symptoms getting out of hand is a worthy challenge, but akin to putting together a jigsaw puzzle without ever seeing the picture on the box. (Oh, and some pieces are missing, and there may be additional pieces from other puzzles thrown in as well.) Enter PTSI Debriefing, the process of methodically breaking down a traumatic event into its constituents and evaluating them through the lens of helping someone navigate what occurred in a healthy manner. The technique can be a valuable tool in laying the groundwork for comprehensive treatment, but it should be utilized with these considerations in mind:

• Respect the Process. PTSI Debriefing isn't a one-and-done panacea. In fact, research indicates that forcing an immediate interaction and then not following up can cause more harm than good. Professionals experienced in such interventions recommend allowing 72 hours to elapse prior to an initial discussion surrounding a traumatic event, and seven days to pass before a more extensive review.
  
  
• Strength in Numbers. PTSI Debriefs should be held in a group setting that includes even those peripherally associated with a traumatic event or scene. As PTSI affects first responders physically, emotionally and spiritually, such meetings should be facilitated by an interdisciplinary team of caring peers and knowledgeable professionals. 
  
  
• Explore New Concepts. Thirty years ago, the most common advice given to those suffering PTSI was simply to “suck it up”. Shudder the thought if new methods hadn’t been utilized at that juncture. Eye Movement Desensitization and Reprocessing (EMDR) is on the cutting edge of PTSI treatment and involves disassociating harmful memories form commonplace sights, smells and sounds.  The technique also doesn’t require the long-lead trust building of traditional psychiatric counseling to reap similar benefits..  

While there’s much left to discover about what the brain does to protect itself in moments of tragedy, the days of speaking about PTSI in hushed tones while it claims another life due to lack of support and resources are numbered. Additionally, TMLIRP has developed a comprehensive program on Resiliency Strategies for First Responders and is offered regularly. Click this link to view our online training calendar.

For more information regarding this topic please see our website at tmlirp.org.