Research: Phenomenological study of PTSD in the first responder workplace

Qualitative research project leads to four recommendations for healthier first responders in EMS, police and fire departments


By Aleksandra Baran, Thomas Barnett and Armando Silva

Post-traumatic stress disorder is a psychological disorder caused by exposure to a traumatic event. Although PTSD has previously been included as an anxiety disorder in the DSM-IV, it is now under trauma-and-stress-related disorders in the DSM-V [1].

First responders are particularly vulnerable to PTSD due to the amount of consistent first-hand exposure to extremely stressful and traumatic experiences that differ between police, fire and EMS departments [2].

Armando Silva, a paramedic with the Chicago Fire Department, was one of the authors of the study. (Photo/Graham School at the University of Chicago)
Armando Silva, a paramedic with the Chicago Fire Department, was one of the authors of the study. (Photo/Graham School at the University of Chicago)

Every day first responders encounter stressful and potentially traumatic events such as shootings, fires, accidents, disasters, and death. These repetitive negative experiences affect not only themselves, but their families, coworkers and those they are sworn to care for and protect.

Without proper education, communication, preventative measures and guidance towards keeping first responders safe, first responders may internalize trauma, which can manifest itself as PTSD or a number of other psychological issues that may affect employment, personal safety, performance and the safety of others. Due to a lack of information, training, proper regulation, and overall understanding and support, PTSD is a serious problem within the first responder community that must be investigated and explored through unbiased primary-source research and experiences to formulate educated recommendations for a more successful police, fire, and EMS work environment.

Our investigation, completed as graduate students in the University of Chicago, Master of Science in Threat and Response Management program, was a phenomenological study. We researched the prevalence, attitudes, guidelines and impact of PTSD in first responders in the workplace.

We recruited three police officers above the rank of sergeant, three fire/EMS personnel above the rank of captain and four mental health professionals that have experience dealing with PTSD in the first responder population. Cumulatively, interviewees defined as police personnel had a total of 80 years of experience, fire/EMS personnel had 85 years of experience and mental health professionals had 50 years of experience.

The interviews, conducted on-site, were transcribed and reviewed to group the data via phenomenological data analysis utilizing horizontalization, which includes highlighting statements that reveal the subject's experience, and then developed clusters of meaning into themes [3]. This study used a transcendental phenomenological approach to qualitative data analysis [4]. This approach allowed the collection of lived experiences of the interviewees in regards to working with or experiencing PTSD in the first responder workplace. Instead of focusing on a single individual, the phenomenological approach explores what a group of participants have in common as they experience a phenomenon [4].

Research results
The interviews and analysis revealed these important results.     

1. While first responders require sufficient and proper training that focuses on correctly utilizing gear and maintaining physical security, departments are lacking in the education and training of mental health safety.  
There is an open dialogue on preventative gear and working safely on the scene, but the emotional strain, recurrent trauma and everyday stressors experienced by a first responder are not discussed freely. While there is open communication on maintaining physical standards, the dialogue for emotional and mental safety is almost nonexistent.

"If you look at the man hours or the hours you've been trained both through individual training records, and the daily training we're supposed to have, and the supervision, and then the CEU's for our licenses, the training that we've had for behavioral health is really nothing. Zero (Fire/EMS, subject 3)."

2. The cumulative effect is the constant exposure to traumatic or stressful events over a period of time, where police, fire, and emergency medical personnel receive much more exposure and re-exposure to trauma and traumatic events on a continuous basis.
First responders can spend years doing multiple runs a day that can range from normal, everyday events to extreme emergency situations. Latent PTSD can appear six months or more after a traumatic incident, which makes pinpointing the exact traumatic incident particularly difficult.

3. There are no set clear regulations or laws in place to solely prevent, catch or monitor PTSD in first responders in the workplace. 
There are no regulated checkups in any of the departments to notice when an employee may be having a difficult time or is behaving abnormally than usual. A stress-related reaction may be hard to spot since it may take time to develop anywhere from six weeks to six months later. 

4. The problems with current monitoring systems include having a reactionary-based program instead of preventative and proactive ones which threaten employment status. 
Preventative measures are complicated to install due to the difficulty of using methods to predict and monitor whether someone will have an adverse traumatic reaction in the future.

5. The stigma of suffering from PTSD and having mental health issues due to trauma is one of the biggest obstacles that current and future first responder workplaces face.  
There is an underlying pride that a first responder does not want to be perceived as weak by their coworkers. Since individuals have professional positions where they are usually taking care of and protecting others, it seems unnatural to be the one needing help. 

Recommendations
A strong focus on education, proper regulations and preventative systems is needed to erase the stigma of having a mental health issue as an emergency responder. Here are four recommendations that will lead to a healthier and more successful first responder department.

1. Consistent mental health education on understanding, monitoring, dealing with, and preventing Post Traumatic Stress Disorder is paramount in keeping employees informed, prepared, and listening.
Employees must fundamentally understand what PTSD and a mental health disorder truly are and how they can impact an individual. Education and training must include monitoring behavioral changes that are viewed in a chronological standpoint.

2. The current systems in place are reactive, but they must focus on prevention instead of dealing with the issue after it has already become a bigger problem.
While preventative measures are hard to enforce due to an individual’s unknown response to a situation at an unknown time, proactive systems can monitor changes in physical or mental health by studying them over a period of time. 

3. It is extremely important for employers and supervisors to let employees know that there should be no stigma attached to getting help that is available.  
The change in mental attitude and perception of mental health issues must start from the leadership at the top since first responder workplaces have very strict hierarchies. The complexity relationships between PTSD, traumatic situations and why disorders manifest has to be explained and understood.

4. It is important to keep departments aware of what programs and resources are available to them and what needs to be done if an employee is suffering from PTSD or any mental health disorder.
New programs and trainings are becoming available, but the lack of communication among the services and the first responder departments minimizes exposure and awareness. 

Contact the authors for more information about the research.

About the authors:
Aleksandra Baran is an emergency management consultant from Hagerty Consulting who works with numerous local, state and federal agencies on various emergency preparedness and recovery projects, as well as HSEEP training and exercises. She has a Master of Science from the University of Chicago in Threat and Response Management and pursues interests in bettering technology and social media outreach in regards to emergency preparedness.

Thomas Barnett is a Sergeant with the Chicago Police Department in the 011th District. He is a 16-year veteran of the department and has been assigned to watch operations, patrol tactical teams, as a terrorism liaison officer and as a violent crime detective. He has a Master of Science in Threat and Response Management from the University of Chicago.

Armando Silva is a paramedic with the Chicago Fire Department with over 14 years of experience in paramedicine. Prior to that position he worked as a first responder for various private ambulance companies throughout the Chicago area. He has also served for over 10 years in the U.S. Army in a Chemical Biological Radiological Nuclear unit, Sergeant, with a deployment from 2003-2005 in efforts of Operation Iraqi Freedom. Email Armando Silva.

References

1. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association, 2013. Print.

2. Levy-Gigi, Einat, Gal Richter-Levin, and Szabolcs KãRi. "The Hidden Price of Repeated Traumatic Exposure: Different Cognitive Deficits in Different First-responders." Frontiers in Behavioral Neuroscience Front. Behav. Neurosci. 17 (2014). Print.

3. Moustakas, Clark E. Phenomenological Research Methods. New York: SAGE Publications, 1994. Print.

4. Creswell, John W. "Five Qualitative Approaches to Inquiry." Qualitative Inquiry and Research Design: Choosing Among Five Approaches. New York: SAGE Publications, 1994. 57-62. Print.

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