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How to keep PTSD out of your EMS agency

Recognize the risk factors and symptoms of PTSD, and how to manage self-talk and meditate to reduce its physical and emotional effects


Dr. Larry Iverson, Institute for Advanced Development, offers strategies for recognizing and breaking through PTSD.

Larry Iverson

The National Center for Post-Traumatic Stress Disorder (PTSD) reports that seven to eight out of every 100 people in North America are living with PTSD symptoms that can disrupt their lives and make it difficult to continue with daily activities. Those in emergency services and military agencies who are repeatedly experiencing traumatic events have the highest levels of PTSD reported for all career fields.

In a session at Fire-Rescue International, “PTSD-How to keep it out of your station and what you can do for those living it,” Dr. Larry Iverson, Institute for Advanced Development, offered strategies for recognizing and breaking through PTSD.

Top quotes on PTSD

Here are some of Iverson’s memorable quotes.

“Severe depression is crushing.”

“Everyone in your station should know how to meditate.”

“Central to managing stress, pressure and frustration is learning to respond resourcefully, instead of just reacting to situations.”

Top takeaways on identifying and managing PTSD

Here are four takeaways on how and why to identify, acknowledge and treat PTSD from Iverson’s presentation.

1. Identify PTSD triggers, risk factors

According to Iverson, risk factors for PTSD among first responders include:

  • Starting work as at a younger age
  • Being unmarried
  • Holding a supervisory rank
  • Proximity to death during a traumatic event
  • Experiencing feelings of fear or horror during a traumatic event
  • Experiencing another stressful event (e.g., loss of a loved one) after a traumatic event
  • Holding negative believes about oneself (e.g., feelings as though you were inadequate or weak)
  • Feeling as though you have little control over your life
  • Hostility, hyper-aggressiveness or anger issues

PTSD triggers can be location-based, Iverson explained. Many people experiencing PTSD will have a safe place, where they want to be all the time, Iverson noted. This safe “place” could also be a person, and the person experiencing PTSD will withdraw from others, they will want to be around that safe person all the time.

Likewise, nightmares and flashbacks are often connected to a place, and the person suffering PTSD will experience anxiety returning to a location where a traumatic event or negative outcome has occurred.

2. Understand the physical ramifications of PTSD

In medical school, Iverson learned between 50-80 percent of illnesses have a psychosomatic component, which influenced him to change paths and pursue psychology. He cited the top illnesses that are influenced by a psychosomatic element:

  • Cardiovascular disease
  • Cancers
  • Sexual disorders
  • Ulcers/colitis/frequent indigestion
  • Anxiety and panic disorders
  • Hypertension
  • High blood pressure
  • Insomnia
  • Non-injury-related back pain
  • Frequent headaches

Left untreated, PTSD has real, chemical reactions in the body that, over time, will tear it down, Iverson said.


Manage your self talk to reduce stress and symptoms of PTSD.

Photo/Kerri Hatt

3. Treat PTSD with open communication

Iverson stressed there is no quick fix for PTSD. That said, there are proven ways to mitigate the effects of PTSD and to come out on the other side. These strategies to overcome PTSD include:

  • Therapy (eye movement desensitization and reprocessing, neuro-linguistic programming, cognitive-behavioral psychology, hypnosis)
  • Yoga, meditation and visualization exercises
  • Getting healthy (food, exercise, attitude)
  • Staying connected to others (work and home)
  • Participating in a support group
  • Getting educated about PTSD
  • Medication and natural options

One of the most effective strategies Iverson has seen public safety agencies and departments use to combat PTSD is to bring in a counselor regularly, and mandate 5-10 minute check-ins, for everyone in the department, from leadership on down.

“If they need more than a couple minutes, give them more time, but everybody checks in. Everybody.” Iverson said, noting this regular debrief could save lives.

4. Manage your self-talk

We don’t realize what our inner voice is saying, but we certainly react to self-talk, Iverson reported. “This is one of the most important things anybody with PTSD has to learn,” he stressed. Self-talk exists both internally (personal self-talk) and externally (organizational self-talk).

Negative self-talk has the following ramifications:

  • Anxiety and panic disorders
  • Heightening of PTSD symptoms
  • Worry, anger, criticism
  • Communication breakdowns
  • Feeling overwhelmed, pressured
  • Fear, guilt, depression
  • Low motivation, lack of production
  • Lowered vitality, physical illness

According to Iverson, the key to stopping this negative cycle is to understand the consequences of self-talk and to actively choose to tell ourselves positive things.

Iverson shared his favorite approach to meditation; four-square breathing, or breathing in a square:

  • Breathe in to the count of four
  • Hold for a count of four
  • Breathe out for a count of four
  • Hold for a count of four

The number isn’t important, but the counting is. It’s a way to put a stop to self-talk. Occupy your mind by counting. Watch the rise and fall of your chest. Feel the air coming in and out of your nose and mouth. Pay attention to the fall of your shoulders. Tell yourself to relax and be calm. “No worries” when your mind wanders off, Iverson advises, just bring it back. Meditating for three to five minutes twice a day can lead to deeper levels of concentration and mindfulness in just one month, he noted.

Additional resources on identifying and overcoming PTSD

According to Iverson, PTSD symptoms include:

  • Physical pain
  • Nightmares or flashbacks
  • Depression or anxiety
  • Withdrawal from others
  • Avoiding stimuli or situations
  • Repression or mental blocking
  • Emotional numbing, guilt or shame
  • Hyper-arousal
  • Irritability or mood swings
  • Hypervigilance or being easily startled

Learn more about identifying and treating PTSD with these resources from EMS1 and FireRescue1.

This article was originally posted Aug. 10, 2018. It has been updated.

Kerri Hatt is editor-in-chief, EMS1, responsible for defining original editorial content, tracking industry trends, managing expert contributors and leading execution of special coverage efforts. Prior to joining Lexipol, she served as an editor for medical allied health B2B publications and communities.

Kerri has a bachelor’s degree in English from Saint Joseph’s University, in Philadelphia. She is based out of Charleston, SC. Share your personal and agency successes, strategies and stories with Kerri at