After Seeing Horrors, Emergency Crews Need Emotional First Aid : Mental health: Tough workers are not immune to stress disorders, counseling group says. Talking about traumatic incidents is vital.

For emergency workers, a day on the job can bring a lifetime of nightmares.

They are the police officers, firefighters and paramedics who are the first on the scene of bloody crimes, accidents and natural disasters. They must deal with the dead, the mangled, the bewildered and stunned.

“There’s no training in all the world that can lower the impact of walking around body parts,” said Jeffrey Mitchell, considered by many to be the leading expert in the specialized field of emergency-related stress management.

“It’s hard to disengage. You get out there and you get your eyeballs stuck on those body parts. The horror stories are unbelievable and without number.”

And often it is the children who leave the most searing impressions.

“I’ve seen an awful lot of dead bodies,” said Joseph Grubisic, commander of the bomb and arson section of the Chicago Police Department and a police officer for 34 years. “When it comes to kids, it really bothers me.”

Don Harrington, a firefighter-paramedic in Hanover, Mass., says, “You can almost always justify in some way adults doing each other in because they’re adults responsible for their actions. But children are innocent.”

As psychology has advanced, so has the study of how emergency workers cope, said Mitchell, a former paramedic who went back to school to get a doctorate in psychology and heads the International Critical Incident Stress Foundation in Ellicott City, Md.

Mitchell’s organization teaches emergency personnel how to deal with job stress and offers a 24-hour hot line for workers suffering critical stress.

“These are normal people who have normal reactions to totally abnormal events,” Mitchell said.

When the emotional state of an emergency worker is overloaded, clearing it takes work, time and a lot of talk.

“A problem shared is a problem halved,” said Grubisic of the Chicago bomb squad. “Talking is the key thing. You have to talk about it, if it’s going to be on your mind and you’re going to keep beating yourself with it.”

Across the country, 305 teams sponsored by Mitchell’s foundation work with local and state agencies to help the emergency workers on the front lines.

Mitchell and his foundation have devised a coping and treatment plan. The program begins by preparing workers for the worst. Then, when a police officer or firefighter actually experiences a critical incident, a two-step program kicks in.

“You ask them to tell you what happened,” Mitchell said. After that step, called “defusing,” advice and tips are offered: If sleep isn’t possible, do something until tired, then go back to bed. Avoid fats, caffeine and salt in times of acute stress.

Defusing can’t occur until one to three days after the event, Mitchell said, because “the brain hasn’t caught up. It takes about 24 hours before they have processed the experience.

“First comes shock and denial. This is a protective mechanism that allows them to do their job. But then the next day, stuff starts coming up in their consciousness.”

Adrenaline will usually carry the worker through the immediate situation, Grubisic said. “Then, an hour later, you realize. . . .”

Harrington, the Massachusetts firefighter, said he, too, has experienced delayed reaction.

In one case, he was summoned to the home of a next-door neighbor who had suffered a heart attack and could not be revived.

That night, Harrington was fine--but not the next day.

“I was a nasty bugger to my family,” he said. “At work, I found myself standing around even though it was past time to go home. I said, ‘I feel like I have unfinished business here.’ Even being educated (in critical stress management), it took me a while to realize what was going on.”

Grubisic recalls events that remain troubling even two decades later--seeing the body of a child who had been tortured and the body of a colleague who had killed himself.

“I don’t drink, I don’t smoke, I don’t gamble,” he said. “I do a lot of walking, and I do a lot of praying. I have friends I can talk to--my wife and other people.

“Communication is really the essence. Many cops may feel ‘I don’t want to talk about it because I’ll be weak.’ If you don’t talk about it, that’s when you’re weak.”

San Diego County uses Mitchell’s stress-management techniques.

“We go to places that roaches and rats run out of every day,” said Teri Andre of Hartson Medical Services, who works on critical incident teams for county emergency workers. “But there are things that get to us.”

Andre says there are about 45 critical incident counselors in San Diego, one-third of them mental health professionals and the other two-thirds emergency workers themselves.

Common causes of critical incidents, she says, include line-of-duty death for police or firefighters and any kind of trauma involving children.

Not talking about such emotional disturbances can have harmful effects, experts say.

Grubisic says that while some kind of emotional detachment and immunity develops over time, too much can be damaging.

“I see a lot of police officers who are very calloused,” he said. “If somebody’s getting hurt, it shows in their reactions to others’ pain. They stop caring and that’s too bad.”

The long-term cost of not dealing with a stress reaction can be horrendous, Mitchell says. Ultimately, it could lead to post-traumatic stress disorder, the delayed reaction first widely identified among Vietnam veterans who could not adjust to life after the war.

“Post-traumatic stress disorder is a trauma caused by stress reaction that got stuck,” Mitchell said. “It’s a difficult disorder and hard to change. Our job on a debriefing team is to prevent PTSD.”

Mitchell says that when he began his work a decade ago, he encountered resistance to the idea of stress training and counseling. There’s less of that now, he says, but it still exists, particularly among police officers, who tend to be more macho.

“We’re fighting the machoism,” Mitchell said. “We’re also fighting the citizens who believe emergency people are beyond human, that they have no reaction to all this broken humanity. That’s trash.”