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Stress Test

It’s stressful being a first responder—that’s a statement that has been accepted as axiomatic for years. But just how stressful, the impact of the stress, and how the stress can be best treated are all issues that have been poorly understood. 

“For too long, we—we being the general public, and we being the government on every level—did not recognize that impact (of stress and trauma) on first responders,” says Deborah Beidel, professor of psychology at the University of Central Florida (UCF) where she directs the UCF RESTORES Clinic, which uses virtual reality tools to treat victims of stress disorders. “There’s no Veteran's Affairs for first responders. This is a problem that each county and each state has to own up to and face.” 

Now, recent research and programs like the one at UCF RESTORES are providing fresh insights into various types of stress and trauma experienced by different first responders, and which types of treatments are most effective. 

Anastasia Miller has experienced first responder stress first-hand. For about five years, she worked as a firefighter and as an emergency medical service responder. She found the work stressful—at least at times, she says.  Later, as a graduate student, she decided to study this stress and its impacts.

At UCF, Miller devoted her doctoral dissertation to stress, burnout, and support strategies for first responders. Last month, her research was published in the International Journal of Police Science and Management. 

In her research, Miller looked at four types of first responders working at state protective agencies in Florida—firefighters, law enforcement officers, emergency medical service providers, and dispatchers. 

She included dispatchers in part because she had already interviewed many of them for a previous unpublished research project, and had found that they suffered symptoms of numbness, anger, and feeling haunted by incidents. “They were describing post-traumatic stress disorder (PTSD) symptoms,” she says. 

In sum, Miller found that different types of responders can experience stress differently. For example, responders who either witness a traumatic event or help a victim overcome an event, but are not directly involved with the event itself, may experience secondary traumatic stress. Because they are not victims of the event itself, they do not have PTSD per se, but some of the symptoms of secondary stress are similar to PTSD symptoms. 

This secondary traumatic stress was common, at least at some level, Miller found. About 60 percent of first responders displayed low levels of secondary traumatic stress, 39 percent displayed moderate levels, and 1 percent displayed high levels, according to her survey. 

But of the four types of responders, dispatchers and EMS personnel were the most likely to experience high levels of secondary traumatic stress. And, as she gathered from her previous unpublished research, dispatchers were the responders who showed the most burnout and felt the least amount of support. 

“I guess I was hoping that would not be the case, but it wasn’t a surprise,” she said of the finding. 

In general, Miller says she is glad there has been more attention paid to first responders’ needs since 9/11, but progress in giving them better support seems slow and incomplete. 

“It’s often blanket statements and blanket policies without much data,” she says, adding that when responders’ needs are addressed, dispatchers are often ignored. Further study is needed on the individual needs of different types of responders, and how programs could be better customized to support each role, she explains. 

Like Miller, Beidel also recognizes the intense stress that dispatchers can undergo. In fact, it was a dispatcher who played a critical role in expanding UCF RESTORES treatment services for first responders. 

Beidel and UCF RESTORES clinicians started working with combat veterans with PTSD in 2011. The results were promising. Beidel examined information about the first 100 patients of the clinic for a study later published in the Journal of Anxiety Disorders; the study found that 66 percent of the patients no longer had PTSD after three weeks of treatment.

Then in 2014, a UCF colleague named Clint Bowers was discussing this work with his sister, an emergency dispatcher. When the dispatcher heard about the PTSD suffered by combat veterans, she said, “PTSD? You ought to talk to me.”

This sparked the group to start working with first responders. As part of this work, they developed a peer support training program for fire departments. Through this program, the clinic developed ties with fire departments in the greater Orlando area, and when the Pulse nightclub shooting occurred last year, clinicians were called in to debrief firefighters on the morning after. 

“It was quite stressful,” Beidel says. In those debriefings, she and her colleagues offered “psychological first aid.” 

Since that time, the clinic has worked with firefighters, police officers, and emergency dispatchers. A few months ago, clinic officials received $5.5 million in U.S. federal and state grant funding to develop an entire virtual reality treatment system for first responders, which is scheduled to be up and running by the first quarter of 2019.

The clinic’s virtual reality treatment program uses sight, sounds, and smells to recreate conditions that cause the responder stress or trauma. It does so through the use of head-mounted viewers, earphones, and a scent machine that blows out the appropriate smells, such as burning or smoky odors.  

Patients may be treated five days a week for three weeks running; this is combined with group-therapy sessions on stress-related topics like anger management and depression.

“If you think about trauma, everything that’s associated with trauma is triggered by a remembering of trauma,” Beidel says. So, if a man in a red shirt is walking a mean dog that gets off his leash and attacks someone, the victim’s memories of that terrible event may later be triggered by a red shirt.

To treat such a victim, a virtual reality scenario might be created wherein the victim encounters a man in a red shirt walking a very friendly dog who stays on the leash. 

“It creates new learning. It breaks those old connections,” she explains. “People are making new connections—neural connections—and they are developing new memories. We never erase the old memory, but that mem­ory loses the power to dictate one’s life.”

With the new grant funding, Beidel hopes that the clinic can increase its reach and treat more first responders. The need for treatment is pressing, she says, given the impact that stress can have. For example, the National Fallen Firefighters Foundation has found that firefighters are three times more likely to die by suicide than from a blaze. 

And the problem is not just an American one; other organizations outside the United States have recognized the need for dealing with first responder stress. In Canada, Simon Fraser University (SFU) in Vancouver started a First Responders Trauma Prevention and Recovery certificate program designed to help responders mitigate the effects of stress and trauma. The SFU program was started in 2016 after the suicide rate for first responders in Canada increased, with 39 Canadian first responders taking their own lives in 2015. 

“That’s the thing—this is something that can be treated,” Beidel says. “But we first have to recognize it.”   ​