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Illustration by Egle Plytnikaite

Haunting After Heroism

​First responders face layers of risk. First is the possible harm during a response—being burned in a fire, hit by a bullet, or injured in a chaotic rescue operation.

Then there’s the possibility of long-term effects. Emerging seemingly unscathed from an event, responders may find at some point in the future—even years down the road—that they are now fighting a terminal disease, or a possibly fatal case of depression or addiction, that was triggered or caused by an experience they had during a response. 

“They are not only putting themselves on the line. They also putting their futures on the line,” says Harry Rhulen, an emergency response expert and ASIS International member who is coauthor of the book Disaster Ready People for a Disaster Ready America.

Take for example the 343 firefighters and paramedics who were among the 2,753 individuals who died in 9/11 attacks on the World Trade Center. The first responders had direct exposure to the building materials and breathed in dust carrying asbestos, lead, dioxins, and other potentially harmful substances.

As of September 11, 2018, the 17th anniversary of the attacks, more than 150 of the responders had died, according to New York Fire Department estimates. Some of these deaths have been recent, and many medical experts expect the death rate to continue to rise in the future. Scientists have found that numerous cancers, such as asbestos-related cancers, can lie dormant for decades before turning deadly.

“It’s not surprising what we are seeing now, 17 years later. Cancer can take a long time to develop when it’s caused by exposure to contaminants,” Rhulen says.

Some have also raised concerns about responders who are exposed to Florida’s recent algae emergency or “red tide,” which plagued the state’s Gulf Coast last year and continues to spread. Caused by the neurotoxin-producing algae Karenia brevis, the red tide has killed thousands of fish, released noxious fumes, and forced widespread beach closures. Studies have associated the recent occurrence of this tide with increases in nearby medical facility visits for respiratory issues.

Moreover, besides the disasters themselves, the way that first responders are now used is also increasing their risk, Rhulen says. “They are being sent in more and more often, and more rapidly than ever before,” he explains. He offered the example of active shooter response. In the past, first responders would gather on the perimeter; now, they are expected to immediately seek out the shooter, which increases their risk.

And besides the physical health challenges, first responders also face long-term mental health risks, experts say.

A recent white paper issued by the Ruderman Family Foundation found that first responders (policemen and firefighters) are more likely to die by suicide than in the line of duty. The study found that there were at least 140 police officer suicides and 103 firefighter suicides in 2017. In comparison, 129 police officers and 93 firefighters died in the line of duty the same year. The suicides were the result of mental illness, including depression and post-traumatic stress disorder (PTSD), which stemmed from constant exposure to death and destruction, the study found.

“First responders are heroes who run towards danger every day in order to save the lives of others,” said Jay Ruderman, president of the Ruderman Family Foundation, in a statement. “They are also human beings, and their work exerts a toll on their mental health.”

Rhulen, who echoes Ruderman’s statement, says that first responders who experience disasters “have a new normal afterward—they are not the same. People are permanently changed by the experience.” But it’s usually impossible to predict the extent and seriousness of the after-effects, he adds. “People who are exposed to catastrophe vary in the limits and amount of impact on their psyches. Each individual is different,” he explains.

That each-individual-is-different sentiment also holds true during the response itself, he says. Often, “unsung heroes” will emerge from the crowd in a disaster or crisis, such as an ordinary citizen who is not a first responder but will still act bravely and effectively. “It’s the ones you never expected who come forward and are ready to perform,” Rhulen says.

And like a cancer that may only emerge after years of dormancy, trauma can be submerged and repressed by the responder, only to emerge years later, says Dr. Judith Kuriansky, a clinical psychologist who was “in the pit” at the bombed-out World Trade Center on 9/11 as a first responder providing psychological aid. She also worked at the site’s family assistance center.

“Any kind of abuse or trauma that is being submerged and repressed can emerge, even 30 years later,” she says. “Trauma gets locked in the body, neurologically, and it can be retriggered.”

For a highly publicized event like the 9/11 attacks or a mass shooting, it is possible for the public commemoration of event anniversaries to retrigger these bad experiences, so it’s possible first responders will suffer during those times, Kuriansky explains. However, for other first responders, such commemorations can have a healing effect, with people gathering, sharing experiences, and honoring victims in memorials, and whole communities coming together. 

There are other practices that can help first responders, experts say. For example, training can mitigate the traumatic response to a crisis. Activities like response exercises and drills can help prepare the worker’s mind for experiencing disasters, so that the event itself has precedent, Rhulen says. At least one study of first re­spond­ers has shown that those with training and preparation “tend to fare better after the fact” in terms of their mental health.

Emotional management is another type of valuable training for first responders, Kuriansky says. This helps the responder to better understand the different manifestations of stress and trauma and how they react to it. They will learn their personal stress symptoms and what is effective in dealing with them, such as exercising and talk therapy.

For coworkers, friends, and family members who want to help first responders deal with these difficult situations, Kuriansky says that it is helpful to know their coping style. Some people are talkers, who benefit from discussing their feelings, and some are doers, who find it best to busy themselves in activity, she explains. And it’s best not to pressure any responder in talking, but advisable to tell them that, “If you have anything you ever want to talk about, I’m here to listen.”

Overall, helping first responders is an important global issue as well, explains Kuriansky, who has been a responder providing psychological aid in regions all over the world, ranging from the Middle East to the Caribbean. Knowing the responder’s coping strategy is important in every region, and it can sometimes be related to cultural or religious beliefs, she explains.

She offered an example from her work in Haiti. A first responder who is very religious might have an attitude of whatever happens is predetermined, because it is “God’s will.” That person’s method of coping may be centered around prayer and keeping faith strong, so assistance techniques can be shaped around this central pillar. “It affects the way you approach them,” she says.