Read the transcript of the fourth episode of the Resiliency in Disaster Behavioral Health podcast. Moderator: Welcome to Resiliency in Disaster Behavioral Health, a six‑part podcast series from the Substance Abuse and Mental Health Services Administration. The goal of this podcast is to inform local behavioral health agencies on strategies for building resiliency in individuals and the community before, during, and after a disaster. The series discusses specific behavioral health interventions across the stages of disaster response, in addition to focusing on the needs of specific populations. Amy Kevis is a 20-year veteran of a midsized police department in Delaware, and she now works part time as a sworn officer. In her current capacity as the Assistant Director for Community Mental Health and Addiction Services, she facilitates statewide training efforts for Delaware law enforcement in dealing with individuals with psychiatric illness and substance use disorders, and serves as a law enforcement liaison for the Public Behavior Health System in Delaware. Amy Kevis: Emergency responders, or first responders, are the men and women that rush into chaos and restore calm. They are the ones that society looks to in times of turmoil to bring things back to normal. In this podcast, I will discuss resiliency within this first responder community. How do firefighters, police officers, paramedics and ambulance crews, emergency dispatchers, and other first responders mentally recover after being involved in a traumatic event? How do they carry on with their daily activities and eventually get back to normal, too? Resiliency is the ability to rebound from a traumatic event or experience, and it’s a trait that we all possess, something inherently present in all of us. Knowing that we need to get back to our regular routine after a particularly stressful event is common sense. We all know how important that is. Being resilient means that a person can mentally bend and then revert back to their original mental state without long-term negative effects. A recent Time magazine article equated resiliency to squeezing a rubber ball. After the ball is squeezed and released, it bounces back to its original shape. We should do the same after experiencing a traumatic event—bounce back to our original selves, provided we have not lost the ability to be resilient. After any stressful situation, we know there’s a certain degree of mental processing that takes place, a slow-motion mental replay of the event to figure out what happened and why. Within the emergency response field, there are so many incidents to process. Within any given shift, there can be dozens of high-risk calls and dozens of incidents to process. It becomes impossible to think through every one. Eventually, the stress and strain of not being able to process these situations may become overwhelming. Even one significant event—think back to 9/11—can so severely traumatize the individuals involved that suddenly they are unable to bounce back to normal, and they may begin to exhibit signs of distress. Slowly, first responders may lose their ability to be as resilient as they once were. It is important that this group of individuals be given the tools and afforded the understanding to seek help when they aren’t as resilient as they once were. The experiences of a first responder may change their ability to recover as quickly as before. Vicariously living through repeated traumatic events inevitably changes their coping ability. At the end of their shift, emergency personnel take off the uniform that defines their role, and they go back to being a husband or a wife, a mom or a dad, a son or a daughter. Taking off that uniform signals more than the end of a shift. It signals a return to normal in a place where they can be themselves and relax, but they can’t stop the thoughts and the memories of the events they handled hours or days before. It may become difficult to get to sleep. It may become hard to communicate with their partner. They don’t feel like talking about work, but they don’t know why the awful events that they handled replay over and over in their heads. They may begin to use drugs or alcohol to feel better and to get some much needed respite. Perhaps they can’t talk to their friends anymore, so they may begin to engage in risky behaviors to feel better. None of this helps. In fact, it typically makes things worse. When first responders start to display difficulties in their personal relationships and have trouble processing stressful events, we need to pay attention as a community. Much like soldiers returning from combat, the everyday emergency responder must find a way to emotionally bounce back and return to normal after each shift. The cumulative effects of dealing with the stress following these repeated incidents, very much like soldiers and PTSD, is where the problems often begin. The International Journal of Emergency Mental Health has identified some of these warning signs that are specific to first responders: threatening suicide or threatening harm to others, displaying out-of-control or reckless behaviors, increased feelings of anxiety or excessive worry, hostility or insubordination towards others and supervisors, an unusual fascination with suicide or homicide, withdrawing or isolating behaviors, changes in sleeping patterns, and an increased use or beginning use of drugs or alcohol to cope. While this is by no means a comprehensive list, some individuals will show some or a few of these signs, or even a combination and may be a reason for concern. SAMHSA also has an excellent listing of warning signs and risk factors for children, adults, and first responders on their website. When these symptoms begin to be difficult to manage or interfere with an individual reverting back to his or her normal functioning, it’s time to ask for help. Emergency personnel are the first to respond and many times the last to admit that they need help. These professionals provide support. They don’t ask for support. Understanding where and how to safely get help is particularly important for first responders. As there is a stigma associated with seeking help in mainstream society, that stigma is magnified within the first responder community, where it’s all about being tough enough to handle the job. Seeking help may equal weakness, which could mean missing a promotion, being criticized—or worse, ostracized by their peers—or being perceived as “crazy”. However, these PTSD-like symptoms that first responders may experience reemphasize the need to build resiliency by guaranteeing them access to good help. Support mechanisms, removal of the stigma associated with experiencing emotional distress, and education about good mental health being equally as important as good physical health needs to be routinely available. Finding a good support group of understanding friends, families, or peers that can exchange feelings and thoughts in a safe environment is essential. It’s dangerous for first responders to ask for help. It signals a fitness-for-duty concern within the ranking supervision, and asking for help could mean the end of a career. Mental health fitness needs to be routinely included in a first responder’s total physical fitness evaluation without bias. By providing effective and accessible treatment options and promoting self-efficacy and empowerment, first responders will feel as if they have control in the intervention that they decide upon. In a profession that’s all about control and making the best decisions in the field, the success of any first responder’s treatment is contingent on that individual’s decision and willingness to engage and accept help. With this being said, mental health education is one of the most important strategies in guaranteeing first responders’ likelihood of seeking treatment. Another highly utilized intervention for first responders is critical incidence stress management, commonly referred to as CISM. Many agencies have policies mandating these debriefing sessions for first responders that are involved in critical incidents. These debriefing events have become the gold standard in crisis intervention management for first responders, although their effectiveness has met with some opposition of late. These teams are comprised of trained peers that provide support to involved agency members upon request. By allowing these individuals to talk inside of a safe group of like-minded colleagues that are discussing their thoughts and feelings following a traumatic event, a support system is formed. These specially trained individuals, oftentimes peers, provide support, foster connectedness, and understand the unique perspective of the first responders’ experience, thus, providing a safe place to talk. Finding a good therapist, one who understands and may have standing within the first responder community, is also important. An example of talk therapy is cognitive behavioral therapy during which current issues or problems are discussed, and the goal is to end or change the unhealthy or unhelpful behaviors and thoughts. Mindfulness is also getting attention and meeting with some success in dealing with PTSD. In a first responder’s world, if you don’t talk about something, eventually it just goes away. We, of course, know that this is not the case and will be part of the challenge in educating first responders about effectively dealing with trauma. Recent studies have demonstrated some measure of success in dealing with PTSD by practicing mindfulness. In closing, it’s important for first responders to understand that the feelings and emotions that they experience are not unusual for their profession and they can get help. Continuing with healthy routines, including eating right, getting regular exercise, and good sleep is important to maintain at all times. Recognizing that the risks and rewards of being a first responder are intermingled and when a first responder needs help, it’s okay and not a sign of weakness. These are the key components to building resiliency within the first responder community. Moderator: Thank you for listening to the Resiliency in Disaster Behavioral Health podcast series. If you would like to learn more about the topics and materials discussed in this episode, contact the SAMHSA Disaster Technical Assistance Center at email@example.com or at 1-800-308-3515. For products such as tip sheets, webcasts, and collections of research materials, visit our website at www.samhsa.gov/dtac. If you or someone you know are experiencing distress related to a natural or human‑caused disaster, call the Disaster Distress Helpline at 1‑800‑985‑5990.