tag:theconversation.com,2011:/au/topics/first-responder-22811/articlesFirst responder – The Conversation2021-09-08T20:12:17Ztag:theconversation.com,2011:article/1660332021-09-08T20:12:17Z2021-09-08T20:12:17Z20 years on, 9/11 responders are still sick and dying<figure><img src="https://images.theconversation.com/files/419188/original/file-20210903-23797-akqghk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2396%2C1595&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos.aap.com.au/search/world%20trade%20center%20attack">Shawn Baldwin/AP/AAP Image</a></span></figcaption></figure><p>Emergency workers and clean-up crew are among 9/11 responders still suffering significant health issues 20 years after the <a href="https://www.history.com/topics/21st-century/9-11-attacks">terrorist attacks</a>.</p>
<p>More than <a href="https://pubmed.ncbi.nlm.nih.gov/18500709/">91,000 workers and volunteers</a> <a href="https://www1.nyc.gov/site/911health/enrollees/rescue-recovery-workers.page">were exposed</a> to a range of hazards during the rescue, recovery and clean-up operations.</p>
<p>By March 2021, some 80,785 of these responders had enrolled in the <a href="https://www.cdc.gov/wtc/">World Trade Center Health Program</a>, which was set up after the attacks to monitor their health and treat them.</p>
<p>Now our <a href="https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/health-trends-among-911-responders-from-20112021-a-review-of-world-trade-center-health-program-statistics/09B87521287B943402782DAADB47E0B9">published research</a>, which is based on examining these health records, shows the range of physical and mental health issues responders still face.</p>
<h2>Breathing problems, cancer, mental illness</h2>
<p>We found 45% of responders in the health program have aerodigestive illness (conditions that affect the airways and upper digestive tract). A total of 16% have cancer and another 16% have mental health illness. Just under 40% of responders with health issues are aged 45-64; 83% are male.</p>
<p>Our analysis shows 3,439 of responders in the health program are now dead — far more than the <a href="https://parade.com/1248604/jessicasager/9-11-facts/">412 first responders who died on the day</a> of the attacks.</p>
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<p>Respiratory and upper digestive tract disorders are the number one cause of death (34%), ahead of cancer (30%) and mental health issues (15%). </p>
<p>Deaths attributed to these three factors, as well as musculoskeletal and acute traumatic injuries, have increased six-fold since the start of 2016. </p>
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Read more:
<a href="https://theconversation.com/how-the-pain-of-9-11-still-stays-with-a-generation-64725">How the pain of 9/11 still stays with a generation</a>
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<h2>An ongoing battle</h2>
<p>The number of responders enrolling in the health program with emerging health issues rises each year. More than 16,000 responders have enrolled in the past five years. </p>
<p>Cancer is up 185% over the past five years, with leukaemia emerging as particularly common, overtaking colon and bladder cancer in the rankings.</p>
<p>This equates to an increase of 175% in leukaemia cases over a five-year period, which is not surprising. There is a <a href="https://pubmed.ncbi.nlm.nih.gov/32771228/">proven link</a> between benzene exposure and acute myeloid leukaemia. Benzene is found in jet fuel, one of the toxic exposures at the World Trade Center. And acute myeloid leukaemia is one of the main types of leukaemia reported not only by responders, but by <a href="https://www.wtc-illness.com/cancers/leukemia-blood-cancer">residents of lower Manhattan</a>, who also have higher-than-normal rates. </p>
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<p>Prostate cancer is also common, increasing 181% since 2016. Although this fits with the age profile of many of the health program’s participants, some responders are developing an <a href="https://pubmed.ncbi.nlm.nih.gov/31221798/">aggressive, fast-growing form</a> of prostate cancer. </p>
<p>Inhaling the toxic dust at the World Trade Center site may trigger a cascading series of cellular events, increasing the number of inflammatory T-cells (a type of immune cell) in some of the responders. This increased inflammation <a href="https://pubmed.ncbi.nlm.nih.gov/26816843/">may eventually lead to prostate cancer</a>.</p>
<p>There may also be a <a href="https://pubmed.ncbi.nlm.nih.gov/31490535/">significant link between</a> greater exposure at the World Trade Center and a higher risk of long-term cardiovascular disease (disease affecting the heart and blood vessels). Firefighters who responded to the World Trade Center on the morning of the attacks were 44% more likely to develop cardiovascular disease than those who arrived the next day.</p>
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Read more:
<a href="https://theconversation.com/air-pollution-causes-cancer-so-lets-do-something-about-it-19380">Air pollution causes cancer, so let's do something about it </a>
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<h2>The mental health effects</h2>
<p>About <a href="https://pubmed.ncbi.nlm.nih.gov/31625489/">15-20%</a> of responders are estimated to be living with <a href="https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/ptsd">post-traumatic stress disorder</a> (PTSD) symptoms — roughly <a href="https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd">four times</a> the rate of the general population. </p>
<p>Despite 20 years having passed, PTSD <a href="https://pubmed.ncbi.nlm.nih.gov/28805168/">is a growing problem</a> for responders. Almost half of all responders <a href="https://pubmed.ncbi.nlm.nih.gov/31776767/">report</a> they need ongoing mental health care for a range of mental health issues including PTSD, anxiety, depression and <a href="https://www.medicalnewstoday.com/articles/325578">survivor guilt</a>.</p>
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Read more:
<a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">9/11 anniversary: a watershed for psychological response to disasters</a>
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<p>Researchers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">have also found</a> brain scans of some responders indicate the onset of early-stage dementia. This is consistent with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">previous work</a> noting cognitive impairment among responders occurs at about twice the rate of people 10-20 years older.</p>
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<h2>COVID-19 and other emerging threats</h2>
<p>Responders’ underlying health conditions, such as cancer and respiratory ailments, have also left them <a href="https://www.usatoday.com/in-depth/news/nation/2021/05/05/covid-risk-911-september-2001-ground-zero-responders-causes-concern/4961779001/">vulnerable to COVID-19</a>. By the end of August 2020, <a href="https://www.newsweek.com/how-many-people-died-911-thousands-perishing-september-11-related-illnesses-1531058">some 1,172 responders</a> had confirmed COVID-19.</p>
<p>Even among responders who have not been infected, the pandemic <a href="https://www.thecity.nyc/2020/9/10/21431746/how-many-9-11-survivors-have-died-of-covid-19">has exacerbated</a> one of the key conditions caused by search and rescue, and recovery after terrorist attacks — PTSD.</p>
<p><a href="https://www.nbcnews.com/news/us-news/covid-19-has-killed-dozens-9-11-first-responders-n1239885">More than 100 responders have died</a> due to complications from the virus, which has also exacerbated other responders’ PTSD symptoms.</p>
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<p>The number of responders with cancers associated with asbestos exposure at the World Trade Center is expected to rise in coming years. This is because mesothelioma (a type of cancer caused by asbestos) usually takes <a href="https://www.canceraustralia.gov.au/cancer-types/mesothelioma-cancer/awareness#:%7E:text=It%20usually%20takes%20a%20very,and%20roofing%2C%20and%20in%20insulation.">20-50 years to develop</a>. </p>
<p>As of 2016, at least 352 responders had been diagnosed with the lung condition <a href="https://www.mayoclinic.org/diseases-conditions/asbestosis/symptoms-causes/syc-20354637">asbestosis</a>, and at least 444 had been diagnosed with another lung condition, <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">pulmonary fibrosis</a>. Exposure to asbestos and other fibres in the toxic dust <a href="https://www.asbestos.com/world-trade-center/">may have contributed</a>.</p>
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Read more:
<a href="https://theconversation.com/health-harms-of-asbestos-wont-be-known-for-decades-14845">Health harms of asbestos won't be known for decades </a>
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<h2>Lessons learned</h2>
<p>Our research involved analysing data from existing databases. So we cannot make direct links between exposure at the World Trade Center site, length of time there, and the risk of illness. </p>
<p>Differences in age, sex, ethnicity, smoking status and other factors between responders and non-responders should also be considered. </p>
<p>Increased rates of some cancers in some responders may also be associated with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764101">heightened surveillance</a> rather than an increase in disease.</p>
<p>Nevertheless, we are now beginning to understand the long-term effects of responding to the 9/11 terrorist attacks. Exposure is still having both a physical and mental health impact and it’s likely responders are still developing illnesses related to their exposures.</p>
<p>Ongoing monitoring of responders’ health remains a priority, especially considering the looming threat of new asbestos-related cancers.</p><img src="https://counter.theconversation.com/content/166033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More 9/11 responders died from physical and mental health issues after the terrorist attacks than on the day itself. And survivors are still suffering 20 years later.Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan UniversityBrigid Larkin, PhD candidate, Edith Cowan UniversityLisa Holmes, Lecturer, Paramedical Science, School of Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/795282017-07-13T13:42:52Z2017-07-13T13:42:52ZHow to reboot Britain’s fractured emergency services<figure><img src="https://images.theconversation.com/files/177868/original/file-20170712-19689-1a6enbq.jpg?ixlib=rb-1.1.0&rect=7%2C4%2C992%2C657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">pixelaway/shutterstock</span></span></figcaption></figure><p>The <a href="https://theconversation.com/grenfell-tower-disaster-how-did-the-fire-spread-so-quickly-79445">Grenfell Tower fire</a> and recent terrorist attacks in Manchester and London have put the spotlight <a href="https://www.theguardian.com/uk-news/2017/jun/20/cressida-dick-calls-for-more-money-for-the-met-after-terrorist-attacks">on spending cuts</a> for emergency services. </p>
<p>In Manchester, <a href="http://www.bbc.co.uk/news/uk-england-manchester-40167454">an independent review</a> into the emergency response was ordered in the aftermath of the bombing to look into the “the strain of spending cuts” on police. The city mayor is also <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/firefighters-infuriated-after-were-stopped-13087703">investigating</a> the fire service after crews were apparentley “held back” from helping the victims. </p>
<p>Whatever the outcome of these investigations – and <a href="https://www.theguardian.com/uk-news/2017/jul/08/grenfell-mayor-orders-urgent-review-of-fire-brigade-kit-after-rescue-delays">others like them</a> – I believe the problems go far beyond staff numbers and resources. The only way forward is to engage in a full system “reboot” to get better results. </p>
<p>The problems are legion. For starters, the emergency services are far too fragmented. There are huge differences across the emergency services when it comes to size, funding and organisational structures with <a href="https://aace.org.uk/news/rusi-calls-for-single-emergency-services-body/">no overarching body for coordination</a>.</p>
<p>Disconnected ministerial oversight also creates uneven and localised outcomes in performance. And the government’s approach to the problem is vague and unclear. The <a href="https://www.gov.uk/government/collections/policing-and-crime-bill">Policing and Crime Act 2017</a> has brought important changes to the governance of the police and fire and rescue services – but ambulance services remain independent of these provisions. It places a duty on police, fire and ambulance services to work together which currently remains undefined. </p>
<p>Ambulance demand is growing at an <a href="https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf">annual rate</a> of about 5.2%. Managing such levels of demand and maintaining the quality of patient care is unsustainable and it is no secret that ambulance services across the country are <a href="https://www.publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/1035/1035.pdf">struggling to meet</a> their performance targets. The police are witnessing a <a href="http://www.college.police.uk/News/College-news/Documents/Demand%20Report%2023_1_15_noBleed.pdf">reduction in recorded crime</a> but are increasingly dealing with cases relating to cybercrime, child and sexual exploitation and mental illness. Meanwhile fire services have seen a <a href="http://www.nlgn.org.uk/public/wp-content/uploads/Fire-Works_Final1.pdf">massive reduction</a> in fire call-outs. But these organisations continue to be performance-managed and target-driven – and current models of service delivery do not reflect these changes. </p>
<p>The focus for the emergency services remains on <a href="http://www.emeraldinsight.com/doi/full/10.1108/09513551111147132">performance metrics</a> and stringent target regimes. Alongside this is the influence that staff associations and unions have on determining the <a href="https://www.gov.uk/government/news/government-response-to-25-september-industrial-action-by-the-fire-brigades-union">scale and pace of reforms</a>. Workforce issues <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8295.1996.tb02575.x/full">such as stress</a> remain largely neglected and recruitment and retention of black, Muslim and ethnic minorities (BME) <a href="http://journals.sagepub.com/doi/abs/10.1350/pojo.2007.80.3.191">continues to be a challenge</a>. </p>
<p>Issues around Post-Traumatic Stress Disorder (PTSD) and other illness – which are common among emergency workers – are <a href="http://www.tandfonline.com/doi/abs/10.3109/10903127.2011.621044">not being fully addressed</a> and ambulance staff sickness is <a href="http://www.emeraldinsight.com/doi/full/10.1108/IJES-02-2016-0004">highest within the NHS</a>. Media reports also increasingly highlight cases of <a href="http://www.dailymail.co.uk/news/article-3609247/Theresa-slams-fire-service-chiefs-allowing-bullying-harassment-flourish-unveils-sweeping-reforms.html.">harassment and bullying</a> within the emergency services.</p>
<p>There are no easy fixes for all these problems but emergency services do need a “road map” to help them navigate the shifting political landscape and the changes to training and performance regimes. Here are five ways to improve the emergency services and better equip them for the future. </p>
<p><strong>Leadership reform</strong></p>
<p>There needs to be a move from <a href="https://www.hsj.co.uk/topics/leadership/break-away-from-heroic-leadership/5053155.article">isolated chiefs</a> calling all the shots to a more collaborative culture. This is because front-line staff and managers should have confidence in their own leadership and decision-making skills while dealing with other 999 services during major incidents and during interactions with the public. </p>
<p><strong>Promote collaboration</strong></p>
<p>A top-down bureaucratic approach to force the merger of police and fire services is unlikely to work and should be abandoned if it proves costly and does not bring results. <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200092/FINAL_Facing_the_Future__3_md.pdf">Proposals for merger</a> and reorganisation of the fire services need to be reconsidered, along with the feasibility of a national or regionally organised police force like in <a href="http://www.scotland.police.uk/">Scotland</a>.
Further reforms should allow pooling organisational and management oversight. </p>
<p>Similarly, the role of the ambulance services within the emergency architecture should be spelt out more clearly, since they derive their <a href="https://www.publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/1035/1035.pdf">funding</a> from the National Health Service budget. They work more as the emergency arm of the health services rather than the health arm of the emergency services. </p>
<p><strong>Adapt to changing demands</strong></p>
<p>There is a clear need to understand how usage is changing – and to support staff to respond to new challenges. This will help to improve workforce motivation and reduce the cost of ill health by building a “<a href="https://hbr.org/2011/06/building-a-resilient-organizat">resilient</a>” organisational culture. </p>
<p><strong>Academic partnerships</strong></p>
<p>Developing partnerships with academia will be useful in building modern and professional organisations and to further improve the research base in the “Blue Light” services. </p>
<p><strong>New management skills</strong></p>
<p>Addressing staff morale and retention and setting performance criteria that make sense will be central to improving the services. The obsession with a <a href="https://www.gov.uk/government/news/police-targets-review-published">target-chasing culture</a> should give way to broader sets of measures to reflect the new challenges and changing organisational realities. We need a new set of collaborative leadership and management skills to inspire a shared purpose across a network of organisations to respond quickly to current and future problems. </p>
<p>This is an important moment for the emergency services. The steady rise in the 999 demand along with shrinking budgets are seen by many as two of the key challenges which are unlikely to go away in the near future. There is an urgent need to restart Britain’s limping emergency services and bring about real “transformational” change. But it requires determination, imagination and leadership – or the 999 services will be facing their own emergency situation.</p><img src="https://counter.theconversation.com/content/79528/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paresh Wankhade does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The UK’s blue light services need to adapt and modernise or they will face their own emergency.Paresh Wankhade, Professor of Leadership and Management with expertise in emergency service management, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/798132017-07-09T23:51:30Z2017-07-09T23:51:30ZLessons for first responders on the front lines of terrorism<figure><img src="https://images.theconversation.com/files/176110/original/file-20170628-3154-7e5e7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">After two terror attacks the prior week, police patrolled the Westminster Bridge on election day 2017 in London.</span> <span class="attribution"><span class="source">AP Photo/Markus Schreiber</span></span></figcaption></figure><p>Acts of terrorism are <a href="http://www.cnn.com/2016/11/16/world/global-terrorism-report/index.html">on the rise globally</a>. Over the past several weeks alone, the world has seen stabbings, shootings and bombings in Flint, Tehran, <a href="https://theconversation.com/us/topics/london-bridge-attack-39289">London</a>, Kabul and Bogota.</p>
<p>We’ve spent the past several years researching how communities can prepare to provide urgent medical care to the large numbers of victims these events produce. </p>
<p>Given the persistent risk of terrorist attacks and large-scale accidents, it’s more critical than ever to learn from past incidents. That will ensure that first responders can work together effectively during the chaotic but critical minutes and hours after an incident. </p>
<h1>Better coordination</h1>
<p>Televised images of attack or disaster scenes often show patients being treated and transported by paramedics. Hours later, hospital press conferences often recount the heroic efforts of emergency physicians, trauma surgeons and nurses to minimize loss of life and limb. </p>
<p>But equally important are the actions of nonmedical first responders. Police, firefighters and even bystanders compress wounds, apply tourniquets or drive casualties to hospitals.</p>
<p>In the <a href="http://jamanetwork.com/journals/jama/article-abstract/1684255">Boston marathon bombing</a>, for instance, 264 victims transported to local hospitals survived, despite many serious injuries. This was credited not only to excellent triage, transport and care by medically trained paramedics, EMS and hospital staff, but also to <a href="http://journals.lww.com/annalsofsurgery/Abstract/2014/12000/The_Initial_Response_to_the_Boston_Marathon.4.aspx">immediate lifesaving actions</a> by police and bystanders. </p>
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<span class="caption">Responders help those injured after a bomb went off near the finish line of the Boston Marathon.</span>
<span class="attribution"><span class="source">AP Photo/Charles Krupa</span></span>
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<p>However, things do not always go so well. In the often chaotic post-incident scene, it can be difficult to coordinate the efforts of multiple response agencies and bystanders. Even as EMS personnel triage and transfer victims, law enforcement needs to maintain security, preserve evidence and locate potential perpetrators. That makes it challenging to manage access to and traffic around the scene. </p>
<p>For instance, <a href="http://www.cbsnews.com/news/orlando-nightclub-shooting-report-reveals-new-details-inside-pulse/">an Orlando Police Department report on the Pulse nightclub attack</a> cited the need for improved communication and coordination between the police and fire departments responding to the incident. While such problems do not always affect how many lives are saved, they can slow down the overall response. </p>
<p>Even when well-coordinated, those not trained in post-disaster casualty triage can unintentionally cause problems. They might transfer patients to hospitals that lack the resources needed to treat them, or transfer them in vehicles that lack critical life-support equipment, such as IVs or oxygen.</p>
<p>What’s more, unforeseen events such as poor weather or volume-related cell tower outages can create additional challenges. </p>
<h1>Preparing for the next attack</h1>
<p>Our recent research looked at three mass casualty incidents in the U.S. between 2013 and 2015, examining both the health care system and community responses.</p>
<p>We identified several best practices that can help medical and nonmedical first responders handle these incidents more effectively. </p>
<p>First, we must provide co-training for medical and nonmedical first responders. Police and firefighters are already starting to be trained in basic lifesaving skills in non-mass casualty incident contexts. In some communities, such as Atlanta and Irvine, California, police patrols carry <a href="http://www.sca-aware.org/sca-news/law-enforcement-agencies-putting-aed-devices-in-patrol-cars">automated electronic defibrillator devices</a> as well as <a href="http://www.emsworld.com/news/12318404/police-departments-carrying-narcan-to-save-both-the-public-and-police">Narcan</a> to reverse opioid overdose. Other police departments, such as in Denver, provide staff training in <a href="https://www.policeone.com/police-trainers/articles/6150110-Saving-lives-in-the-tactical-space-Training-to-use-tourniquets/">tourniquet application</a>. These efforts should be continued. </p>
<p>Moreover, both medical and nonmedical responders should be trained in scene safety, bystander management, field triage and medical techniques such as effective application of tourniquets. Even many medical professionals lack sufficient training in these skills. </p>
<p>Second, we need to ensure open communication lines. A dedicated radio frequency can facilitate communication among the various responder disciplines, as well as guard against problems caused by cell tower outages. Also, responders can be trained to rely, when necessary, on text messaging, which worked when voice communication did not during the events we studied.</p>
<p>Third, interdisciplinary disaster drills are critical. Communities should conduct regular citywide disaster drills that include EMS, fire and police departments, as well as area hospitals and health care systems. Responders need to test their training and protocols under conditions that simulate some of the complexity and stress of real events. This could include adding components without notice, to <a href="https://www.phe.gov/Preparedness/planning/hpp/surge/Pages/default.aspx">simulate the sudden onset of terrorist events</a>. </p>
<p>Such drills will help each group understand how its actions contribute to an integrated multidisciplinary response. They can also promote more effective collaboration during response to an incident. </p>
<p>Finally, we need to build relationships in advance that can be leveraged during emergencies. Our research indicates that one of the most important ingredients of an effective multidisciplinary medical response is strong relationships and trust among key players. Regular exercises and drills can help, but they need to be supported by leaders and organizational cultures. </p>
<p>For example, in recent years, with support from the federal government, many communities across the U.S. have created health care coalitions that provide formal mechanisms – including regular multi-stakeholder meetings and agreements to share critical resources – for coordinating the preparedness and response efforts of first responders, health care providers and private sector partners. </p>
<p>Moreover, given the frequent role of bystanders, professional responders should reach out to community emergency response teams and other organizations. That can help raise citizen awareness of basic lifesaving techniques. </p>
<h1>Public support</h1>
<p>Effective medical response to terrorism and disasters requires sustained investment. That can be difficult to muster in an era marked by increasing skepticism about public investment and distrust in public institutions. </p>
<p>However, experience suggests that we need collaboration among medical and nonmedical response organizations – and civilians. Through supporting public investments in mass casualty incident preparedness and response, both policymakers and civilians should have the confidence that, even when attacks cannot be prevented, their communities are resilient enough to respond to and recover from them.</p><img src="https://counter.theconversation.com/content/79813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mahshid Abir is an Affiliated Adjunct staff member at the RAND Corporation and received funding from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR) for the research discussed in this article. </span></em></p><p class="fine-print"><em><span>Christopher Nelson is Professor of Policy Analysis at the Pardee RAND Graduate School and Senior Political Scientist at RAND. He received funding from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR) for the research discussed in this article.</span></em></p>Given the persistent risk of terrorist attacks and large-scale accidents, it’s more critical than ever for EMTs, police, firefighters and others to learn from the past.Mahshid Abir, Assistant Professor, Department of Emergency Medicine, Director of the Acute Care Research Unit, Affiliated Adjunct and Natural Scientist, RAND Corporation, University of MichiganChristopher Nelson, Professor of Policy Analysis, Pardee RAND Graduate SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/508622015-11-24T13:39:14Z2015-11-24T13:39:14ZTetris … and other surprising ways to help emergency workers cope with trauma<figure><img src="https://images.theconversation.com/files/102730/original/image-20151122-408-1juuasw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">First responders are usually resilient</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?autocomplete_id=&language=en&lang=en&search_source=&safesearch=1&version=llv1&searchterm=first%20responders&media_type=images&media_type2=images&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=124092664">www.shutterstock.com</a></span></figcaption></figure><p>Some people seemingly can deal with anything. They save a stranger from bleeding out in a bombed restaurant, protect passers-by from heavily armed gunmen, pull dead and dying people out of collapsed buildings, and they keep going because it is their job. These people are first responders.</p>
<p>When trauma goes on for days, as it has recently in Paris, however, the odds of them bouncing back from the violence, death and injury they are witnessing rapidly diminishes. They are at <a href="http://occmed.oxfordjournals.org/content/63/3/175.full">greater risk</a> of developing a severe stress reaction known as post-traumatic stress disorder (PTSD). </p>
<p>One study found that the worldwide rate of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974968/">PTSD among first responders</a> is 10%, much higher than the 3.5% rate among those not involved in rescue work.</p>
<h2>Tetris to the rescue</h2>
<p>So how best to address the problem? Research is in its infancy, but there are some promising studies. <a href="http://www.neuroscience.cam.ac.uk/directory/profile.php?emily.holmes">Emily Holmes</a>’ group at the University of Cambridge has been looking at the benefits of playing Tetris, a video game, after a traumatic experience. The idea is that this could block the consolidation of traumatic memories so they don’t “flash back” later on. </p>
<p>For the study, her team first <a href="http://pss.sagepub.com/content/early/2015/07/01/0956797615583071.full.pdf+html">traumatised people</a> by showing them distressing footage from public safety videos. The next day they invited them back into the lab to reactivate the memories with still images taken from the videos. One group then played Tetris for 12 minutes while the other sat quietly. Over the following week, the group who played Tetris had about 50% fewer unwanted memories from the films compared to the group who didn’t.</p>
<p>The team concluded that playing Tetris helps because it soaks up a person’s visual processing capacity, making it harder for the brain to consolidate the visual parts of a traumatic memory.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102729/original/image-20151122-389-s26ikx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Tetris soaks up your visual processing capacity.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?autocomplete_id=&language=en&lang=en&search_source=&safesearch=1&version=llv1&searchterm=tetris&media_type=images&media_type2=images&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=222766411">www.shutterstock.com</a></span>
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<p>Since it takes about six hours for the brain to cement a memory, the key is to play the game soon after trauma or within six hours of re-activating the traumatic memory. How long the helpful effects of playing Tetris will last and whether it will translate into helping people after real-life trauma is still unknown.</p>
<h2>Talking it through</h2>
<p>Other techniques, such as “updating”, taken from a <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2013.13040552">highly-effective talking treatment</a> for PTSD, may be more practical and easier to implement.</p>
<p>Like a detective, updating is a technique that focuses on finding new information and linking it to the case, the past memory. This is necessary because when the brain and body are in survival mode during trauma, the mind finds it difficult to <a href="http://science.howstuffworks.com/life/inside-the-mind/human-brain/human-memory1.htm">encode</a> all the relevant facts. Often key pieces of information that could make the memory less traumatic are lost. Updating links new information to someone’s memory of their trauma to make it less upsetting. </p>
<p>But can updating help to reduce unwanted memories after trauma? </p>
<p>We carried out a study, published in <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122971">PLOS ONE</a>, in which we traumatised people by showing them terrifying films of humans and animals in distress. We then divided our participants into three groups. One group watched the films again but were given new information about how long people suffered and whether or not they lived or died – essentially, they were updated. The second group watched the same films again but without the new information. And the third group watched films of humans and animals who were not in distress. The updated group had fewer traumatic memories and PTSD symptoms than the other two groups. </p>
<p>Updating is now being used by some UK emergency services. First responders will gather after critical incidents and update their memories of what happened before they go home.</p>
<h2>Sleep deprivation</h2>
<p>There are other techniques that may be helpful. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26118556">One study</a> found that depriving people of sleep may be useful in the aftermath of trauma. </p>
<p>But the same study found that a week after the trauma, people who had been deprived of sleep had the same number of unwanted memories as people who had slept well afterwards. Consequently, it remains unclear whether there would be any long-lasting benefits using this method. There are, however, certainly health risks linked to lack of sleep. </p>
<h2>Still looking for a solution</h2>
<p>To develop preventative interventions, we need to study newly-recruited emergency workers who haven’t yet suffered on-the-job trauma and follow them over time, spotting which “coping styles”, present before trauma, may predict their reactions afterwards. </p>
<p>For example, some people naturally react to stressful life events by dwelling on them, thinking about why they happened for hours on end. This strategy, called rumination, has been linked to PTSD in people who <a href="http://psycnet.apa.org/journals/abn/107/3/508/">survived car crashes</a>. </p>
<p>If rumination predicts PTSD in first responders, then preventative interventions could train people to spot when they are dwelling on an event and refocus their attention to the task at hand. </p>
<p>When we have identified which factors heighten emergency workers’ risk of developing PTSD, programmes can be developed to target those vulnerabilities. Only then can an intervention, directed at first responders most at risk of developing PTSD, properly protect them in their line of work.</p><img src="https://counter.theconversation.com/content/50862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Wild receives funding from Mind. </span></em></p>First responders are hugely resilient – but here’s what to do when the memories become too much.Jennifer Wild, Senior Research Fellow in Clinical Psychology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.