When the Heroes Are Also the Victims

PTSD is common among those who respond to disasters and other emergencies. It’s hard to deal with, but there are ways to help them.

Emergency-services professionals know that one of their key tasks is to take care of the people who deal firsthand with crises and trauma: firefighters who run into burning buildings, first responders at the scene of a mass murder, personnel who try to rescue people from floods and tornadoes. These brave people do truly heroic work under the most trying conditions. Sadly, they often suffer from post traumatic stress syndrome (PTSD). Consider:

• On April 16, 2007, a student at Virginia Tech killed 32 people and wounded 17 others. It was the deadliest shooting incident by a single gunman in our country’s history. Police got inside the classroom building in eight minutes and found the shooter dead. But the suffering had only just begun. As medical personnel carried the dead students out of the building, cellphones on the students’ bodies began to ring. Horrified parents were calling to see if their children were safe. Some of the first responders had great difficulty getting over the scene. At least one of them retired early from a career he loved.

• When firefighters began fighting a house fire in a New England town a few years ago, most of them went to the main floor where the fire was blazing. After a while, one firefighter went to the top floor (the most dangerous spot in most fires) and found an unconscious young woman. He brought her outside and medics administered CPR. But it was too late; she died of smoke inhalation. The firefighter who had found her blamed himself for not getting to her earlier; he had nightmares and suffered depression for months.

Why do so many emergency-services personnel suffer PTSD? There are many reasons. One has to do with the nature of people drawn to the profession. According to trauma experts, emergency management attracts people of a particular sort. They are caretakers, action-oriented, flexible in chaotic situations, proud of serving others, very tolerant of stress, excited by high-stimulation events, and in need of structure.

Of course, many of these qualities are perfectly suited to emergency-services work. Many, but not all. Those with high needs for structure are frequently frustrated by situations in which systematic methods aren’t effective. People who thrive on high stress and constant action often get depressed when the emergency is over. People who love to care for others sometimes blame themselves when they can’t save someone, and it often sometimes help to provide evidence showing that it was impossible to save the person.

What does help? Emergency-services personnel find a number of interventions useful. Some seek individual therapy. Others benefit from group counseling. One effective group approach is Critical Incident Stress Debriefing, a seven-phase supportive small-group intervention that has helped many people with PTSD. Those who work in law enforcement are usually more comfortable talking with other law-enforcement professionals, which is why peer counseling works well for them. And some people benefit from telling their story to a supportive friend or colleague.

And what can leaders do to address the human side of crises? Three key leadership tasks are to identify people who seem to be suffering from a traumatic event, help them understand that they need some kind of assistance, and show that it’s normal for people with PTSD to require some kind of help.

Many emergency personnel feel that it’s weak to seek counseling, so they tough it out on their own. A study conducted by the Army in 2011 revealed that 40 percent of soldiers believed leaders will blame them for having post-trauma problems, and 50 percent believed they would be seen as weak if they sought help. But in many situations, the person simply needs to hear from a trusted colleague or respected leader that there is nothing else he or she could have done.

Here’s a poignant example from the NASA Challenger accident. On Jan. 28, 1986, the space shuttle exploded in an inferno of fire 73 seconds after liftoff. The night before the launch, Bob Ebeling and four of his colleagues at Morton Thiokol (a NASA contractor) tried to convince NASA managers to delay the flight, arguing that rubber seals called O-rings wouldn’t function properly in the cold temperatures forecast for the next day. One of NASA’s managers told the engineers’ supervisor to “take off your engineer hat and put on your management hat.” The engineers stopped protesting, and the rest is history.

Ebeling felt extreme guilt about the launch. “I could have done more, I should have done more,” he told people. For 30 years he blamed himself. Many people tried to tell him that he did the right thing. It didn’t help. Then, after Ebeling told a National Public Radio interviewer a few months ago that he still blamed himself, a former NASA official who worked on the Challenger launch wrote to Ebeling: “You and your colleagues did everything that was expected of you. You should not torture yourself with any assumed blame.” And NASA sent Ebeling a statement which said, in part, “We honor [the Challenger astronauts] … by constantly reminding each other to … listen to those like Mr. Ebeling who have the courage to speak up so that our astronauts can safely carry out their missions.”

Those two messages were what Bob Ebeling needed. His guilt started to ease. His daughter noted a real change in him: “He doesn’t have a heavy heart like he did.” Bob Ebeling died three weeks later, with a clean conscience.