Understanding Vicarious Trauma Among First Responders

Background and Purpose:

Among first responders, work-related or vicarious trauma exposure may result from witnessing the aftermath of traumatic events day after day. On average, among firefighters, rates of depression and post-traumatic stress are five times higher than the general population. In fact, the emotional upheaval associated with vicarious trauma may also be related to high rates of suicide among firefighters with suicide exceeding the rate of on-duty death by 30%.

To address these dangerous conditions, the Center for Applied Behavioral Health Policy (CABHP) partnered with a fire department in the Southwest to assist in creating resources to help first responders access services after experiencing stressful or traumatic events. Specifically, fire department administrators asked, “which types of emergency calls most impact first responders mentally and emotionally? What mitigating factors are present and how might they be enhanced?”

As a first step in this community-led effort, we sought to determine what emergency call types (e.g., welfare check, overdose, child drowning) were associated with perceived stress. Next, we hypothesized that the presence of interpersonal (i.e., friends and family) and work (i.e., peer colleagues) supports would be inversely related with (a) dissociation, (b) anxiety, (c) depression, and (d) post-traumatic growth (i.e., positive change).

Methods

In collaboration with a fire department in the Southwest, the CABHP developed a survey tool for first responders measuring a-d above. One hundred fifty-seven firefighters completed the online survey. We determined the association between level of stress caused by different call types (1=low stress to 5=high stress), demographic characteristics, and scores on validated scales and screenings. Next, we regressed a-d on several demographic and social support variables controlling for time on the job.

Results

We learned that call types resulting in highest increases in all (a-d) indicators were vehicle accident, child drowning, behavioral health crisis, and overdose. When modeling the four outcomes measuring level of stress, we found that higher levels of support from colleagues resulted in significantly lower dissociation scores (score decrease=-0.6320, p-value=0.0134), lower sleep disturbance scores (score decrease=-1.2472, p-value=0.0005) and lower anxiety scores (score decrease=-0.7627, p-value=0.0051). Furthermore, higher levels of support from colleagues and family resulted in significantly lower depression scores (score decrease=-1.1359, p-value=0.0004; score decrease=-0.7178, p=0.0392 respectively). When modeling post-traumatic growth scores, we found that higher levels of support from colleagues resulted in significantly higher post-traumatic growth scores (score increase=0.936, p-value=0.0004).

Conclusions and implications

Using the information from this survey, fire department administrators are able to better identify when a first responder may need health and wellness resources (as a result of experienced call type). The fire department will also use the data to determine if the first responders need services immediately following particularly stressful calls, increasing access to peer-based wellness resources. Ultimately, implications are related to the development of tailored wellness programs, enhanced peer supports, and trauma-informed protocols within fire and other crisis responding organizations.