Abstract
First responders, including Emergency Medical Services personnel and firefighters, support community members in times of crisis. When responding to emergencies, first responders often experience both direct and vicarious trauma. Over time, the pace and intensity of a career as a first responder leads to poor health habits and high risk for mental health issues including posttraumatic stress disorder. Due to concern about peer perception and mental health stigma, these professionals are less likely to seek mental health supports to manage and process trauma. This chapter explores Narrative Therapy as an ideal option for mental health treatment of first responder trauma, providing a collaborative approach to therapy using the natural coping strategy of storytelling.
TopBackground
Emergency Medical Services (EMS) includes Emergency Medical Technicians (EMTs) and Paramedics. The scope of practice outlined by the National Highway Traffic Safety Administration defines the roles and training of EMS (USDOT, 2007). In this scope of practice, EMTs focus on basic life support (BLS) services which encompass treating and transporting stable patients not in imminent harm of death or disability. Beyond the training of EMTs, Paramedics represent the highest level of certification for EMS. Paramedics oversee the work of EMTs and direct firefighters on scene in the interest of prioritizing patient health outcomes. Paramedics perform invasive medical procedures for advanced life support (ALS) services addressing life-threatening emergencies during patient treatment and transport (USDOT, 2007). Nationally, 70% of EMS personnel are EMTs, and only 24% are Paramedics (USDHS, 2017).
EMS as a field is generally young. The Highway Safety Act of 1966 established the Department of Transportation (DOT; NHTSA, n.d). This marks early organization and development of the EMS system as represented today, with DOT tasked with regulation and implementation of training standards (NHTSA, 2011). Mainstream media representation of EMS dating back to the 1970s, primarily with the television show Emergency, began to create both public awareness of 911 services, as well as public misconceptions about emergency support in communities (NHTSA, n.d). EMS often work closely with, or cross train as firefighters. Nationally, 40% of EMS work directly with fire departments (NHTSA, 2011).
Early firefighters in the 1800s in the US were largely volunteers (Kenlon, 1913). Later, through central government regulation, firefighters established a fraternal order or “brotherhood” still recognized today in response to early rivalries between volunteer firefighting communities. In modern firefighting, the United States Fire Administration (USFA) trains, supports, and governs firefighters as a division of the Federal Emergency Management Agency (FEMA), first established in 1973 to address fire prevention (Kruger, 2018). Firefighters focus on fire prevention and response in the community (USDHS, 2017). Training for firefighters includes Firefighter I and Firefighter II certifications (NFPA, 2019). Both levels of certification include foundational training including response to alarms, tools and equipment for fire management, navigating environments safely to address fires, and helping rescue fire victims. The Firefighter II certification includes further skills training with a wider variety of equipment than Firefighter I.
Key Terms in this Chapter
Vicarious Trauma: The impact of exposure to unusually stressful events experienced by others over time.
First Responder: A common term for professionals including emergency medical services personnel and firefighters trained to respond to community emergencies.
Posttraumatic Stress Disorder: A stress-related disorder occurring after a traumatic event characterized by symptoms including sleep disturbance, distressing dreams, avoidance of reminders of the traumatic event, negative mood, and emotional reactivity for at least one month after the traumatic event.
Direct Trauma: An unusually stressful event happening directly to an individual.
Dominant Narrative: The common story, lens, or perception of the principal societal group.
Stigma: The shame perceived or expressed by others when an individual is associated with a certain group, need, or condition.
Compassion Fatigue: The gradual loss of the capacity to care for the suffering of others after repeated need to support others over time.