There is a cost to caring for others, but it does not need to be a lifelong debt that continues to overwhelm not only the people who stepped up but those around them. With the right plan of support and the willingness to explore coping options, that cost is manageable. It becomes an investment with a very positive return rather than a crippling debt that seems never to be satisfied.
Responders of all types bring a level of caring to work with them each day. Most days are typical – the days they trained for, the daily routines they expected when they got dressed to go to work, and their return home as usual at the end of the shift. However, sometimes, it is not a typical day – when a police officer, firefighter, hospital worker, or emergency medical technician (EMT) has the privilege (and the responsibility) of being part of someone else’s worst day of their lives. Furthermore, it may be one of those days no one wants to happen, but when it does, these responders step up and step in to give it all they have.
On typical days, professional responders – those giving care (the caregivers) – go to the next call, the next assignment, and the next patient while reflecting on another experience. Again, they leave each call with new thoughts, memories, and maybe mental pictures that seem stuck in their heads and are not easily washed or wished away. They continue their day feeling satisfied that they have done their jobs to the best of their abilities, training, and experience. In other words, they put this call on the shelf with the others they have responded to in the past, with the hope that it gets filed away as just part of the job.
For some reason, responders have the desire and the aptitude to go to these calls for other people. It is what they do and who they are, and the world is thankful for them. Many people understand that this is a job they cannot do. Whether a typical day or an unimaginable one, consider what happens to those experiences, thoughts, memories, sights, and sounds that are a part of the job. The brain is an amazing organ that collects experiences and stores them in “files.” Sometimes, the memories and experiences of those they have treated mix with their own lives – their children, parents, neighbors, or friends. That is not to say they always overlap, but they can and often do.
At times when leaving a scene, responders think about not only the people they served but also their own families, their own lives, and their communities. For example, a personal family member who is a law enforcement officer responded to a fatal auto accident that involved teenagers. When he left the scene, he called his just-turned-13 teenage daughter to tell her he loved her. She answered the phone in a typical teenage fashion with a brisk “What do you want, Dad? I’m busy!” That was what he needed to hear at that moment, to know that his sassy, charming, sweet, sarcastic daughter was just fine. She was still there and would be there when he got home. That short interaction between dad and daughter helped to put his experience of managing a scene with the bodies of young people into perspective. He had great empathy and compassion for the parents who had lost children, but he also knew it was not his loss. He knew he had done his best that day, but the memory would stay with him forever. Being able to find perspective and balance in professional and personal life is an important factor in managing the emotions that come with any experience, whether acknowledged or not.
Some experiences have more impact than others, such as “critical incidents.” The World Health Organization (WHO) describes a critical incident as:
[A]n event out of the range of normal experience – one which is sudden and unexpected, involves the perception of a threat to life and can include elements of physical and emotional loss. Often such events are sufficiently disturbing to overwhelm, or threaten to overwhelm, a person’s coping capacity. Most people would be severely shaken by a critical incident but are likely to recover from its impact with appropriate support.
A definition used in International Critical Incident Stress Foundation training presentations adds the elements of “sudden, out of the ordinary, perceived as life-threatening to someone you know or involves children.” Others would add events that include having to witness or experience tragedy, death, serious injuries, and other threatening situations. The definitions can vary, but all include witnessing or being a part of an emotionally overwhelming event, even if the emotional reaction does not come until later.
Most people who experience a critical event will have some type of reaction within 30 days. Some resources say that can be as high as 85%. Nevertheless, long-term impacts can be mitigated with support and understanding from others and themselves. Some responders tend to second-guess themselves later about what they did or could have done differently. They can blame themselves with thoughts of “I coulda, or I shoulda, or If I woulda done [fill in the blank], things would be different.” The reality is that, despite the differences, there are no guarantees that the outcome would not have been the same. Many programs and services are available to help manage these reactions, and the simple acknowledgment in the workplace that the job can be emotionally difficult is helpful.
Responding to Mass Casualty Events
Those who respond to catastrophic events such as 9/11, the Boston Marathon bombing, school shootings, or COVID-19 – especially in the early days when there was so much loss of life – face additional challenges. The impacts of these types of events are complicated by not only the horrific experience itself but also the media attention, political climate, and human response to blame someone (and sometimes, it involves the responders or their agencies who stepped in as everyone else was running away).
When COVID-19 emerged, it was not a single local event. It was a global event, and the magnitude was such that anyone in any country could be at risk of dying and causing the death of others, including loved ones. For those who responded directly to the sick and dying people – doctors, nurses, other medical staff, EMTs, and funeral home workers – it was a frightening, new experience. For the first time in their careers, those front-line personnel – despite years of training and experience – may not have been able to change the outcomes for those infected. However, in the process of caring for them, they may have been putting their own lives and families at risk of illness or death. Helplessness, exhaustion, and emotionally intense situations magnified what would have been called a critical incident under the best of circumstances.
Targeted violence incidents like school shootings and the Boston Marathon bombing are naturally extreme events that leave carnage in their wake. Carnage to not only the victims and families but also the responders, who often are overwhelmed by the sheer magnitude of the event, the number of people involved, and the sights and sounds of the scene. Neuroscience researchers talk about survival chemicals that protect workers as needed to do the job. These chemicals can help responders tune out the larger scene, concentrate on what is in front of them, and perform their jobs based on training and experience, which may seem like superhuman strength and competence. However, survival chemicals that help bodies and brains confront the unimaginable go away, leaving questions about what to do next.
Much has been written about 9/11 responders and others whose lives changed forever after going to the scene of targeted violence, an active assailant, a catastrophic accident, or a destructive natural disaster response. No one is entirely immune to lingering thoughts, memories, or reactions that overwhelm the emotional and mental health systems of the individuals who respond to others’ pain and suffering. These may include an occasional memory, a flashback, or a triggered emotional reaction to a sight, sound, or smell. Fortunately, society, in general, is talking more publicly about post-traumatic stress disorder (PTSD) in responders and others exposed to sights, sounds, and experiences they run toward as others run the other way. PTSD, in its simplest form, includes intrusive thoughts or reactions that last more than 30 days. Those intrusive thoughts or reactions can last a lifetime, and a long-term plan of support to deal with them is essential.
Getting Help for Responders and Caregivers
If you or someone you know is one who steps up in roles as responders or caregivers, expect that the experience has changed who you were and made you who you are now. Make a difference to yourself and others by getting the help and support needed to manage the outcome of these experiences.
Remember that caring for others may come with a cost that can be overwhelming to both the responders and those who care about them. However, coping options and support plans can make this cost more manageable. Resources that can help educate and provide support and guidance are plentiful. The task is to find one that fits your needs and feels right. Not all are right for everyone, but here are a few to consider:
- Disaster Distress Hotline 1-800-985-5990,
- The International Critical Incident Stress Foundation,
- Substance Abuse and Mental Health Administration, and
- Make The Connection – a resource for veterans (many responders are also veterans).
Mary Schoenfeldt, Ph.D., is the board president of Green Cross Academy of Traumatology and has responded to countless disasters. She is an emergency management professional specializing in community and school crises and has a passion for disaster psychology. She is a faculty member of FEMA Emergency Management Institute, an adjunct faculty at Pierce College, and a subject matter expert for the U.S. Department of Education. She also serves clients through her consulting business. She can be reached at email@example.com.