It is frequently assumed, especially by the lay public, that those responding to a critical incident are protected from psychological trauma by virtue of their training and experience. Symptoms of post-traumatic stress are felt to be the unfortunate aftermath of being exposed to a catastrophe for which one is totally unprepared. For those who routinely respond to critical incidents and cases of trauma, the horrifying and tragic become somewhat commonplace. Experience has shown, however, that even for these workers, psychological trauma may occur from the stress of physical and mental overwork that occurs in a mass disaster-type situation, and/or when the worker identifies personally with a particular victim (e.g. a child victim with the age and physical characteristics of a responder's child). For most critical incident responders, such psychological trauma is acute, transient, and self-limited. The incident is subsequently related to others as a personal but matter-of-fact experience.

For some, however, the psychological trauma persists for months and even years later. In an effort to discover preexisting factors leading to the persistence of such distress in emergency service personnel, Marmar, et al, studied 322 rescue workers involved in the Loma Prieta Earthquake collapse of the I-880 Nimitz Freeway in San Francisco, CA (J. Nerv Ment Dis 187:15-23, 1999). Via questionnaires and statistical analyses, these workers were evaluated 3.5 years after the incident, a follow-up of the initial data collected 1.5 years after the freeway collapse. The authors concluded that workers with more catastrophe exposure, and those with a tendency to dissociate at the time of the incident, were more likely to have persistent symptoms of post-traumatic stress disorder (PTSD) for 3-5 years after the experience. Identifying those most likely to suffer from PTSD has implications for critical incident debriefings and subsequent psychological and pharmacologic management.

Control groups for the 1-880 Rescue Worker study consisted of responders to small scale incidents (e.g. vehicular crashes, house-fires, etc.) in San Francisco and San Diego. However, responding to a mass disaster is much different than responding to a "smaller incident" or even a series of smaller incidents. Small incidents are handled routinely and generally devoid of the salient features typical of a major catastrophe such as the crash of the commercial jet liner, a class IV hurricane or a major earthquake. Smaller incidents do not overwhelm the internal capacity of a community or an organization to adequately respond. A major incident such as mass disaster requires outside help, and with that comes interagency conflict, public and media scrutiny, and political attention along with the overwhelming stress and work. Confounding the situation of a mass disaster is the effect of the group dynamics of a large number of workers which may exacerbate, attenuate, or even ameliorate the psychological trauma. Since the environment of a mass disaster is so different, it would seem appropriate to compare responders in similar mass disasters (e.g. earthquakes, hurricanes, airplane crashes, etc.). To be sure, there will still remain significant differences, but comparisons and contrasts may be more valid and insightful.

In the TWA-800 disaster, volunteers in the Medical Examiner office were often psychologically traumatized (e.g. photographers, radiologic technicians, and dentists) by the sheer magnitude of the situation coupled with the extensive mutilation of the victims. Stress debriefings were held for both volunteers and regular medical examiner staff five weeks after the incident. A survey following stress debriefings of the 75 dental personnel who helped in the identification effort revealed 15% felt the need for further debriefing sessions. Consequently, we have began a program of desensitization for potential future volunteers (police auxiliary, dentists, clergy, psychologists, etc.). Although this may help avert acute symptoms, future studies such as that by Marmar et al, should help prevent persistence of symptoms precipitated by a major catastrophe.

Marmar, C.R., Weiss, D.S., Metzler, T.J., Delucchi, KL, Best, S.R, & Wentworth, K.A. (1999). Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. The Journal of Nervous and Mental Disease, vol. 137, no.1, pp.15-22.