Psychology

This paper will analyze the literature available regarding first responders and subsequent medical health problems or posttraumatic stress.  The literature and articles will be reviewed and analyzed during the process. 

Chopko, B., Schwartz, R. (2009). The relation between mindfulness and posttraumatic growth  A study of first responders to trauma-inducing incidents.  Journal of Mental Health Counseling, volume 31, (4), 363-376.

This article presents evidence on rescue workers respond when given negative information, rather than the positive.  The study looked at the relationship between mindfulness (Using the Kentucky Inventory) and posttraumatic growth (using the PTG Inventory).  The study used 181 police officers to gain the results. Multiple regress analysis results of the study indicated that the movement towards spiritual growth was correlated positively, and the acceptance of non-judgmental events was correlated negatively with posttraumatic growth.  The article explains how this information is valuable in mental health counseling. 

Analysis
An analysis of the article finds it lacking in several areas.  For instance, there is not significant emphasis or focus on the police officers themselves.  The article does not study the relationship of spiritual growth as the officers become increasing exposed to trauma.  The article does not answer the question as to whether the trauma began the spiritual outreach which led to the posttraumatic growth outcome.  In addition, the sample was too convenient.  Readers could not determine if the officers in the study were any different to those that did not participate.  Therefore, care needs to be used when quoting such results.  Another glaring limitation of the article and study was that there was no analysis of how religion, race, or gender correlated in the posttraumatic growth study.  Also, there was no discussion of how coping skills, social support, or any other psychosocial issue and how the areas related to posttraumatic stress issues.  An area not addressed should tell us if certain types of traumatic incidents relate more or less to the posttraumatic growth.

Heglund, J. (2009). Helping first responders withstand traumatic experiences. FBI Law Enforcement Bulletin, 78, (9), 1-4.

This article tells of the West Coast Post-Trauma Retreat in San Rafael, California.  The goal of the retreat is to help professionals who suffer from post-traumatic stress syndrome to regain control of their lives that have been adversely affected from the trauma experienced.  The hope of the program, as detailed in the article, is to get the professional back on his or her feet with a fresh perspective regarding their experience and the resulting stress.  The article explains how each participant in the retreat process is matched up with a clinician to assist them as they work through the process.  The center also offers in-house chapel services, as well as alcoholics anonymous meetings, the article explains.  The article explains how the retreat assists the clients in understanding their reactions to the things they experienced.  It presents a list of the warning signs to give first responders an idea of characteristics that show they suffer from the affects of trauma. 

Analysis
Although the article discusses in detail the therapeutic and educational program of the program, it does not present any data supporting the need for such a program.  The article could have been enhanced if it had isolated on one person and provided their story and how the retreat had turned that persons life around.  The article, however, was informative providing the details of the California program.  Although the article gives a chart detailing the signs of potential posttraumatic stress, it does not give detailed examples that an individual could identify with.  Readers are left wondering if this is the only program of its type in the country.  If other such programs exist throughout the nation, it would have been a positive step to explain that to readers who may want help and live in Florida.  Additionally, the article does not tell readers if there is a cost to the program, or if it is covered by insurance, or if it is paid for by the employers.  Therefore, there was much information lacking in the bulletin.

Reissman, D., Howard, J. (2008). Responder safety and health  Preparing for future disasters. Mount Sinai Journal of Medicine, 75, (2), 135-141.

This article presents an informative review of the lessons that have been learned since the 911 disaster regarding the management of the health and safety of recovery workers. The article looks at the disaster response, recovery and cleanup after the disaster.  The article looks at the ongoing health burdens from a health and safety worker perspective.  The article looks at the changes in infrastructure, response planning and the resources to protect first responders in the future.  The article stresses the need for planning and knowledge of how to use equipment in the event of another tragedy.  The planning consists of assurances that the first responders are fit to engage in such activity.  It discusses the need to anticipate hazards in an emergency and encourages responders to consider all the possible scenarios that might occur.  The article completely reviews both the tragedies at the World Trade Center and Katrina.  It discusses the lessons learned from both disasters.

Analysis
This is an extremely good article filled with what has been learned since the day of September 11, 2001.  The article admits that in the desire to reach people in trouble, workers emphasized speed, rather than protecting themselves from hazards.  This cost the lives of many fire department personnel at the World Trade Center.  However, with the admission of the problem, no real solution was suggested.  The article recommends joint planning and exercises to learn how to meet disaster challenges head-on, yet does not suggest that any one agency be responsible for organizing and insuring progress in this area.  The integrated disaster planning makes good sense, but unless headed up by the Office of Homeland Security, then the matter would continue to be disorganized and ill prepared.  All in all, the article is worth the attention of first responders and caregivers alike.

Robbers, M., Jenkins, J. (2005). Symptomatology of post-traumatic stress disorder among first responders to the Pentagon on 911 A preliminary analysis of Arlington County first responders. Police Practice and Research, 6, (3), 235-249.

This article examines the psychological impact that the attacks of 911 had on the responders who arrived at the Pentagon.  The article details a study performed on Arlington County first responders.  The results indicated that one-third of the officers who responded immediately to the attack were suffering from some form of post-traumatic stress disorder.  The article provides a lengthy background on post-traumatic stress disorder and a review of how law enforcement officers across the nation suffer with the problem.  Three main issues are dealt with in the article.  First, the psychological impact of 911 is discussed.  Second, the degree of post-traumatic stress among first responders is reviewed.  Thirdly, discussion continues as to if there is any chance of moderation among those suffering from the disorder with the passage of time.

Analysis
The problem with this article and subsequent study is that is focuses on too small a group to get a good read as to the severity of post-traumatic stress among those first responders to the Pentagon sight.  Although, researchers claim that they examined race in their study, there does not appear to be any evidence that gender was studied.  Apparently, researchers also failed to take the age of the respondents into consideration in the study.  Since the number of those suffering from the disorder is so low, one asks the question as to why some first responders are affected and others are not.  The article does not indicate what form of debriefing the first responders received after the disaster.  It also does not indicate if any of the responders sought counsel from clergy or other professionals after the attacks.  Therefore, the article leaves the reader asking more questions than he or she gets answered.

Enright, P., Skloot, R. (2008). Standardization of Spirometry in assessment of responders following man-made disasters World Trade Center Worker and Volunteer Medical Screening Program.  Mount Sinai Journal of Medicine, 75, (2), 109-114.

This article has to do with testing completed on first responders with the use of Spirometry.  Spirometry is a pulmonary functioning testing procedure that screens for diseases of the lungs.  The instrument was used to measure the severity of lung deterioration from exposure to damaging fumes and dust.  This article describes the approach that is used in an effort to minimize the differences between the various institutions that are treating first responders of the World Trade Center disaster.  The instrument quickly diagnosed first responders with differing degrees of lung disease.  The article explains how smoke, dust and fumes can cause serious lung problems that potentially could cause the loss of lung function due to the inflammation of the individuals airway.  In October 2001, the report indicates that more than 1,000 first responders had five minute Spirometry tests.  Half of the tests provided evidence of abnormality in lung function.

Analysis
The article provided a wealth of information regarding the use of Spirometry in determining debilitating lung function.  The article, however, did not explain how different results coming from the same lab could vary depending on the pulmonary specialist doing the testing.  Additionally, the article when testing the first responders did not consider previous illness or lung impairment.  For instance, the first responder may have COPD, asthma, or may be a smoker.  Also, there was no baseline used in the study and no way to measure pre-exposure results against post-exposure.  The article, in general, presents an excellent overview, however, in the growing screening programs used for first responders.  However, the article does not recommend associated follow-up for individuals suffering from lung disease.  The article does give quality results to other scientists and researchers who study post-disaster issues and care for first responders.

Ko, S., Ford, J., Kassam-Adams, N., Layne, C., Berkowitz, S., Wilson, C., Wong, M., Bryer, M. (2008). Creating Trauma-Informed Systems Child Welfare, Education, first responders, health care, juvenile justice. Professional Psychology  Research and Practice, 39, (4), 396-404.

This article has to do with treating children who have been traumatized.  It describes the federally funded national effort to assist welfare, teachers, health care, justice personnel and first responders in addressing the impact of trauma on children.  The article does not deal with the suffering of the first responder.

Moody, R., Akram, M., Dickson, E., Ih, C. (2007). In vitro dermal absorption of Methylsalicylate, Ethyl Parathion, and Malathion  First responders safety. Toxicology and Environmental Health, 70, (12), 985-999.

This article deals with the skin absorption research that has been done since the 911 attacks at the World Trade Center in New York.  Research has been focusing on the protection and preparedness of those officials first on the scene of a disaster.  This article provides a report of the reaction of the first responder to chemical, radiological, biological, and other nuclear events.  First responders are likely to be exposed through their skin to such chemicals from terrorists packages or devices or from contaminated building and structures.  The study investigated dermal absorption of three different chemicals normally used in chemical warfare.  The study results indicated that the chemicals quickly were absorbed by the skin even if washed thoroughly within a 30 minute period.

Analysis
This article was very impersonal only presenting facts and statistics regarding the absorption of dangerous chemicals by the first responder.  The article, however, offers no suggestions as to how to keep from getting exposed to the chemicals in light of the nature of the job.  The article, also, does not present alternatives as to what a first responder should do when they are exposed.  One main concern with this article and study is that it was not tested on a living human being.  Skin was garnered for the study from a plastic surgeon.  There was no detail as to the skin condition, type, or even race.  Therefore, there is no factor that would explain if all first responders would be in the same danger if exposed to the mixture.

Duarte, C., Hoven, C., Ping, W., Fan, B., Cotel, S., Mandell, D., Nagasawa, M., Balaban, V., Wernikoff, L. (2006). Posttraumatic stress in children with first responders in their family. Journal of Traumatic Stress, 193, (2), 301-306.

This article presents a discussion and study of children when exposed to high levels of the occupational stress of their parents.  The study indicates that after the attacks of 911, many children in first responder families became traumatized.  The study used a sample of children in the New York City schools.  The results of the study stated that children with the first responder in the family had a high degree of posttraumatic stress disorder.  The article discussed the fact that 13 percent of first responders get posttraumatic stress disorder.  Their children may, after being in close contact with the first responder, may get posttraumatic symptomatology by way of secondary translation.  In fact, the report tells readers that parental psychological behavior is a predictor of children and their mental health issues.  The report stated that the emergency management technician, or EMT, suffers from the highest degree of posttraumatic stress disorder.

Analysis
The article is helpful as it relays a study that if confirmed, would support the need to monitor and support the children of first responders, especially the EMTs.  A problem with the study in the article is that it uses a very small sample size.  The study does not look into the life of the EMT.  It does not indicate whether he or she has a more difficult work schedule, less training, or little opportunity to get help for posttraumatic stress.  The article does not indicate whether any type of assistance is available for the first responders employed by New York City or private firms involved in handling health care crises.  The article also does not look into how many first responders are in the family of the child.  Also, the report does not indicate the relationship between the child and the first responder.  For instance, a childs father may be a first responder, but the child may not see the father except on weekends and might live with the mother.  Additionally, the precision of the results may be impaired by the differences in the sizes of the groups of first responders analyzed.  However, the focus on getting help for the children of first responders is an admirable goal for the researchers involved in this study analyzed in the article.

Abatemarco, A., Beckley, J., Boran, M., Robson, M. (2007) Assessing and improving bioterrorism preparedness among first responders. Journal of Environmental Health, 69, (6), 16-23.

This article details a study conducted on the training of first responders in the use of respiratory equipment.  After 911 individuals recognized the need for respiratory devices for protection.  The study detailed in this article was to find out the prior knowledge of emergency workers when it comes to bioterrorism and to build more knowledge to be ready should another attack occur.  The idea of the study was to determine if the train the trainer program was an effective means for first responders to gain knowledge about the N-100 respirators.  The program was deemed effective to prepare public health officials in disaster preparedness.  With the advent of SARS, anthrax scares, and 911, there is more need for first responders to wear respiratory protective devices.  First responders need to maintain their own health while caring for those in greater need.  The study occurred in Hunterdon County, New Jersey.  The goal was to train and educate on the N-100 face mask. 

Analysis
Although the article presents some important information, the results of the study outlined are questionable.  Researchers admit that they did not get the kind of results that they anticipated.  The only reason researchers can give for that fact is that people are more knowledgeable about respiratory needs and face masks than they realized.  Ironically, the group of public health officials who participated in the study were not model subjects.  Forty-two percent of the participants involved in testing the respiratory devices were smokers.  Sixty-eight of them were considered obese.  It seems illogical to test respiratory equipment on unfit subjects.  It is difficult to ascertain whether the respiratory device was failing, or the individual.  There also was no information given on what to do if the equipment became contaminated.  Therefore, more data is needed to determine the effectiveness of respiratory equipment for first responders in a disaster.

Grover, W., Ramani, R., Radomsky, M., Flick, J. (2004). Protecting first responders. Professional Safety, 49, (11), 31-41.

This article evaluates a study on the effectiveness of government guidelines presented to first responders at the site of the World Trade Center and Pentagon attacks.  It posts the response evaluation of how adequate equipment and procedures were and how to identify issues and insure that the problems experienced were corrected.  The article discusses the World Trade Center and Pentagon attacks that were similar in the scale, duration, and hazards on site.  The article discusses the fact that in these two attacks, the role of the first responder was increased to include the exposure to the different hazards found in fumes, dust, and contaminants.  The article tells how these originally responders were not trained or equipped for a disaster the size and scope of the Pentagon or World Trade Center attacks.  The article, therefore, outlines the pros and cons of the equipment used, including respiratory equipment, and how it could hamper other means of rescue equipment.  For instance, although the respiratory equipment may help the responder to breath, it also may make it more difficult for communication.  The goal of the project discussed was to collect, and categorize all guidelines available regarding emergency equipment.  The idea is to prepare a reference type of document that can identify problems areas and shortcomings in the use of emergency equipment.  The study indicated that adequate guidelines were available to list head, hearing, foot, hand, respiratory, faceeye protection.  However, there were no guidelines covering the problem of falling by first responders. 

Analysis
It was not clear from the study and article as to whether or not the lack of adequate protection for falls indicated a weakness in the emergency guidelines and plans, or if it was problem just associated with the disaster location itself.  The debris and rubble found at the sites make falling a difficult aspect to guard against.  One issue with the article is that it did not include all documents that were passed out after the twin disasters in its analysis.  Also, creation of these guidelines does not mean that the information will be distributed to the emergency responders.  It is a good thing to provide directives and information regarding the different kinds of equipment, but it does not do anything to control the exposure to hazardous chemicals during an attack.  The article does not offer information as to if there has been training on the emergency equipment since the attacks.  If workers are not trained adequately, there will be considerable injury just in the misuse of the equipment.  The article also did not discuss how to distribute equipment or how to maintain its appropriate use.  This article remains more effective than the article by Abatemarco, Beckley, Boran and Robson, in that it looks at the problem from a larger perspective.  However, neither article meets the challenges to insure that first responders are adequately prepared to do their jobs.  Neither article explains the first steps should a hazardous material be suspected, how to distribute equipment, and how to clean up after the incident.

Bills, C., Levy, N., Sharma, V., Charney, D., Herbert, R., Moline, J., Katz, C. (2008). Mental health of workers and volunteers responding to the events of 911 Review of the literature. Mount Sinai Journal of Medicine, 75, (2), 115-127.

This article presents information about a study conducted on all of the literature measuring the mental health of workers at any one of the September 11 attack sites.  A total of 25 articles were studied.  The articles that were examined reveal varying degrees of symptomatology of mental health problems, and whether or not mental health services were acquired.  The study detailed in this article presented the mental health needs of workers and described them as suffering from no adverse effects to needed assistance of medication.  The article explains that a disaster spreads and ends up creating a community of people that are effected.  The articles main focus is on the care that these people needed in the aftermath of the tragedy.  Some of these people were exposed to ongoing and severe trauma.  Some of the first responders lost co-workers, friends, and even helped to search for the loved ones that others lost.  It is estimated by the articles data that more than 40,000 people worked on rescue and recovery operations at the World Trade Center, Pentagon and in Shanksville, Pennsylvania.  The purpose of the article is to examine all literature surrounding the event and determine the mental health needs within future disasters.  Researchers hope the data will provide an extensive amount of information to mitigate mental health needs in the future.  Most of the people examined through the study suffered from posttraumatic stress syndrome, posttraumatic stress disorder, severe depression, anxiety disorder, panic disorder or drug and alcohol abuse.  The article states that outcomes discovered in the study indicated that the information varied according to procedure used by the different studies.

Analysis
The article is very informative and offers insight to the problems associated with the first responders on September 11, 2001. However, little was documented detailing whether or not the distressed worker sought help from mental health professionals.  No studies at this point have detailed the numbers of first responders who have gone for help and no outcomes have been able to be measured.  The quality of services available to the first responders was not discussed in the article.  Additionally, the article fails to recommend the type of care that a first responder on 911 might need.  Ironically, the article did state that most first responders who suffer from mental health issues do not seek care.  This makes it vitally important that the first responders on the scene of a disaster are well trained and mentally fit for the job.  Additionally, the article does explain whether those that are not seeking assistance are male or female responders.  This could be a factor in that many males are reluctant to seek help in the mental health field.  A factor to be considered is that the 25 studies outlined in the article use different forms of assessment and differing subpopulations.  This could present a disparity in the outcomes.  However, the strength of the article is that it presents a composite look at the literature on first responders from the tragic attacks on 911.

Howard, J. (2008). The 911 World Trade Center Disaster Past and Future.  Mount Sinai Journal of Medicine, 75, (2), 65-66

This was a short article indicating that the World Trade Center disaster has left its mark on first responders both mentally and physically.  According to the article fires burned at the trade center from the day of the attack until December 2001.  All of the time the fires produced dangerous smoke and dust filled with hazardous physical and chemical agents.  The article discussed how many of the early responders suffered from stress reactions to the disaster and with acute respiratory problems.  The article states that after the attacks, screening was begun on all first responders.  Treatment programs were then offered by the city and federal governments to assist with mental health or physical ailments.

Analysis
This is an extremely brief article discussing the ramifications of the 911 disasters on the first responders.  It details implicitly what the responders have dealt with on both a mental and physical basis.  The article is short on suggestions to alleviate the suffering of those first responders and does not discuss the need for better preparedness in the future.  More attention to the needs of the first responder is recommended, yet the article does not say how to meet these individuals needs.  It does not go into detail on the quality of existing literature in this area and proves inadequate except for the recollection of events.

Potera, C. (2008). Disaster response.  Mental health effects among World Trade Center rescue and recovery workers. Environmental Health Perspectives, 116, (9), 395

This short article recognizes the problems that first responders had in handling the disaster of the World Trade Center attacks.  It explained how the first responders had both airborne pollutants and psychological stress to deal with after the incident.  The article quotes a recent five-year study on the health of World Trade Center responders which indicated a lingering mental health problem among those workers.  To prepare the study researchers had 10,000 World Trade Center responders fill out a questionnaire from 10 months after the tragedy to 61 months.  Without any clinical evaluation, 11.1 percent of the responders suffered from posttraumatic stress disorder, 8.8 suffered depression, five percent experienced panic attacks, and while 62 percent of the responders indicated they had serious stress reactions to the incidents of 911. 

The author of the article does recommend continued screening for first responders and treatment if necessary.  Also, recommended is that rescue workers received medical screenings to lessen the adverse health issues related to disasters.

Analysis
The article is brief but does focus on the problem facing first responders years after the 911 experience.  The article only quotes one long-term study but does not give any attribution if the reader should want to look it up.  Other than recommending follow-up treatment for the first responders, the author of the article fails to make specific recommendations to assist the first responder in the future.

Summary
There is considerable information on the needs of the first responders who arrived at the World Trade Center and Pentagon on September 11, 2001.  Yet, there appears to be a shortage on how to prevent the first responders from experiencing the mental stress of dealing with a disaster.  The articles available offer more discussion on the events of that day, rather than giving methods for such responders to move forward with their lives and leave that day behind.  The Chopko article was the only one that studied the aspect of spiritual growth among first responders from 911.  More data on spiritual growth could prove helpful to those trying to assist the first responders through their difficulties.  There was one article, however, that did detail a retreat organized to help first responders deal with their mental health issues.  However, the program is in California, a very long way from New York City.  The article does not detail if any other such programs are available for first responders anywhere else in the country.  There was one article, by Duarte, which made people realize that the children of first responders also suffer after such a tragedy as 911.  The article, however, is short on recommendations for the children of first responders.

There is considerable literature regarding the physical health of the first responders, especially in the area of respiratory problems.  The survey indicates that more emphasis is being placed in cities across the nation, in getting first responders the equipment they need to protect themselves from harm in an emergency.  However, more application is now necessary in these areas.  Studies are important, but it is recommended that application begin soon.