Taking Care Of Those Who Take Care Of Us

Taking Care of Those Who Take Care of Us By Thomas A. Vaccaro My name is Thomas. I am a freshman at Mount Saint Joseph High School in Baltimore finishing the fourth quarter of the school year. As part of my English class, we were instructed to pick a question about a topic that we wanted to investigate. From that, we were to figure out a solution for the question and compile a final product as a result of our yearlong research. For my topic, I chose to investigate Post Traumatic Stress Disorder (PTSD) among Maryland’s first responders: firefighters, emergency medical services (EMS) technicians and police officers. To maximize my efforts, I narrowed my focus to the Anne Arundel and Baltimore Counties, two of the largest counties in the state of Maryland. I wanted to discover if there was anything I could do as a civilian to help my first responders. First, I consulted internet resources to find different types of treatment options. Then, I interviewed eight first responders: four police officers and four fire/ EMS personnel to judge the Critical Incident Stress Management and Debriefing (CISM, CISD, or CISMD) programs. To back up what the interviewees said, get professional opinions, and ask important questions, I interviewed Officer Steve Duley and Dr. Victor Welzant (Psy. D.). I was able to form a comfortable conclusion based on all of my research. When beginning to research PTSD on the internet, I wanted to find out what options in general were used to treat PTSD. I found that psychotherapy and medications are used in cases of PTSD. Psychotherapy ranges from group debriefing sessions to aquatic and physical therapy. It can help victims talk about their incident, work through it, and develop coping mechanisms. Drugs are also commonly prescribed to more severe cases of PTSD. Antidepressants are used as selective serotonin reuptake inhibitors, which means that they are used to numb specific neurons and restrict the uptake of serotonin. However, prescription drugs can lead to substance abuse problems among teenagers who have suffered from trauma. I found that through processes like Cognitive Behavior Restructuring (CBR) and CISMD, people can actually improve without the use of drugs. I also found a bar graph on the national average rates of suicide. This bar graph labeled first responder suicide rates higher than veterans. I found this alarming, but I decided that it proved nothing because it did not provide a credible source for its information. I found local organizations, such as “Operation: We Are Here” which is a program that works with organizations like the American Humane Society and America’s Vet Dogs to provide therapy for veterans. This foundation, however, only offers its services towards military veterans. Then I discovered the International Critical Incident Stress Foundation (ICISF) and Operation Warrior Refuge (OWR). The ICISF, based in Ellicott City, Maryland, is an international foundation that offers debriefing and group therapy sessions to anyone who is suffering from a traumatic event. It also trains other agencies in psychotherapeutic methods to use. OWR offers an extensive program that helps those afflicted cope with and overcome the symptoms of PTSD. It has program has four major steps: Reboot, Retrain, Renew, and Sustain. Their website has detailed plans and programs that are, in a word, impressive. For one of my English assignments, I wrote a comparison paper of drug use and therapy, and the ICISF and OWR. Between October, 2014 and March, 2015, I interviewed four male firefighters, three male police officers, and one female police officer. I asked them a standard set of questions that I developed and then added a few follow-up questions at the end. All of these first responders work in either Anne Arundel County or Baltimore County. I learned about the operations of their departments, how the county handles traumatic incidents, how traumatic incidents have affected them, what they did to cope with it, and what they think could be better in the PTSD/ CISMD operations. With the police officers, their answers to my questions were really similar. Each responded that they knew people who had suffered from PTSD, some who survived and some who didn’t. They were mostly aware of the procedures that follow a critical incident and what the counties and departments have to offer. I learned about the Mobile Crisis Unit (MCU). The MCU pairs a police officer with a mental health care clinician that responds to incidents at the request of the Baltimore County Police Department. The interviews with the firefighters brought up a lot of questions. Their answers to the generic questions were similar, if not the same as the police officers. But I did get to hear emotion in their responses when I asked them, “Do you think there are adequate treatment plans available to you through your job?” Firefighter Candidate #2 said: “My personal opinion ‘No!’ The State of Maryland who I work for has poor resources available when it comes to mental health issues.” I was taken aback by this statement. I asked him if he thought the plans available to him could be better and he answered, “Unsure. I feel that PTSD needs to be included in basic level training so Fire & EMS personnel are aware and then the training needs to be expanded to the company level officers so they can monitor their personnel on daily basis especially after calls that may impact them. Then take it a step further department level chief officers need to monitor calls and be ready to inquire and take action to ensure their personnel are taken care of.” This intrigued me, so I added that to the list of questions I had to ask Dr. Welzant. The rest of the firefighters also said that their critical incidents services had to be more publicized so that people could take advantage of the programs. Firefighter Candidate #3 made me think about the core part of my project. I asked him if he thought the plans available to him were sufficient enough so that everyone could recover, and he answered: “I don’t know what to call recovery.” I did not know what to define it as, either. I decided to add this question to those I would ask Dr. Welzant. Another answer that caught my attention was in Firefighter Candidate #4’s interview. I asked if he knew whether or not there were adequate treatment plans available to him through his job. He answered this question and a previous question from the interview: “I believe there are, but I’m not familiar with all of the particulars. I can add something though. The part where you asked if we were offered anything, it was after a particularly bad call where an uncle had run over his nephew on his birthday. A team did ask if they could come down to the station and provide assistance, but my fellow officers and I that were on the call talked it over ourselves. We thought we could handle the situation better if we worked it out together than if the CISMD came to the station.” This proved that group debriefing sessions do help in traumatic situations. I interviewed Officer Steve Duley, who is assigned to the Baltimore County Police Mobile Crisis Unit (MCU). In his interview, he described the debriefing process for his jurisdiction, what the MCU is and does, common treatments, and where the state government could improve in the area of PTSD. He said: “We need to educate the public so they can better understand that the counseling and help is there when they need it. Usually when people think of PTSD, they immediately think of veterans returning from war. Regular people can get PTSD from a being in an accident or losing a loved one. People just need to learn.” This backed up what the firefighter candidates had said about publicizing the help more. But in Officer Duley’s case, we also need to publicize the problem and educate the public. I asked him, “Do you think that the current treatment options for first responders are sufficient enough to help everyone recover?” He answered, “Well you can't help everybody because everyone is different. We're like the Band-Aid for therapy. We keep you together until we can get you specific help.” I like this metaphor. It reminds me of the purpose of all aid foundations: “To keep you together.” I also asked him how successful Transcendental Meditation was and if that was a legitimate option to be used as a government program. He said, “I have heard of using Transcendental Meditation (TM) as a coping strategy as well, but to truly teach TM it can cost as much as $2500 and that is simply money that governments do not have to spend per officer who are suffering from PTSD. For more severe cases of PTSD in police officers, psychological counseling services can be afforded through the medical insurance each employee has in his or her benefits packages.” The last interview I conducted was with Dr. Victor Welzant, (Psy. D.) a leading expert in the field of PTSD. He is a past member of the Board of Directors and is currently the Director of Education and Training for the ICISF. Dr. Welzant also served as the director of Acute Trauma Services at Sheppard Pratt Health System, and served in Sheppard Pratt’s Trauma Disorders Program. He also holds a private psychotherapy practice in Towson, Maryland, which is where I conducted the interview on April 9, 2015. He answered all of my questions with long, complete answers. He explained what the ICISF does, where it offers its services, rudimentary facts about PTSD, what support systems and treatments he recommends, and what the state does and can do. I also asked him if the plan Firefighter Candidate #2 suggested would be beneficial, and if it would help prevent PTSD and combat it early on. He said, “Absolutely. He is absolutely right.” He also said that it would cost little to equip recruits with basic CISMD training. During the course of the interview, he told me that there is a growing percentage of PTSD cases among veterans who join first responder services. “I think especially recently as people are coming back, and have been back for a while, you see it. When people first come back, sometimes they’re really okay. They don’t have the symptoms. As they are back for while they re-adjust, hit a couple of road blocks to adjusting, sometimes that is when it starts. You see people six to nine months later who were fine the first six months start to have PTSD symptoms half a year in.” As my interview with Dr. Welzant drew to a close, I asked him: “Can you think of a program or agency that responds to critical incidents that has a successful program?” He replied: “Sure. There are a lot of departments even in this area who have really good programs. Baltimore County Fire Department, Baltimore City has one of the oldest, Baltimore City Fire, they have an extremely successful program and they have been doing it a long time and they have handled some really awful situations. They are also a very experienced team. Baltimore County has the fire side and the police side. The police side has just been taken over by mobile crises, which is right downstairs. They have started doing that but I haven’t talked to them recently. Howard County Fire Department has one of the longest running programs in Maryland and that is one of the founders, Dr. Jeff Mitchell, critical management, he started that team. Carroll County has a team that is for both fire and police. Harford County has Sherriff’s Department team and a fire department team. All of those are really successful programs and most of those have been around at least 10 years. We are lucky in this area. We have a lot of good teams that can help each other out.” “We are lucky in this area.” This was convincing proof that my project, in its current proposal at the point, needed some slight adjustments. My last question to Dr. Welzant was as follows: “What would you define as recovery from PTSD?” His response was one that I think is the most important part of my research, and one that I will go back and share with Firefighter Candidate #3: “I think that one measure of recovery is that you are able to think about the event without being triggered, that is without that instant “fight or flight” reaction. You might still get upset, because it was a horrible event, but it doesn’t take over when you think about it. You don’t have a flashback, you can think about it when you want to, but also not think about it when you don’t want to. That control over how you think about it is one measure. The other measure that is really important is sleep. Believe it or not, that is one of the stress reactions that really is a good measure of recovery. When your sleep gets back to normal, usually that is a good sign. When that startle response gets back to normal, that is another good measure, but really the best measure is when the person feels they have dealt with it in the way that they need to. Because everybody is going to be a bit different with what they need. So the best measure is to ask the person, “Do you feel like you are okay with where it is at?” You look in to the mental health side and think what would you look for? I would say being able to talk about it when you want to and put it away when you need to is important. Sleep and that startle response. Those three together seem to be good measures of you getting back to where you were.” Getting to those points is crucial in any plan. My challenge was putting together a plan where people could get to those points in accordance with their work schedule and the department. The time I spent talking with Dr. Welzant and the answers he provided helped me understand the state of the government’s programs and as well as what they achieve. In conclusion, I discovered a lot about PTSD and the operations of Anne Arundel County and Baltimore County. With all of the notes I gathered, I have made my final product which is a plan to help combat PTSD. I do not recommend the use drugs in my plan because most trial tests have been proven not to work over psychotherapy. According to Britain’s National Institute for Clinical Excellence (NICE), psychotherapy is more successful than antidepressants. The use of antidepressants is not recommended. However, I realize that people do suffer severely, and cannot control PTSD on their own. I also recognize that price is always of concern when it comes to new plans. However, employee salaries are any government budget’s highest cost, so making sure that people are mentally able to perform their job is of the utmost importance. PTSD training and services would be a small price to pay. My plan: In all proceeding first responder entry or “recruit” classes, a rudimentary CISMD is to be included in the basic training, and should be taught by the training personnel at the ICISF. This is to help innovate and streamline the identification and diagnosis of PTSD symptoms. Calls for service should be monitored by supervisors at all times, and in the case of calls that could have a traumatic impact on first responders, supervisors are to respond to evaluate the need for an intervention team, similar to the MCU in Baltimore County. Annual or quarterly checkups should be allotted as well, to evaluate morale and the state of mind of the department. The first responder’s therapeutic needs should be paid for by the employee’s health insurance. If prescription drugs are prescribed, the employee needs to disclose it to a supervisor as some prescription drugs have powerful side effects and could impact the employee’s ability to perform effectively. If it is concluded that drug use is necessary and the first responder may have effects that prevent their ability to perform the job with the full attention required, the first responder should be put in a “non-line” function. In the case of a diagnosis of PTSD, the victim should be allowed to use sick leave according to personnel procedures in a particular police or fire department. If leave is taken, the victim should be checked on regularly by their supervisor and evaluated by a mental health professional to make sure that the first responder is fit for duty upon return.

Taking Care of Those Who Take Care of Us

Taking Care of Those Who Take Care of Us

By Thomas A. Vaccaro

My name is Thomas. I am a freshman at Mount Saint Joseph High School in Baltimore finishing the fourth quarter of the school year. As part of my English class, we were instructed to pick a question about a topic that we wanted to investigate. From that, we were to figure out a solution for the question and compile a final product as a result of our yearlong research. For my topic, I chose to investigate Post Traumatic Stress Disorder (PTSD) among Maryland's first responders: firefighters, emergency medical services (EMS) technicians and police officers. To maximize my efforts, I narrowed my focus to the Anne Arundel and Baltimore Counties, two of the largest counties in the state of Maryland. I wanted to discover if there was anything I could do as a civilian to help my first responders. First, I consulted internet resources to find different types of treatment options. Then, I interviewed eight first responders: four police officers and four fire/ EMS personnel to judge the Critical Incident Stress Management and Debriefing (CISM, CISD, or CISMD) programs. To back up what the interviewees said, get professional opinions, and ask important questions, I interviewed Officer Steve Duley and Dr. Victor Welzant (Psy. D.). I was able to form a comfortable conclusion based on all of my research.

When beginning to research PTSD on the internet, I wanted to find out what options in general were used to treat PTSD. I found that psychotherapy and medications are used in cases of PTSD. Psychotherapy ranges from group debriefing sessions to aquatic and physical therapy. It can help victims talk about their incident, work through it, and develop coping mechanisms. Drugs are also commonly prescribed to more severe cases of PTSD. Antidepressants are used as selective serotonin reuptake inhibitors, which means that they are used to numb specific neurons and restrict the uptake of serotonin. However, prescription drugs can lead to substance abuse problems among teenagers who have suffered from trauma. I found that through processes like Cognitive Behavior Restructuring (CBR) and CISMD, people can actually improve without the use of drugs. I also found a bar graph on the national average rates of suicide. This bar graph labeled first responder suicide rates higher than veterans. I found this alarming, but I decided that it proved nothing because it did not provide a credible source for its information. I found local organizations, such as "Operation: We Are Here" which is a program that works with organizations like the American Humane Society and America's Vet Dogs to provide therapy for veterans. This foundation, however, only offers its services towards military veterans. Then I discovered the International Critical Incident Stress Foundation (ICISF) and Operation Warrior Refuge (OWR). The ICISF, based in Ellicott City, Maryland, is an international foundation that offers debriefing and group therapy sessions to anyone who is suffering from a traumatic event. It also trains other agencies in psychotherapeutic methods to use. OWR offers an extensive program that helps those afflicted cope with and overcome the symptoms of PTSD. It has program has four major steps: Reboot, Retrain, Renew, and Sustain. Their website has detailed plans and programs that are, in a word, impressive. For one of my English assignments, I wrote a comparison paper of drug use and therapy, and the ICISF and OWR.

Between October, 2014 and March, 2015, I interviewed four male firefighters, three male police officers, and one female police officer. I asked them a standard set of questions that I developed and then added a few follow-up questions at the end. All of these first responders work in either Anne Arundel County or Baltimore County. I learned about the operations of their departments, how the county handles traumatic incidents, how traumatic incidents have affected them, what they did to cope with it, and what they think could be better in the PTSD/ CISMD operations. With the police officers, their answers to my questions were really similar. Each responded that they knew people who had suffered from PTSD, some who survived and some who didn't. They were mostly aware of the procedures that follow a critical incident and what the counties and departments have to offer. I learned about the Mobile Crisis Unit (MCU). The MCU pairs a police officer with a mental health care clinician that responds to incidents at the request of the Baltimore County Police Department.

The interviews with the firefighters brought up a lot of questions. Their answers to the generic questions were similar, if not the same as the police officers. But I did get to hear emotion in their responses when I asked them, "Do you think there are adequate treatment plans available to you through your job?" Firefighter Candidate #2 said: "My personal opinion 'No!' The State of Maryland who I work for has poor resources available when it comes to mental health issues." I was taken aback by this statement. I asked him if he thought the plans available to him could be better and he answered, "Unsure. I feel that PTSD needs to be included in basic level training so Fire & EMS personnel are aware and then the training needs to be expanded to the company level officers so they can monitor their personnel on daily basis especially after calls that may impact them. Then take it a step further department level chief officers need to monitor calls and be ready to inquire and take action to ensure their personnel are taken care of." This intrigued me, so I added that to the list of questions I had to ask Dr. Welzant. The rest of the firefighters also said that their critical incidents services had to be more publicized so that people could take advantage of the programs. Firefighter Candidate #3 made me think about the core part of my project. I asked him if he thought the plans available to him were sufficient enough so that everyone could recover, and he answered: "I don't know what to call recovery." I did not know what to define it as, either. I decided to add this question to those I would ask Dr. Welzant. Another answer that caught my attention was in Firefighter Candidate #4's interview. I asked if he knew whether or not there were adequate treatment plans available to him through his job. He answered this question and a previous question from the interview: "I believe there are, but I'm not familiar with all of the particulars. I can add something though. The part where you asked if we were offered anything, it was after a particularly bad call where an uncle had run over his nephew on his birthday. A team did ask if they could come down to the station and provide assistance, but my fellow officers and I that were on the call talked it over ourselves. We thought we could handle the situation better if we worked it out together than if the CISMD came to the station." This proved that group debriefing sessions do help in traumatic situations.

I interviewed Officer Steve Duley, who is assigned to the Baltimore County Police Mobile Crisis Unit (MCU). In his interview, he described the debriefing process for his jurisdiction, what the MCU is and does, common treatments, and where the state government could improve in the area of PTSD. He said: "We need to educate the public so they can better understand that the counseling and help is there when they need it. Usually when people think of PTSD, they immediately think of veterans returning from war. Regular people can get PTSD from a being in an accident or losing a loved one. People just need to learn." This backed up what the firefighter candidates had said about publicizing the help more. But in Officer Duley's case, we also need to publicize the problem and educate the public. I asked him, "Do you think that the current treatment options for first responders are sufficient enough to help everyone recover?" He answered, "Well you can't help everybody because everyone is different. We're like the Band-Aid for therapy. We keep you together until we can get you specific help." I like this metaphor. It reminds me of the purpose of all aid foundations: "To keep you together." I also asked him how successful Transcendental Meditation was and if that was a legitimate option to be used as a government program. He said, "I have heard of using Transcendental Meditation (TM) as a coping strategy as well, but to truly teach TM it can cost as much as $2500 and that is simply money that governments do not have to spend per officer who are suffering from PTSD. For more severe cases of PTSD in police officers, psychological counseling services can be afforded through the medical insurance each employee has in his or her benefits packages."

The last interview I conducted was with Dr. Victor Welzant, (Psy. D.) a leading expert in the field of PTSD. He is a past member of the Board of Directors and is currently the Director of Education and Training for the ICISF. Dr. Welzant also served as the director of Acute Trauma Services at Sheppard Pratt Health System, and served in Sheppard Pratt's Trauma Disorders Program. He also holds a private psychotherapy practice in Towson, Maryland, which is where I conducted the interview on April 9, 2015. He answered all of my questions with long, complete answers. He explained what the ICISF does, where it offers its services, rudimentary facts about PTSD, what support systems and treatments he recommends, and what the state does and can do. I also asked him if the plan Firefighter Candidate #2 suggested would be beneficial, and if it would help prevent PTSD and combat it early on. He said, "Absolutely. He is absolutely right." He also said that it would cost little to equip recruits with basic CISMD training. During the course of the interview, he told me that there is a growing percentage of PTSD cases among veterans who join first responder services. "I think especially recently as people are coming back, and have been back for a while, you see it. When people first come back, sometimes they're really okay. They don't have the symptoms. As they are back for while they re-adjust, hit a couple of road blocks to adjusting, sometimes that is when it starts. You see people six to nine months later who were fine the first six months start to have PTSD symptoms half a year in."

As my interview with Dr. Welzant drew to a close, I asked him: "Can you think of a program or agency that responds to critical incidents that has a successful program?" He replied: "Sure. There are a lot of departments even in this area who have really good programs. Baltimore County Fire Department, Baltimore City has one of the oldest, Baltimore City Fire, they have an extremely successful program and they have been doing it a long time and they have handled some really awful situations. They are also a very experienced team. Baltimore County has the fire side and the police side. The police side has just been taken over by mobile crises, which is right downstairs. They have started doing that but I haven't talked to them recently. Howard County Fire Department has one of the longest running programs in Maryland and that is one of the founders, Dr. Jeff Mitchell, critical management, he started that team. Carroll County has a team that is for both fire and police. Harford County has Sherriff's Department team and a fire department team. All of those are really successful programs and most of those have been around at least 10 years. We are lucky in this area. We have a lot of good teams that can help each other out." "We are lucky in this area." This was convincing proof that my project, in its current proposal at the point, needed some slight adjustments.

My last question to Dr. Welzant was as follows: "What would you define as recovery from PTSD?" His response was one that I think is the most important part of my research, and one that I will go back and share with Firefighter Candidate #3: "I think that one measure of recovery is that you are able to think about the event without being triggered, that is without that instant "fight or flight" reaction. You might still get upset, because it was a horrible event, but it doesn't take over when you think about it. You don't have a flashback, you can think about it when you want to, but also not think about it when you don't want to. That control over how you think about it is one measure. The other measure that is really important is sleep. Believe it or not, that is one of the stress reactions that really is a good measure of recovery. When your sleep gets back to normal, usually that is a good sign. When that startle response gets back to normal, that is another good measure, but really the best measure is when the person feels they have dealt with it in the way that they need to. Because everybody is going to be a bit different with what they need. So the best measure is to ask the person, "Do you feel like you are okay with where it is at?" You look in to the mental health side and think what would you look for? I would say being able to talk about it when you want to and put it away when you need to is important. Sleep and that startle response. Those three together seem to be good measures of you getting back to where you were." Getting to those points is crucial in any plan. My challenge was putting together a plan where people could get to those points in accordance with their work schedule and the department. The time I spent talking with Dr. Welzant and the answers he provided helped me understand the state of the government's programs and as well as what they achieve.

In conclusion, I discovered a lot about PTSD and the operations of Anne Arundel County and Baltimore County. With all of the notes I gathered, I have made my final product which is a plan to help combat PTSD. I do not recommend the use drugs in my plan because most trial tests have been proven not to work over psychotherapy. According to Britain's National Institute for Clinical Excellence (NICE), psychotherapy is more successful than antidepressants. The use of antidepressants is not recommended. However, I realize that people do suffer severely, and cannot control PTSD on their own. I also recognize that price is always of concern when it comes to new plans. However, employee salaries are any government budget's highest cost, so making sure that people are mentally able to perform their job is of the utmost importance. PTSD training and services would be a small price to pay.

My plan:

In all proceeding first responder entry or "recruit" classes, a rudimentary CISMD is to be included in the basic training, and should be taught by the training personnel at the ICISF. This is to help innovate and streamline the identification and diagnosis of PTSD symptoms. Calls for service should be monitored by supervisors at all times, and in the case of calls that could have a traumatic impact on first responders, supervisors are to respond to evaluate the need for an intervention team, similar to the MCU in Baltimore County. Annual or quarterly checkups should be allotted as well, to evaluate morale and the state of mind of the department.

The first responder's therapeutic needs should be paid for by the employee's health insurance. If prescription drugs are prescribed, the employee needs to disclose it to a supervisor as some prescription drugs have powerful side effects and could impact the employee's ability to perform effectively. If it is concluded that drug use is necessary and the first responder may have effects that prevent their ability to perform the job with the full attention required, the first responder should be put in a "non-line" function.

In the case of a diagnosis of PTSD, the victim should be allowed to use sick leave according to personnel procedures in a particular police or fire department. If leave is taken, the victim should be checked on regularly by their supervisor and evaluated by a mental health professional to make sure that the first responder is fit for duty upon return.