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  • Print publication year: 2009
  • Online publication date: May 2010

18 - Uniformed Rescue Workers Responding to Disaster

from Part Four - Special Groups


This chapter describes the interface of mental health and disaster. The burden of mental illness for families, communities, and nations is substantial, and the mental illness that follows extreme traumatic events is part of this global burden. Accurate and real-time health surveillance information on the population rates of mental health and illness and the barriers to care are needed to address the mental and behavioral health-care needs of disaster populations. The chapter discusses the range of psychological and behavioral responses to disaster, from subsyndromal symptoms of distress, to initial behavior, distress and health risk behaviors, to the development of specific psychiatric disorders. Cognitive-behavioral psychotherapeutic interventions for children and adults with complex grief are under investigation. The chapter focuses on the complexity of modeling psychopathology after disaster-posttraumatic stress disorder (PTSD). The conceptualization of postdisaster pathology and PTSD requires a broader view across domains of suffering, altered functional capacity, and disability.


Alexander, D. A. (1993). Stress among police body handlers: A long-term follow-up. British Journal of Psychiatry, 163, 806–808.
Alexander, D. A., & Klein, S. (2001). Ambulance personnel and critical incidents: Impact of accident and emergency work on mental health and emotional well-being. British Journal of Psychiatry, 178, 76–81.
Armstrong, K., Lund, P., McWright, L., & Tichenor, V. (1995). Multi-stressor exit debriefing and the American Red Cross: The East Bay Hills fire experience. Social Work Journal, 40, 83–90.
Armstrong, K., Zatzick, D., Metzler, T., Weiss, D. S., Marmar, C. R., Garma, S., et al. (1998). Debriefing of American Red Cross personnel: Pilot study on participants’ evaluations and case examples from the 1994 Los Angeles earthquake relief operation. Social Work in Health Care, 27(1), 33–50.
Bartone, P. T., Ursano, R. J., Wright, K. M., & Ingraham, L. H. (1989). The impact of a military air disaster on the health of assistance workers: A prospective study. Journal of Nervous and Mental Disease, 177(6), 317–328.
Beaton, R., Murphy, S., Johnson, C., Pike, K., & Corneil, W. (1998). Exposure to duty-related incident stressors in urban firefighters and paramedics. Journal of Traumatic Stress, 11(4), 821–828.
Berah, E. F., Jones, H. J., & Valent, P. (1984). The experience of a mental health team involved in the early phase of a disaster. Australian and New Zealand Journal of Psychiatry, 18(4), 354–358.
Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and Posttraumatic Stress Disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.
Brunet, A., Weiss, D. S., Metzler, T. J., Best, S. R., Neylan, T. C., Rogers, C., et al. (2001). The Peritraumatic Distress Inventory: A proposed measure of PTSD criterion A2. American Journal of Psychiatry, 158(9), 1480–1485.
Bryant, R. A., & Guthrie, R. M. (2007). Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 75(5), 812–815.
Carlier, I. V. E., Lamberts, R. D., & Gersons, B. P. R. (1997). Risk factors for posttraumatic stress symptomatology in police officers: A prospective analysis. Journal of Nervous and Mental Disease, 185(8), 498–506.
CDC. (2006). Health hazard evaluation of police officers and firefighters after Hurricane Katrina – New Orleans, Louisiana, October 117–28 and November 30-December 5, 2005. MMWR Morb Mortal Wkly Rep, 55(16), 456–458.
Chang, C. M., Lee, L. C., Connor, K. M., Davidson, J. R., Jeffries, K., & Lai, T. J. (2003). Posttraumatic distress and coping strategies among rescue workers after an earthquake. Journal of Nervous and Mental Disease, 191(6), 391–398.
Chemtob, C. M., Bauer, G. B., Neller, G., & Hamada, R. (1990). Post-traumatic stress disorder among Special Forces Vietnam Veterans. Military Medicine, 155(1), 16–20.
Conlon, L., Fahy, T. J., & Conroy, R. (1999). PTSD in ambulant RTA victims: A randomized controlled trial of debriefing. Journal of Psychosomatic Research, 46(1), 37–44.
Corneil, W., Beaton, R., Murphy, S., Johnson, C., & Pike, K. (1999). Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. Journal of Occupational Health Psychology, 4(2), 131–141.
Deahl, M., & Bisson, J. I. (1995). Dealing with disasters: Does psychological debriefing work? Journal of Accident and Emergency Medicine, 12(4), 255–258.
Difede, J., Malta, L. S., Best, S., Henn-Haase, C., Metzler, T., Bryant, R., et al. (2007). A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers. Journal of Nervous and Mental Disease, 195(10), 861–865.
Dougall, A. L., Herberman, H. B., Delahanty, D. L., Inslicht, S. S., & Baum, A. (2000). Similarity of prior trauma exposure as a determinant of chronic stress responding to an airline disaster. Journal of Consulting and Clinical Psychology, 68(2), 290–295.
Duckworth, D. H. (1986). Psychological problems arising from disaster work.Stress Medicine, 2, 315–323.
Durham, T. W., McCammon, S. L., & Allison, E. J. (1985). The psychological impact of disaster on rescue personnel. Annals of Emergency Medicine, 14, 664–668.
Epstein, R. S., Fullerton, C. S., & Ursano, R. J. (1998). Posttraumatic stress disorder following an air disaster: A prospective study. American Journal of Psychiatry, 155(7), 934–938.
Ersland, S., Weisaeth, L., & Sund, A. (1989). The stress upon rescuers involved in an oil rig disaster: “Alexander L. Kielland”: 1980. Acta Psychiatrica Scandinavica, 80 (Suppl. 355), 38–49.
Foreman, C., & Eranen, L. (1999). Trauma of world policing: Peacekeeping duties. In J. M. Violanti & D. Paton (Eds.), Police trauma: Psychological aftermath of civilian combat (pp.189–200). Springfield, IL: Charles C. Thomas.
Fullerton, C. S., McCarroll, J. E., Ursano, R. J., & Wright, K. M. (1992). Psychological responses of rescue workers: Fire fighters and trauma. American Journal of Orthopsychiatry, 62(3), 371–378.
Fullerton, C. S., Ursano, R. J., & Wang, L. (2004). Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. American Journal of Psychiatry, 161(8), 1370–1376.
Gabriel, R., Ferrando, L., Corton, E. S., Mingote, C., Garcia-Camba, E., Liria, A. F., et al. (2007). Psychopathological consequences after a terrorist attack: An epidemiological study among victims, the general population, and police officers. European Psychiatry, 22(6), 339–346.
Galea, S., Vlahov, D., Resnick, H., Ahern, J., Susser, E., Gold, J., et al. (2003). Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology, 158(6), 514–524.
Gross, R., Neria, Y., Tao, X., Massa, J., Ashwell, L., Davis, K., et al. (2006). Posttraumatic Stress Disorder and journal psychological sequelae among World Trade Center clean up and recovery workers. Annals of the New York Academy of Sciences, 1071, 495–499.
Heffron, E. F. (1977). Project Outreach: Crisis intervention following natural disaster. Journal of Community Psychology, 5(2), 103–111.
Hobbs, M., Mayou, R., Harrison, B., & Worlock, P. (1996). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. British Medical Journal, 313(7070), 1438–1439.
Hodgins, G. A., Creamer, M., & Bell, R. (2001). Risk factors for posttrauma reactions in police officers: A longitudinal study. The Journal of Nervous and Mental Disease, 189(8), 541–547.
Hytten, K. (1989). Helicopter crash in water: Effects of simulator escape training. Acta Psychiatrica Scandinavia Supplement, 355, 773–78.
Jacobs, G. A. (1995). The Development of a National Plan for Disaster Mental Health. Professional Psychology: Research and Practice, 26(6), 543–549.
Jayasinghe, N., Giosan, C., Difede, J., Spielman, L., & Robin, L. (2006). Predictors of responses to psychjournalapy referral of WTC utility disaster workers. Journal of Traumatic Stress. Special issue: Innovations in trauma research methods, 19(2), 307–312.
Jones, D. R. (1985). Secondary disaster victims: The emotional effects of recovering and identifying human remains. American Journal of Psychiatry, 142(3), 303–307.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Liao, S. C., Lee, M. B., Lee, Y. J., Weng, T., Shih, F. Y., & Ma, M. H. (2002). Association of psychological distress with psychological factors in rescue workers within two months after a major earthquake. Journal of the Formosan Medical Association, 101(3), 169–176.
Liberman, A., Best, S., Metzler, T., Fagan, J., Weiss, D., & Marmar, C. (2002). Routine occupational stress and psychological distress in police. Policing: An International Journal of Police Strategies and Management, 25(2), 421–439.
Lundin, T., & Bodegard, M. (1993). The psychological impact of an earthquake on rescue workers: A follow-up study of the Swedish group of rescue workers in Armenia, 1988. Journal of Traumatic Stress, 6(1), 129–139.
Maes, M., Mylle, J., Delmeire, L., & Janca, A. (2001). Pre- and post-disaster negative life events in relation to the incidence and severity of post-traumatic stress disorder. Psychiatry Research, 105(1), 1–12.
Maguen, S., Metzler, T. J., McCaslin, S. E., Inslicht, S., Henn-Haase, C., Neylan, T. C., et al. (2007). Routine work environment stress and PTSD symptoms in police officers. The International Society for Traumatic Stress 23rd Annual Meeting. Baltimore, MD.
Marmar, C., Best, S., Metzler, T., Chemtob, C. M., Gloria, R., Killeen, A., et al. (2003). Impact of the World Trade Center attacks on New York City police officers; A prospective study, invited address. Paper presented at the 34th Annual Meeting of the International Society of Psychoneuroendocrinology, New York.
Marmar, C., Weiss, D., Metzler, T. J., & Delucchi, K. L. (1996). Characteristics of emergency services personnel related to peritraumatic dissociation during critical incident exposure. American Journal of Psychiatry, 153(7), 94–102.
Marmar, C. R., McCaslin, S. E., Metzler, T. J., Best, S., Weiss, D. S., Fagan, J., et al. (2006). Predictors of posttraumatic stress in police and journal first responders. Annals of the New York Academy of Sciences, 1071, 1–18.
Marmar, C. R., Metzler, T. J., & Otte, C. (2004). The peritraumatic distress inventory: A proposed measure of PTSD criterion A2. In J. Wilson & T. Keane (Eds.), Assessing psychological trauma and PTSD (pp.144–167). New York: Guilford Press.
Marmar, C. R., Weiss, D. S., Metzler, T. J., Delucchi, K. L., Best, S. R., & Wentworth, K. A. (1999). Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. Journal of Nervous and Mental Disease, 187(1), 15–22.
Marmar, C. R., Weiss, D. S., Metzler, T. J., Ronfeldt, H. M., & Foreman, C. (1996). Stress responses of emergency services personnel to the Loma Prieta earthquake interstate 880 freeway collapse and control traumatic incidents. Journal of Traumatic Stress, 9(1), 63–85.
Marmar, C. R., Weiss, D. S., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Kulka, R. A., et al. (1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. American Journal of Psychiatry, 151(6), 902–907.
Martin, C. A., McKean, H. E., & Veltkamp, L. J. (1986). Post-traumatic stress disorder in police and working with victims: A pilot study. Journal of Police Science and Administration, 14, 98–101.
Mayou, R. A., Ehlers, A., & Hobbs, M. (2000). Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. British Journal of Psychiatry, 176, 589–593.
McCaslin, S. E., Rogers, C. E., Metzler, T. J., Best, S. R., Weiss, D. S., Fagan, J. A., et al. (2006). The impact of personal threat on police officers’ responses to critical incident stressors. Journal of Nervous and Mental Disease, 194(8), 591–597.
McCaslin, S., Jacobs, G., Johnson-Jimenez, E., Metzler, T., & Marmar, C. (2005). How does negative life change following disaster response impact distress among Red Cross responders? Professional Psychology: Research and Practice, 36(3), 246–253.
McFarlane, A. C. (1986). Long-term psychiatric morbidity after a natural disaster. Implications for disaster planners and emergency services. Medical Journal of Australia, 145(11–12), 561–563.
McFarlane, A. C. (1988a). The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors. Journal of Nervous and Mental Disease, 176(1), 30–39.
McFarlane, A. C. (1988b). The phenomenology of posttraumatic stress disorders following a natural disaster. Journal of Nervous and Mental Disease, 176(1), 22–29.
McFarlane, A. C. (1988c). Relationship between psychiatric impairment and a natural disaster: The role of distress. Psychological Medicine, 18(1), 129–139.
McFarlane, A. C. (1989). The aetiology of post-traumatic morbidity: Predisposing, precipitating, and perpetuating factors. British Journal of Psychiatry, 154, 221–228.
McFarlane, A. C. (2000). Posttraumatic stress disorder: A model of the longitudinal course and the role of risk factors. Journal of Clinical Psychiatry, 61 (Suppl. 5), (15–20), 21–13.
McFarlane, A. C., & Papay, P. (1992). Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. Journal of Nervous and Mental Disease, 180(8), 498–504.
Morren, M., Dirkzwager, A. J., Kessels, F. J., & Yzermans, C. J. (2007). The influence of a disaster on the health of rescue workers: A longitudinal study. CMAJ, 176(9), 1279–1283.
Morren, M., Yzermans, C. J., van Nispen, R. M., & Wevers, S. J. (2005). The health of volunteer firefighters three years after a technological disaster. Journal of Occupational Health, 47(6), 523–532.
North, C. S., Tivis, L., McMillen, J. C., Pfefferbaum, B., Cox, J., Spitznagel, E. L., et al. (2002). Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. Journal of Traumatic Stress, 15(3), 171–175.
North, C. S., Tivis, L., McMillen, J. C., Pfefferbaum, B., Spitznagel, E. L., Cox, J., et al. (2002). Psychiatric disorders in rescue workers after the Oklahoma City bombing. American Journal of Psychiatry, 159(5), 857–859.
Ozer, E., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73.
Paton, D. (1994). Disaster relief work: An assessment of training effectiveness. Journal of Traumatic Stress, 7(2), 275–288.
Perrin, M. A., DiGrande, L., Wheeler, K., Thorpe, L., Farfel, M., & Brackbill, R. (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry, 164(9), 1385–1394.
Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., et al. (2002). Pilot study of secondary prevention of Posttraumatic Stress Disorder with propranolol. Biological Psychiatry, 51(2), 189–192.
Pitman, R. K., Shalev, A. Y., & Orr, S. P. (2000). Posttraumatic Stress Disorder: Emotion, conditioning, and memory. In M. D. Corbetta & M. S. Gazzaniga (Eds.), The new cognitive neurosciences (pp. 687–700). New York: Plenum Press.
Pole, N., Best, S., Weiss, D., Metzler, T., Liberman, A., Fagan, J., et al. (2001). Effects of gender and ethnicity on duty-related Posttraumatic Stress symptoms among rrban police officers. Journal of Nervous and Mental Disease, 189(7), 442–448.
Raphael, B., & Middleton, W. (1987). Mental health responses in a decade of disasters: Australia, 174–1983. Hospital and Community Psychiatry, 38(12), 1331–1337.
Raphael, B., Singh, B., Bradbury, L., & Lambert, F. (1983). Who helps the helpers? The effects of a disaster on the rescue workers. Omega: Journal of Death and Dying, 14(1), 9–20.
Renck, B., Weisaeth, L., & Skarbo, S. (2002). Stress reactions in police officers after a disaster rescue operation. Nordic Journal of Psychiatry, 56(1), 7–14.
Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. J. (1993). Prevalence of civilian trauma and Posttraumatic Stress Disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61(6), 984–991.
Robinson, H. M., Sigman, M. R., & Wilson, J. P. (1997). Duty-related stressors and PTSD symptoms in suburban police officers. Psychological Reports, 81(3, Pt. 1), 835–845.
Schell, T., Marshall, G., & Jaycox, L. (2004). All symptoms are not created equal: The prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113, 1115–1119.
Shalev, AY (1996). Stress versus traumatic stress: From acute homeostatic reactions to chronic psychopathology. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, & society (pp. 777–101). New York, NY: The Guilford Press.
Slottje, P., Twisk, J. W., Smidt, N., Huizink, A. C., Witteveen, A. B., van Mechelen, W., et al. (2007). Health-related quality of life of firefighters and police officers 8.5 years after the air disaster in Amsterdam. Quality of Life Research, 16(2), 239–252.
Slottje, P., Witteveen, A. B., Twisk, J. W., Smidt, N., Huizink, A. C., Mechelen, W. V., & Smid, T. (2008). Post-disaster physical symptoms of firefighters and police officers: Role of types of exposure and post-traumatic stress symptoms. British Journal of Health Psychology, 13(2), 327–342.
Solomon, Z., Mikulincer, M., & Avitzur, E. (1988). Coping, locus of control, social support, and combat-related posttraumatic stress disorder: A prospective study. Journal of Personality and Social Psychology, 55(2), 279–285.
Stein, M., Walker, J., Hazen, A., & Forde, D. (1997). Full and partial Posttraumatic Stress Disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.
Terry, D. J. (1994). Determinants of coping: The role of stable and situational factors. Journal of Personality and Social psychology, 66(5), 895–910.
Thompson, J. (1993). Psychological impact of body recovery duties. Journal of the Royal Society of Medicine, 86(11), 628–629.
Ursano, R. J., Fullerton, C. S., Kao, T. C., & Bhartiya, V. R. (1995). Longitudinal assessment of Posttraumatic Stress Disorder and depression after exposure to traumatic death. Journal of Nervous & Mental Disease, 183(1), 36–42.
Ursano, R. J., Fullerton, C. S., Vance, K., & Kao, T. (1999). Posttraumatic Stress Disorder and identification in disaster workers. American Journal of Psychiatry, 156(3), 353–359.
Vaiva, G., Ducrocq, F., Jezequel, K., Averland, B., Lestavel, P., Brunet, A., et al. (2003). Immediate treatment with propranolol decreases Posttraumatic Stress Disorder two months after trauma. Biological Psychiatry, 54(9), 947–949.
Violanti, J. M., & Aron, F. (1993). Sources of police stressors, job attitudes, and psychological distress. Psychol Rep, 72(3, Pt. 1), 899–904.
Wagner, D., Heinrichs, M., & Ehlert, U. (1998). Prevalence of symptoms of Posttraumatic Stress Disorder in German professional firefighters. American Journal of Psychiatry, 155(12), 1727–1732.
Weiss, D. S., Brunet, A., Metzler, T. J., Best, S., Fagan, J., Liberman, A., et al. R. (1999). Critical incident exposure in police officers: Frequency, impact and correlates. Paper presented at the Paper presented at the International Society for Traumatic Stress Studies, 15th Annual Meeting., Miami, FL.
Weiss, D. S., Marmar, C. R., Metzler, T. J., & Ronfeldt, H. M. (1995). Predicting symptomatic distress in emergency services personnel. Journal of Consulting and Clinical Psychology, 63(3), 361–368.
Wilkinson, C. (1983). Aftermath of a disaster: The collapse of the Hyatt Regency Hotel skywalks. American Journal of Psychiatry, 140(9), 1134–1139.
Williams, C. L., Solomon, S. D., & Bartone, P. (1988). Primary prevention in aircraft disasters. Integrating research and practice. American Psychologist, 43(9), 730–739.
Witteveen, A. B., Bramsen, I., Twisk, J. W., Huizink, A. C., Slottje, P., Smid, T., et al. (2007). Psychological distress of rescue workers eight and one-half years after professional involvement in the Amsterdam air disaster. Journal of Nervous and Mental Disease, 195(1), 31–40.
Wright, K. M., Ursano, R. J., Bartone, P. T., & Ingraham, L. H. (1990). The shared experience of catastrophe: An expanded classification of the disaster community. American Journal of Orthopsychiatry, 60(1), 35–42.
Zatzick, D. F., Marmar, C. R., Weiss, D. S., Browner, W., Metzler, T., Golding, J. M., et al. (1997). Posttraumatic Stress Disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 154(12), 1690–1695.