Police Psychology | Mass Casualties

by Gary S. Aumiller, Ph.D.  ABPP

In light of the Orlando night club shooting this week, I wanted to give you some information on the effects this kind of tragedy can have on first responders and what can be done as a police leader or psychologist to help the situation.  Unfortunately, I have worked on too many mass casualty situations, from TWA Flight 800, to the embassy bombings in Africa, to both World Trade Center bombings and quite a few in-between.  Being in the New York area I still have cops processing their work at 9/11 and Flight 800.

First off let me explain the concept of “burst stress.”  Burst stress is the norm for police officers and first responders.  Sgt. Friday of Dragnet said it best when he described police work as hours and hours of boredom surrounded by moments of sheer terror.  Burst stress is that sheer terror.  It is the amusement park rides that jerks you into the air and tosses you upside down to be caught just before you descend to your death (or puke in my case).  In the amusement park it is fun for many (I actually hate those rides) as you know that you will probably not die or else the amusement park would have closed years ago.  It is also over in a few seconds, then you go on.  Not quite that way when it happens in real life.  A first responder is in that situation, then he or she goes home and tries to get some sleep, wakes up the next morning and returns again to the same  situation sometimes for weeks.  It’s not just feeling the jeopardy, but also seeing the death that makes them confront their mortality.  When you handle mutilated bodies you picture yourself, your children and many others in that position and it is not pleasant.  It haunts you.

One way you can try and start to moderate burst stress is by giving people a chance for their body to rest.  There was an interesting study back when I was in college about nursing students that had a bus ride from their emergency room placement versus other than had no such bus ride.  They found the student that had the bus ride were less uptight and anxious because the ride allowed them time to deprogram and talk to friends about the day.  The students who were able to go directly home became more uptight as the semester progressed.  (And they made worse dates for us guys.)  This was the opposite of what they expected as they wanted to show the detriment of the commute, but instead they got contradictory results.  In a mass disaster, having a cool off period after the day is a very healthy thing instead of releasing people immediately to go home.  They don’t necessarily process what happened by talking it out, although some may want to do that, but just a half an hour to relax can have a highly positive effect.  It gets them away from the blood and bodies, or the evidence long enough so they can try and separate from it before they go home.

In the same line, forcing a two-day break after working seven, ten or twelve days in a row, can be tremendously therapeutic.  One day is not really enough to get away from it all.  Emergency workers are known to go until they drop, and gather as much overtime while it is available.  A mandatory two days off after a week or so can make a big difference in the workforce.  We particularly found this a good strategy after 9/11, but also in other disasters.

Psychological debriefings are useful for some, but there is evidence that may not be useful for all.  The timing is essential on debriefings.  You have to make sure people are not still in the mix of working, or the mindset if not in the work.   In Oklahoma City, many of the emergency folks wanted to kill the social workers that were coming up to them to trying to get them to talk while they were trying to rescue the victims.  Well-meaning doesn’t mean well-timed.  Some people will greatly appreciate the mental health worker sitting with them and getting them to process; some may not be ready for weeks or even months.  The clear message is to have a follow-up in these situations so people can talk it out.  It is essential to have a follow-up a couple of months after all has cleared from the disaster, just as people are re-adjusting to life back to normal.  This by the way goes for one-to-one interactions as well.

I cannot possibly overemphasize the need to make sure you staff is sleeping.  What happens after these major incidents is that people’s sleep pattern change and their bodies go on deficit.  That get very scary at times and spells out a lot of problems down the road.  One or two nights of good sleep is essential for them to get themselves reset.  This needs to be told to people and a good trauma team has a physician available to make sure the emergency workers are sleeping.  If not get them to their regular physician for a check.  This is key and sleep can create more burnout and aberrant behavior than you ever want to deal with.

If possible, it is good and healthy to have a mental health training day also within a year of a major disaster.  It need to be someone who will make them laugh as well as teach them good mental health technique.  With large departments, this is not always possible.  With smaller departments, you might want to combine with another department or two to find someone to come and that has a good way about them.  Give the speaker a list and encourage them to send your first responders to good therapists after their speech.  After 9/11, I went in to talk to a group in Tampa that had a plane crash into a government building.  I gave out my email address and you wouldn’t believe how many used it asking for a referral.  It was close to 55% of the audience.  Myself and the EAP coordinator couldn’t believe it.  People find the need is stronger and the panic modes come out very strong after your department is attacked.

Now it is time to worry about yourself.  If you are a police leader or a police psychologist, have a colleague or a shrink nearby to just run things over with.  Make it a lunch or something.  Modeling is the strongest way to make others know you believe in the work done in psychology, and you probably wouldn’t even be reading this if you didn’t.  If your staff knows that you are willing to talk to someone they will be more likely to do that.  And it will probably be good for you also.

Cues of a disaster site are important to assess.  People tend to bring up past memories by some of the present cues, very often without even noticing it.  On Flight 800, they rushed to build a helicopter pad to be used while I was warning that people who had military background may have strong reactions to a helicopter sound.  I mentioned it to the commander at the site and they put the word out to the workers.  We had many of the military guys thank us for the warning and said they did have an uneasy feeling but were glad they know where it was from.  John Nicoletti, a brilliant psychologist from Colorado who has worked many major incidents including Columbine and the Aurora theater, reports that people at shooting incidents often have a reaction to the smell of gunpowder.  Many cues reactions can be lessened or avoided just by forewarning people.  Look for the cue while it is going on, and look for the reactions long after, perhaps on the next incident.  These kinds of things stay in our memories.

Regardless, whenever you are faced with a major casualty situation, it will be a big help to either know the psychology or bring people in who help inform you of the psychology in a situation and how your staff can best be prepared and helped afterwards.  These situations are always difficult but with easy simple steps we can make them better and easier to deal with.  This is only a few suggestions for after the problem, but there are many other things that can be done.

As all of us, our prayers and good wishes go out to all the first responders in Orlando, Florida as well of the victims families.

Note:  To refer you elsewhere, John Nicoletti, Ph.D., ABPP wrote Violence Goes to Work, Violence Goes to School, Violence Goes to College, and a new guide with the federal government called Preparing for the Unimaginable about mass casualty situations.  He is brilliant man and a good friend, and I will try to get him to write for us soon.

Site Editor:  Gary S. Aumiller, Ph.D. ABPP

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