Guide to Recognize and Cope with Stress for First Responders

The scene has cleared. The wildfires have subsided. Adrenaline has slowed. And reality starts to set in. That’s likely what happens to first responders after the devastating East Tennessee wildfires and tragedies like the recent Nashville school bus crash that sent 23 students and three adults to area hospitals and the Chattanooga school bus crash that killed six children and sent dozens of others to local hospitals last week.

As a board certified psychiatrist who has practiced in the Middle Tennessee community since 1996, currently with HCA Healthcare’s TriStar Skyline Madison Campus, a Behavioral Health facility in Nashville, my heart goes out to everyone impacted by these horrific tragedies. In the days to come, behavioral health professionals like myself, community members and friends can help support everyone involved and create an environment that encourages the coping process.

Acute stress reactions can occur with those directly involved in the traumatic event, but it can also affect family members, colleagues and first responders, too. And for first responders who worked to battle the wildfires, evacuate residents, conduct search, rescue and recovery efforts, as well as rescue children from a wreckage, care for the injured and scared, and transport them for medical treatment, the process of coping with the event is far from over.

Sometimes emotional and physical symptoms appear immediately and go away quickly, but other times they appear as many as three to four days after a traumatic event and persist. Stress reactions can manifest as:

• Anxiety
• Irregular moods
• Irritability
• Sadness
• Stress
• Inability to sleep
• Nightmares
• Flashbacks and lapses in concentration

And with physical symptoms like:

• Heart palpitations
• Shortness of breath and other breathing difficulties
• Gastrointestinal discomfort
• Nausea, and
• Symptoms that present similarly to a mild anxiety attack.

Another adverse reaction to stress may cause first responders to isolate themselves from anything that may trigger a recurrence of their symptoms. This may lead them to withdraw from others.

While research shows that talking about a traumatic event can significantly help process feelings, friends and loved ones should allow the individual experiencing an acute stress reaction to direct the conversation and allow them to talk at their own pace about how they experienced the community tragedy.

Trying to restore typical sleep patterns and an appetite as soon as possible can also help to combat disruptive reactions to stress. Additionally, primary care providers can help with short-term solutions such as medications, but if the acute stress reaction continues, a clinical assessment for cognitive behavioral therapy or counseling may be needed.

The physical and emotional toll of the East Tennessee wildfires (as seen by the viral image of five firefighters asleep on the sidewalk), and Nashville and Chattanooga school bus crashes may be felt by first responders in the days, weeks and months to come. We at TriStar Skyline Madison Campus in Nashville and colleagues at sister HCA Healthcare facility Parkridge Valley Behavioral Health in Chattanooga are here to help those who help us in times of need.

Dr. Chandra Sastry, psychiatrist, has served as the medical director of TriStar Skyline Madison Campus since 2000. If you, a family member or friend is experiencing symptoms of an acute stress reaction please seek help.  If it is of an emergent nature please go to the nearest emergency room.  Your primary care provider is also a helpful resource, or if you would like to schedule an appointment with a specialist, please call 615-342-1450 or the national crisis support line at 1-800-273-8255.