Responders still dealing with Sandy Hook trauma
Public safety culture is changing, with it perhaps the notion that responders are immune to emotional injury from traumatic events
NEWTOWN — Peter Houlahan of Redding has never missed a day of work over a bad emergency call. He has never been so emotionally overwhelmed by trauma that he lost his focus on patient care.
But something changed the day he was called to the worst crime scene in Connecticut history -- at the Sandy Hook Elementary School, where 20 first-graders and six educators were killed by a young gunman who then killed himself.
"Before Sandy Hook I looked at the world as a good place where bad things happened," the 53-year-old father of two said. "Now I look at the world as a bad place where good things happen."
Like most EMTs and firefighters and police who responded to Sandy Hook on Dec. 14, 2012, Houlahan is doing the same job he was doing that horrible day, coping with the stress that comes with confronting death so frequently.
But unlike a growing number of police and firefighters, Houlahan has not sought help -- either from peers or from professionals -- even though he knows where to find it.
"You almost feel like `I can't close my eyes anymore -- I see those children, I see those parents,' " said Houlahan, recalling the kids he saw running from the school building as he approaced, and the parents in the Newtown firehouse waiting to hear the worst.
"Then there is the anxiety and the anger and the fear," he says. "But I haven't had to get help. I feel like. What's the point? I have gone on a lot of bad calls."
As recently as a generation ago, Houlahan's reservations might have gone unchallenged. But Connecticut's public safety culture is changing, and with it perhaps the notion that emergency service workers are somehow immune to emotional injury.
"Brain science and the accumulative and acute effects of post-traumatic stress have shown us that this needs to be put on the front burner," said state police Sgt. Troy Anderson, who has been running a peer-driven counseling and support program since 2007. "There is no predisposition or DNA gene that allows us to go to scenes nobody signed up to see."
In addition to stress management sessions for first responders, which have gained acceptance in firehouses and police departments in Connecticut over the past two decades, a new Trauma Recovery Network has started in Fairfield County and a new Recovery and Resiliency Team has begun outreach in Newtown as a result of the Sandy Hook tragedy.
Both groups strive to help first responders recognize problems with sleep, appetite and intimacy as manifestations of emotional injury that must be treated just like physical injury.
"We are not so stigmatized by this anymore," said Bernie Meehan, assistant fire chief in Danbury and a paramedic in Roxbury who has run about 400 debriefings for first responders after traumatic incidents. "It is not a big deal now if you go to a varsity-level tragedy and you say `I took a hit there.' If you took a good shot traumatically, most first responders won't bust a person's chops for that."
Still, obstacles remain. The stigma that keeps some first responders from making the connection between trauma and mental health is rooted in a culture where asking for help has traditionally been seen as a sign of weakness.
In Newtown, a handful of officers have left the department and several others have faced disciplinary hearings since the Sandy Hook shootings, said Eric Brown, an attorney for the Newtown police union.
"It's speculative because none of it is proven, but most people would agree that Sandy Hook had an impact on them," Brown said.
In neighboring Danbury, where Brown also represents police, an city officer was disciplined for off-duty behavior that was eventually linked to his hospital duty the day of the tragedy.
"I think people want to believe that cops are superheroes," Brown said. "Nobody wants to hear that a cop has a mental health issue."
With the second anniversary of the mass shooting one week away, officials are saying little publicly in deference to the families of the victims. But first responders are using peer programs to keep the conversation open about stress management.
"We are keeping it alive because we know we have to," said Anderson, the state police sergeant. "If anybody sets the tone that we have to move on, that creates a barrier to treatment if somebody needs it."
Barriers to recovery
Houlahan's was the third ambulance to arrive at Sandy Hook. Two ambulances before him had rushed victims to the hospital. He was poised to enter the school when he was told no one else could be saved.
"We knew what was inside there and I was grateful I didn't go in," Houlahan said. "I saw others, from the most highly trained law enforcement we have, come out upset, resting on each other's shoulders. I saw one guy who was in such shock I can still see his eyes. I will never forget it."
Equally unsettling for him and scores of other first responders was the empty feeling of knowing that they couldn't help.
"I had EMS guys lined up behind me and what was really disturbing was this deep feeling of sadness that there was nothing to hold on to," he said. "I had days where I felt like my legs were kicking out from under me, but I didn't think that I had anything to talk about."
"I felt like, Who am I to go get help, when all I was doing was sitting there?"
His experience is common among first responders, said Dr. Jill Barron, a psychiatrist who completed a study for Newtown in 2013 about recovering from the tragedy.
"(E)vidence has shown that the more aware or reflective one is, the better able they are to withstand stress, and they are less likely to experience `burnout' in addition to a host of physical problems," Barron wrote in her recommendations for first responders.
Houlahan has reflected deeply on that day, and has written a moving first-person account of his experience.
"I have been to very dark places with depression," he said. "It's not that I am spiraling into this acute depression; it is just my perspective on things. I have tried to face it and take it on when I saw it coming."
Since the beginning of stress debriefings for first responders after the L'Ambiance Plaza collapse in Bridgeport killed 28 workers in 1987, the tools to diffuse trauma-related stress have increased substantially.
One therapeutic technique that is becoming popular is called EMRD -- for Eye Movement, Desensitization and Reprocessing.
"There is research indicating that these traumatic experiences are damaging to people's brains," said Meehan. "EMRD is a way to redirect some of those thought patterns."
Anderson says there are more treatment options than people might expect.
"We were able to get many of our people trained in Transcendental Meditation," he said. "What we are saying is you really need to explore the options. There is an option out there for everyone."
Part of the challenge of helping all first responders get the help they need is the special nature of their work environments.
A firehouse is more amenable to a conversation than an ambulance garage, for example, particularly when firefighters are sitting around a meal of pork roast and potatoes.
"It is fairly easy to diffuse a rough call when you are breaking bread with your brothers," Meehan says. "You can look at these young guys and remember what it was like when you were their age and say, `You did a good job.' "
EMTs tend to be more isolated and overworked.
"Every good EMT I know becomes detached at the scene," said Houlahan. "Detachment has its good points, but the bad side is you almost don't have the emotional vocabulary to take these things on and recognize them."
While hundreds of first responders were affected by the tragedy at Sandy Hook, either as part of the investigation or in a support role, those closest to the horror were Newtown's first responders.
"I think the men and the women in the police department understand the need to be vigilant and take care of their mental health," Brown said. "I don't think it is easy but I think they are doing okay.
"I don't know the extent to which they are suffering," he added. "It would be hard for me to imagine that they aren't suffering."
The Newtown Police Department was in the headlines last year because of its plans to fire an officer named Thomas Bean, who said he was so traumatized by Sandy Hook that he could not pick up a gun. The department backed off those plans under public pressure, but informed Bean that the town insurance policy would pay his long-term disability benefits for only two years.
Bean had arrived at Sandy Hook 20 minutes after the gunfire ended. He was assigned to interior security, and later called what he saw `horrific.' He awoke the next morning feeling numb and thought about cutting himself with a razor blade "just to feel something."
Bean is fighting the town for what he says is his right under the police union contract to receive disability benefits until the date of his retirement, which would be 12 more years.
The case is being heard by the state Board of Mediation and Arbitration. A key point at issue is that post-traumatic stress disorder is not covered in state workers compensation law as a workplace injury.
Bean went to Hartford in March to ask the General Assembly's Public Safety and Security Committee to pass legislation that would cover his condition.
Brown, who represents Bean, said the bill stalled because legislators fear it would cost municipalities too much money.
"The politicians don't have the will because their constituents don't," Brown said. "If you have a broken arm, you can X-ray it, but if you have a broken heart, no X-ray is going to show that."
Newtown police Capt. Joe Rios said the effect trauma has on emergency service workers and first responders is a reality.
"We recognize there are significant mental health issues concerning 12/14 and other critical incidents such as a serious crash or the death of a child," Rios said. "So how we take care of each other on a daily basis is important, and I think the awareness and the understanding is growing."
Meanwhile the Newtown community has rallied around its first responders.
"They are such a dedicated and stoic group of people that I don't know if they know how much we appreciate them and respect them," said Donna Culbert, director of the Newtown Health District. "They are still our rock."
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