It has been 16 years since the September 11 terror attacks in the United States, but for the first responders who survived it feels like yesterday.
Many suffer from ongoing post-traumatic stress disorder and physical illnesses.
A total of 7,000 first responders are listed on the World Trade Center health registry with illnesses directly related to their response to the attacks on that day in 2001.
It is an issue for first responders all over the world, including those at the Bourke Street Mall attack in Melbourne, where emergency services and medical personnel were thrust into a chaotic scene.
World Association for Disaster and Emergency Medicine deputy chair Erin Smith spoke at a trauma conference at Royal Perth Hospital recently, and told of the importance of implementing a system to help first responders’ mental health post-crisis.
Royal Melbourne Hospital’s director of emergency medicine George Braitberg shared the same view, following his experience when the hospital floodgates opening after the Bourke Street Mall attack.
Dr Braitberg recalled how the hospital staff were under immense pressure.
“They were all running on adrenaline and did not want to take breaks,” he said.
“They did not want to even go to the toilet during the incident.”
Dr Smith said the 9/11 first responders, who dealt with the 55,000 calls throughout the day of the attack in 2001 that killed nearly 3,000 people, continue to suffer survivors guilt to this day.
“They feel they were in charge of sending all of the emergency first responders into their death,” she said.
“Secondly, they were telling all these people in the towers to stay put even after the evacuation orders had been given at the scene by fire and police.”
Toll on families of those responding to tragedies
New York firefighter Rudy Sanfilippo told Dr Smith of how much a toll that “the pile” took on his own family.
“We lost control at the site, and we lost control at home. In both places, we were doing the best we could, but it wasn’t sufficient,” he said.
Around 18 months after 9/11, Mr Sanfilippo realised how absent he had been when he sat down for a family dinner.
“One of them says to me … my kid says, ‘Dad, welcome home.”’
‘Respond with little or no information’
Dr Smith and Dr Braitberg said in both attacks the first responders were forced to respond and improvise with little to no information about what had actually happened.
“They actually knew less than the public who were watching it all unfold live at home,” Dr Smith said.
While Dr Braitberg said his staff did not learn of the attack until it was all over.
“It was not until we turned on the news that we found out what actually happened. The scene was so chaotic,” he said.
Initial debriefing had been offered to emergency responders after both attacks but Dr Smith said some form of ongoing post-event support for those responding to extreme crises should be made mandatory.
“If you leave it up to responders they will generally say ‘I am OK, I do not need it’, even though deep down they do,” Dr Smith said.
“We can start doing things here now, we can start looking at the way we will provide support and ongoing counselling and provide family support.”
‘Looking after respondents is really important’
Royal Perth Hospital director of trauma Dr Sudahkar Rao attended the conference and said both the 9/11 and Bourke Street Mall attack, among others, show how important it is to develop a system to help care for those doing the caring.
“We always focus on treating the injured and the patient but as we know from other recent experiences, looking after respondents is also really important,” he said.
Dr Rao said it should happen sooner rather than later because everyday incidents also affect responders.
“How we address that appears unclear, whether they do have psychological debriefing or whether it is immediate psychological first aid,” he said.
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