Coping with the aftermath of horror Psychologist helps emergency workers


Shortly after a Howard County 911 dispatcher overheard a murder-suicide in the middle of the night last week, her supervisor woke an Ellicott City psychologist, Dr. Jeffrey T. Mitchell, with an urgent phone call.

Within minutes, Dr. Mitchell -- who developed a debriefing technique used throughout the world to help emergency personnel deal with horror -- was in the county's 911 command center listening to the tape of the murder-suicide and going over the case with the dispatcher.

When events turn ghastly, Dr. Mitchell gets the call -- not just in Howard County, but in Oklahoma City, Charleston, S.C., Los Angeles, Yugoslavia and Kobe, Japan.

When there is a bombing, a deadly hurricane or earthquake, a riot or a civil war anywhere in the world, a hot line rings in the Howard County 911 center for Dr. Mitchell and teams trained by his Ellicott-City-based International Critical Incident Stress Foundation.

Often, Dr. Mitchell and the foundation's teams are on the next plane out to offer free help to emergency personnel coping with trauma.

At 1: 29 on the morning of April 2, it was a Howard County dispatcher who needed help. As she was talking to a Columbia woman whose husband was threatening suicide, the dispatcher heard the man load a .357-caliber Magnum, then kill his wife and himself.

Police broke down the couple's door 101 seconds after the shootings. The dispatcher, who has not been identified, would have had to suffer alone in the same situation 20 years ago. In those days, the average paramedic's career lasted about seven years.

"If you couldn't handle it, you didn't stay on the job," said John A. Hampton Jr., Howard County's 911 bureau chief and a veteran of 30 years with the Washington, D.C., fire service.

But after veterans returning from the Vietnam War showed signs of continuing trauma, physicians and psychologists discovered that anyone faced with tragedy, death, serious injury or a threatening situation is a candidate for what is now called post-traumatic stress disorder.

Feelings of guilt

The symptoms are many, but essentially sufferers seem unable to rid themselves of images associated with the event and often express feelings of guilt about their part in it.

"I am called in for some pretty significant events, highly unusual cases" about once a month, Dr. Mitchell said. "About 95 percent of the calls involve children."

Dr. George S. Everly Jr., a Towson psychologist who in 1989 helped Dr. Mitchell create the critical incident stress group, said post-traumatic stress disorder is "just as disabling as schizophrenia."

The main goal of the 4,300-member foundation is prevention: helping dispatchers, firefighters, paramedics, police and hospital workers keep tragedies from overwhelming them.

Dr. Mitchell, 47, gets Howard County's most difficult calls, not only because he developed one of the most widely used debriefing techniques, but because he, too, has seen tragedy.

As a young paramedic 25 years ago, he was the first person to arrive at an automobile accident involving a bride and groom still wearing their wedding finery. The couple's car had rammed the back of a pickup truck loaded with plumbing pipes. The pipes entered the hood of the car, passed through the 20-year-old bride's chest and lodged in the back seat.

'A better way'

"For six months, I couldn't go past a bridal shop or see a wedding gown without visions of her contorted face in my brain," said. "I started thinking there must be a better way to help emergency personnel through horrible things."

So he set about finding that way.

One of the first things he does now when discussing an incident with emergency personnel is to "stabilize the situation" by telling them, "You did the best that you could."

When things turn out badly -- as when a firefighter is unable to save a child -- Dr. Mitchell switches quickly from content to intent, from "what happened and what did you do?" to "I know you feel terrible that things did not turn out as you wanted. What did you want to occur?"

Since intent is rarely malicious, shifting from content to intent enables people to learn from experience without judging themselves, he said, and helps ensure that what went wrong will not recur.

Crucial decisions are often made instantaneously, he said, but brooding over those decisions can last for hours, days or years. It is important, therefore, to begin debriefing -- discussing an incident with the personnel involved -- as soon after an incident as possible, he said.

The first thing, Dr. Mitchell said, is to let the emergency workers know that their emotions are normal, that they are feeling what anyone would feel in similar circumstances.

It is important for the emergency workers' well-being to get them functioning in their jobs again as quickly as possible, Dr. Mitchell said. With a little support, he said, that can happen right away.

The Howard County dispatcher who listened to the murder-suicide last week was back on the job after spending about 45 minutes with Dr. Mitchell and has been functioning well ever since, said Chris McNamara, who is in charge of Howard County's 911 training.

County 911 officials say the dispatcher handled the call from the victim in the murder-suicide properly and did not contribute to the events that unfolded.

"When you're working with emergency personnel, you're working with generally pretty healthy people," Dr. Mitchell said. "But in the classroom of life, we're all 'C' students when it comes to stress. What's exciting is to see people come out of their pain -- come out a survivor" after being debriefed.

Personalities in peril

Not all of those Dr. Mitchell works with are able to resume their duties. He tells of an out-of-state paramedic who found a woman in a bathtub, bleeding profusely. The woman had died of a rare blood disease, and as the paramedic touched her body, she bled even more.

The paramedic was so traumatized that for two years, he would not touch anyone, believing that anyone he touched would bleed to death. After two years of therapy, the man could hold his child, but he was never again able to function as a paramedic, Dr. Mitchell said.

The case underscores a point Dr. Mitchell would like the public to understand about emergency personnel everywhere: "They daily jeopardize not just their lives, but their personalities."

Howard County Executive Charles I. Ecker is a strong supporter of Dr. Mitchell and his debriefing techniques.

Even when a story has a happy ending -- as when a dispatcher successfully talks someone through the birth of a baby or helps someone resuscitate a heart attack victim -- "it can be very draining," Mr. Ecker said. When emergency workers are traumatized, he said, "It is our responsibility to help them."

Pub Date: 4/15/96

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