rescuing civilians. Others were unsure of the whereabouts and safety of their families, or only knew that they were scattered indifferent shelters across the country, as were so many other families. These local first responders worked tirelessly, oftencombating their own fight, flight, and freeze responses. They generally were also dealing with hazardous working conditions(e.g., flood waters, toxic mud, downed power lines) and limited resources (e.g., rescue boats, helicopters, food, water) makingrescue efforts more difficult.During the weeks after Hurricane Katrina, as things slowed down, with rescue efforts being completed and recovery effortswell underway, the local first responders who stayed and performed their duty to save and/or take care of New Orleanscivilians often dealt with dual trauma. Dual trauma can best be described as the collective experience of occupationalexposure as first responder in one's own community as well as having personal exposure as a citizen of the same (or aneighboring) community whose life has been interrupted by a trauma event such as a natural disaster. Dual trauma isexperienced only by local first responders and, more specifically, local emergency personnel (fire and police) and those localswho provide care for victims of trauma, such as emergency medical technicians, paramedics, physicians, and nurses. The 1:1crisis counseling, along with other psychological "first aid" and support, was provided to help New Orleans local firstresponders with dual trauma. Although it is believed that many of the local first responders successfully managed unaided todeal with the dual trauma, others were in need of some aid. These individuals' normal coping skills had been overtaxed, andthey were struggling with high levels of distress.Hurricane Katrina has brought to the forefront that local first responders may be dealing with dual trauma, with some strugglingwith high levels of distress and in need of aid. Existing research has generally focused separately on the occupationalexposure of the first (sometimes local) responders to such things as high impact disasters, severe injury and death, andreactions to child victims (Boxer & Wild, 1993; Dyregrov & Mitchell, 1992; Leffler & Dembert, 1998). Much of the research hasattempted to identify aspects that might impact the first responders' coping ability, focusing on age and job responsibilities(Marmer, Weiss, Metzler, Ronfelt, & Foreman, 1996), and perception of the world (McCann & Pearlman, 1990), operating froman internal, versus external, locus of control (Solomon, Mikulincen, & Avitzur, 1988; Solomon, Mikulincen, & Benbensishty,1989), trying to cope through avoidance (McFarlane, 1989; Shalev, Peri, Canetti, & Schrieber, 1996), keeping feelings tothemselves (Evans, Carman, & Staney, 1993), and resiliency (Walsh, 1998). Other research has focused on citizens exposedto trauma events such as terrorism (Jordan, 2002), school shootings (Jordan, 2003), natural disasters (Jordan, 2006), andposttraumatic stress disorder (PTSD) (Pfefferbaum, 1997; Yule et al., 2000) and resiliency (Melzal, 1997), to name only a few;however, thus far, there has been no focus on the joint occupational exposure and personal exposure of local first responders.Therefore, this single case study will focus on a local first responder with dual trauma who was in need of aid. For the purposeof this study, psychological first aid was limited to 1:1 crisis counseling.The 1:1 crisis counseling lasting from 15 min to 2 hr and not exceeding three sessions was used to assist the local firstresponders to achieve short-term mastery of his/her overwhelming affect and develop some idea of what to do next. Whendoing 1:1 crisis counseling with trauma survivors, five factors were used to guide the crisis counselor in the assessmentprocess. These five factors included (a) personal factors (Hettler & Cohen, 1998; Pine & Cohen, 2002), (b) predisposingfactors (Brewin, Andrews, & Valentine, 2000; Epps, 1997), (c) peridisposing factors (Jordan, 2005), (d) postdisposing factors(Mitchell & Everly, 2003), and (e) protective factors, which involve resiliency (Ursano, 1981; Walsh, 1998) and stress buffers(Cleary & Kessler, 1982; Thoits, 1982). These five factors have previously been described when used with citizens after atrauma event (Jordan, 2005) and were revised to serve as an informational and assessment guide for dealing with local firstresponders with dual trauma. As part of the single case study, each of the five revised factors is described in detail. The nameand identifying information of the person in the case example was changed to protect his identity.
A New Orleans local first responder, a police officer, was referred for 1:1 crisis counseling after he had gotten very agitatedand walked out during a formal debriefing session. According to his supervisor, he had been observed becoming more andmore agitated in the days after Hurricane Katrina. He also identified that this was unusual behavior for the local first responder.
These can best be described as the local first responder's personal, familial, relational, and cultural history (Nader, 1994) aswell as spiritual and/or religious beliefs, values and practices (Hettler & Cohen, 1998; Woodcock, 2001), age, gender, race,
Crisis Counseling With Local First Responders After Hurricane Katrina (p...http://www.medscape.com/viewarticle/559405_print2 of 88/22/2010 4:32 PM