First responders experience trauma as job-related way of life

WESTBOROUGH,  MA There is a new question in my mind about the exposure to trauma, e.g. war-related PTSD and the possibility that it plays a role in domestic violence and domestic violence homicide later on.  While this relationship may be plausible, there are no mitigating truths to the notion that DVH is caused by one’s exposure to war or on-the-job exposure to horrific events.  Returning veterans and those in the police and EMS service witness suffering and anguish that are outside of the normal human experience rendering them vulnerable to recurring trauma and a host of physical and emotional ills. Some believe the prevalence of PTSD among EMS first responders (including EMT paramedics) is as high as 16 percent (DeAngelis, 1995, p.36).  Most services require critical incident debriefing after incidents that are particularly catestrophic – especially those resulting in death of a member of service or the death of a child.  These sessions have been shown to reduce the incidence of post-incident symptoms by offering support and context for individual responders as to their individual role in the event. It is not psychotherapy although emotions are often evoked as remembered details emerge and become palpable.

What is the link between unresolved trauma and DV? It is well known that a high incidence of substance abuse exists among first responders.   “The emotional wellness of emergency service workers is at risk. Stress and grief are problems that are not easily detected or easily resolved. Severe depression, heart attacks, and the high rates of divorce, addiction, and suicide in the fire and EMS services proves this” according to Peggy Rainone who offers seminars in grief and surviving in EMS. To what extent this behavior evolves from on-the-job experience is subject to debate but chronically high levels of stress contribute markedly to marital discord, job conflict, and a host of physical anomalies like hypertension and cerebral vascular accident.

The link between chronic stress and behavioral health is well known.  Does this link extend to higher risk for domestic or intimate partner homicide?  I believe that high levels of stress slowly errode coping skill leaving an emotionally vulnerable person at higher risk of acting out.  The recent case of domestic violence homicide in Arlington, Massachusetts raises the specter of DVH in first responders. In this case, a decorated paramedic allegedly killed his children, his wife and then himself.  The abuser had a history of physical and emotional abuse as reported by a first wife.  There was a history of alcohol abuse.  The abuser was involved in a whistle blower case against his employer that was slowly making its way through the courts.  But outwardly, he and his family seemed happy. What might trigger such an emotional breakdown and deadly maelstrom?  What triggered the terminal rage that released this decorated man – creating a monster?

In some cases, post incident analysis of the psychological forces acting on the abuser is necessary and will provide insight into the chain of events that pulled on the trigger. There is no single answer but a host of preincident “red flags” likely contributed to the loss of control associated with DVH.  The prior history of violence toward an intimate partner coupled with substance abuse are red flags in the case of DVH in the Arlington murders.  A thorough psychological autopsy may uncover unique factors leading to the murders like unrecognized triggers for anger and other heretofore unknown variables driving violent behavior.  I have previously published blogs on the psychological autopsy and its utility.  The benefit of a thorough psychological autopsy has value for all of mankind.  Most jurisdictions have professional bodies that examine on a yearly basis the facts of domestic violence homicide.  These boards must publish their findings which in some cases might drive political change and legislation that can save future victims.

1. DeAngelis, (1995, February). Firefighters’ PTSD at dangerous levels. Monitor, pp. 36-37.
2. Rainone, P. (2013) Emergency workers at risk. Taken 12-1-2013 (website) http://www.emsvilliage.com/articles/article.cfm?ID=176.
3. Allanach, R.A., Gagan, B.F., Loughlin, J., Sefton, M.S., (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011