Psychological Care 25 Years After the 9/11 Attacks

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS | More

In this episode, we bring back paramedic and professor, Bram Duffee. Bram was previously on the show to discuss the book he co-wrote with Joseph Brigandi, MS, M.Ed., NCC, LPC-S. Psychological Emergency: Communication and Care by First Responders. Unfortunately, Joseph passed away suddenly recently and Bram spends the initial parts of the episode giving tribute to his friend, fellow paramedic, and co-author.

Dr. Joe Holley joins the team and along with co-host, Sam Bradley, talks about the 25 years since the 9/11 attacks and response. Joe responded with a Federal USAR team to the Pentagon attack and Sam was at ground zero in New York with a California DMAT team supporting the responders with medical care after working on the pile at the World Trade Centers sites each day.

The episode also was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

---

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

---

Podcast Discussion Summary

Psychological Casualties in Disasters

Bram explained the Iceberg Effect, which highlights that for every physical casualty in a disaster, there are 4-10 psychological casualties that go unaddressed. He noted that while physical casualties are visible and what incident commanders plan for, the psychological toll represents a much larger underlying issue that can overwhelm systems designed only for physical injuries.

Sam shared her experience with CISM teams during disasters like Katrina, emphasizing how responders often feel they abandon patients who need long-term psychological support rather than quick medical treatment.

First Responder Family Preparedness

The group discussed the importance of first responders’ family preparedness during major incidents, with Jamie emphasizing that having a well-prepared home life allows first responders to better focus on patient care. Bram shared his experience with government versus private company responses to disasters, noting that government agencies typically provide better support for personnel and their families.

Sam contributed by sharing her role in launching critical incident stress management (CISM) in 1996 with American Medical Response in Northern California, which later expanded nationwide.

Psychological Phases of Disaster Response

Bram explained four psychological phases of disaster response: impact, inventory, rescue, and recovery, drawing from CISM principles and Dwight Polk’s work on pre-hospital behavioral emergencies. He described how each phase represents different emotional states and challenges, with the recovery phase often being the most important but least recognized phase that requires sustained attention and resources.

Bram also outlined how psychological triage can be applied by identifying distinct population groups with different needs, including survivors, witnesses, bereaved individuals, and the wider community, each requiring different approaches based on their specific circumstances.

Individualized Disaster Psychological Support Approaches

The group discussed the importance of individualized approaches when providing psychological support during disasters, noting that different people require specific treatments based on their unique needs and trauma presentations. Bram emphasized how people in states of fear and shock can be particularly vulnerable to hypnotic trances, highlighting the critical importance of careful communication and word choice by first responders. The discussion also touched on how both victims and their caregivers can exhibit signs of psychological distress during disaster situations.

Disaster Management Frameworks Discussion

Bram explained three frameworks – Focus, START, and CALMS – that he created using mnemonics to help with disaster management situations. The Focus framework helps with situational assessment by examining population impact, operational zones, critical phases, urgent needs, and strategy.

START addresses resource allocation, while CALMS provides an interactive approach for individual support. The discussion then shifted to potentially discussing Dr. Joe’s experience at the Pentagon, though the transcript ended before this topic was fully explored.

9/11 First Responder Reflections

The group discussed their experiences responding to the 9/11 attacks 25 years ago. Joe described being deployed within hours of the attack and spending 14 days on-site doing search and rescue work, while Sam shared her experience with the federal team providing medical care to firefighters, noting their psychological distress.

The participants discussed how psychological support for first responders has improved significantly over the past 25 years, with more real-time and robust support systems in place. They also reflected on the long-term psychological impacts on responders, with Joe mentioning that some team members still struggle with PTSD, and Bram comparing the experience to dealing with grief.

First Responder Psychological Impact Discussion

The meeting was a podcast recording discussing the psychological impact on first responders, particularly focusing on a book written by Bram about communication techniques for handling psych emergencies. Sam shared her experience coordinating supervisor check-ins with hospital staff following a crisis, while Jamie emphasized the importance of remembering historical events for future generations.

The discussion concluded with information about where to find the participants online and announcements about upcoming podcast episodes covering hurricane season and recent events in Hawaii.

Wrap up and updates

The team went through contact information and the team encouraged listeners to stay safe. The group discussed the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.