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2014 Toolkit


First Responders

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Introduction…

First responders deal with accidents and emergencies, both large and small, on a daily basis.  These men and women include law enforcement, fire fighters, emergency medical technicians (EMTs), search and rescue workers, and other personnel.  They provide support in times of turmoil and can play vital roles in assisting people with mental and/or substance use disorders who may have very specific needs during and after disasters.  By reaching individuals during times of crisis, as well as through their roles in building public awareness and promoting safety on a day-to-day basis, first responders are valued partners in facilitating access to treatment and promoting recovery.

Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) (http://www.samhsa.gov), within the U.S. Department of Health and Human Services (HHS) (http://www.hhs.gov), sponsors National Recovery Month (Recovery Month) to increase awareness of behavioral health conditions.  This observance promotes the message that behavioral health is essential to health, prevention works, treatment is effective, and people recover from mental and substance use disorders.

The 25th annual Recovery Month theme, “Join the Voices for Recovery:  Speak Up, Reach Out,” encourages people to openly discuss mental and substance use disorders and the reality of recovery.  It aims to foster public understanding and acceptance of behavioral health conditions, including ways first responders can speak up if they recognize issues and reach out to help others, as well as themselves.

In the United States, there are approximately 794,300 police officers and detectives,1 more than 1.1 million firefighters operating in more than 30,000 fire departments,2 and approximately 226,000 EMTs and paramedics.3  These first responders save lives by recognizing and diffusing threats to public safety, assisting with evacuations, and treating the ill or injured.

Their daily sacrifices have earned them trust within their communities.4  Recognizing the relationships that first responders have developed within their communities, it’s important for members of the recovery community to partner with first responders regarding how best to intervene with people who need help during times of crisis and how to promote and support recovery on an ongoing basis.

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Speak Up…

First responders are often first-hand witnesses to behavioral health disorders that become evident during or after a traumatic episode(s) or over a period of multiple interactions.  For this reason, it is critical that first responders are equipped to recognize mental and/or substance use disorders during a crisis.  Greater knowledge of these problems will allow them to better assess a situation, help a community get through an emergency, recommend resources for behavioral health treatment and support services to individuals who need them, or seek help for themselves.

Given the fast pace of emergency situations, it may be challenging to recognize all signs and symptoms of behavioral health disorders in the moment.  However, possible signs of a behavioral health disorder may be easily observed, such as:5

  • Odor of alcohol on a person’s breath or smell of marijuana on clothing;
  • Burned fingers, lips, or needle marks on arms;
  • Slurred speech;
  • Difficulty maintaining eye contact;
  • Dilated (enlarged) or constricted (pinpoint) pupils;
  • Shaking or twitching of hands and eyelids;
  • Hyperactivity or, in contrast, sluggish behavior;
  • Impaired coordination;
  • Rapid or very slow speech;
  • Wide mood swings (highs and lows);
  • Impatient, agitated, or irritable demeanor;
  • Anger or defiance;
  • Difficulty concentrating; or
  • Short-term memory loss.

First responders can be influential in connecting people to prevention, treatment, and recovery resources available in their communities.  For example, to help prevent substance use, first responders can organize prescription drug take-back days.  These events provide a safe, convenient, and responsible means of disposing prescription drugs, while educating the general public about the potential for misuse of medications.6

First responders can also work with other organizations, such as community-based treatment providers, the American Red Cross, disaster relief organizations, or community leaders (such as policymakers or faith leaders) to host an emergency preparedness clinic.  They can detail ways the community can better respond during an emergency or crisis and assist those in need of behavioral health treatment.7

Here are some additional ways first responders can speak up for the recovery community:

  • Set up exhibit booths at local events to educate visitors about mental and substance use disorders, the resources that are available to seek help, and facts about the benefits of recovery.
  • Choose words wisely when speaking with the media before, during, or after an emergency or disaster.  When describing a suspect or victim, avoid using words like “wacko,” “crazy,” “psycho,” “schizophrenic,” “addict,” or “lunatic.”  These words can lead to discrimination or fear.  Instead, use person-first language and explain the person and the condition separately.  For example, say, “a person who may have a mental illness.
  • Talk to students during school assemblies or after-school programs about mental and substance use disorders.  Promote group activities, like ice breakers, that increase acceptance and reduce bullying.
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Reach Out…

First responders provide help and comfort to people experiencing fear, hopelessness, grief, shock, anxiety, guilt, or shame after an emergency or crisis.  When navigating these complex situations, first responders should promote an environment of safety, calm, connectedness, and empowerment.8  The recovery community can educate first responders on how to effectively interact with someone dealing with a behavioral health issue.  For example, they can teach first responders the following tips for when confronting a person with a behavioral health disorder, an emergency, or crisis:9,10

  • Stay calm and provide a quiet place free of distractions and noise to encourage someone experiencing a crisis to open up;
  • Give instructions or directives one at a time, to avoid overwhelming the person;
  • Be patient and avoid crowding the individual;
  • Maintain eye contact and actively listen to people who wish to share their stories and emotions, taking notes as necessary using the person’s name to demonstrate interest;
  • Ask open-ended questions and double-check the information given by restating it;
  • Help people contact friends and loved ones;
  • Find out the types and locations of government and nongovernment mental health and substance use treatment services, and direct people to available services; and
  • Remind people, if they express fear or worry, that more help and services are on the way.

The “Treatment and Recovery Support” (http://recoverymonth.gov/Recovery-Month-Kit/Targeted-Outreach/2014-Treatment-and-Recovery-Support.aspx) section of the toolkit also provides information on the different treatment options available for mental and/or substance use disorders.

Equally as important as helping others, first responders should be aware of their own behavioral health needs.  High-risk jobs like these can cause stress or fatigue, and unaddressed trauma can increase the risk of mental and/or substance use disorders.11  It is not unusual to experience feelings of depression, anxiety, suicidal or homicidal thoughts, substance abuse, or acute psychosis after experiencing a traumatic event.12

The following steps may help first responders manage their own stress:13

  • Use counseling assistance programs;
  • Take frequent, brief breaks from the scene, if possible;
  • Stay in touch with family and friends; and
  • Pair up with another first responder to monitor each other’s stress.

At home, the following actions can help first responders adjust to stressful experiences:14

  • Connect with family, spiritual, and community supports;
  • Keep a journal;
  • Be aware that feeling particularly fearful for loved ones is normal, and will pass in time;
  • Remember that “getting back to normal” takes time and may warrant gradually working back into a routine; and
  • Get plenty of rest and normal exercise, and eating well-balanced, regular meals.

First responders should also monitor their own alcohol consumption levels and be aware that post-traumatic stress disorder (PTSD) can commonly result from experiences on the job.  The recovery community can also emphasize to first responders that behavioral health services are available, should they need them.

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Make a Connection…

Given the critical nature of first responders’ jobs, it is important to be considerate about when to reach out.  The following tips may be helpful when approaching first responders to raise their awareness about mental and/or substance use disorders.

  • Create a list of key individuals representing community first responders that you would like to reach.
  • Diversify your communication efforts to make connections to all types of first responders.  The “New Media Glossary” (http://recoverymonth.gov/Recovery-Month-Kit/Resources/New-Media-Glossary.aspx) or “Develop Your Social Network” (http://recoverymonth.gov/Recovery-Month-Kit/Resources/Develop-Your-Social-Network.aspx) documents in this toolkit provide digital methods of engagement, if necessary.
  • Search online for preferred-contact methods.  Some first responders may not have strict office hours.  However, they may have active social and online platforms that have more consistent response rates.
  • Develop talking points to convey the importance of prevention, treatment, and recovery.
  • Introduce yourself and your role in the community – demonstrate credibility and respect by localizing the issue.
  • Bring a flyer with critical statistics, resources, and your contact information for wider dissemination.  Consult the “Mental and Substance Use Disorders:  Fast Facts” (http://recoverymonth.gov/Recovery-Month-Kit/Resources/Fast-Facts.aspx) document in this toolkit for guidance.  Join a first responder online community, such as the one on firstresponder.gov (https://communities.firstresponder.gov/web/guest/home), to further share your information.
  • Send a thank you letter after you’ve made contact with a first responder and follow up with any information that you said you would provide.

Additional resources for first responders are provided in the “Targeted Outreach Resources” (http://recoverymonth.gov/Recovery-Month-Kit/Targeted-Outreach/2014-TO-Resources.aspx) section of the toolkit.

Inclusion of websites and resources in this document and on the Recovery Month website does not constitute official endorsement by the U.S. Department of Health and Human Services or the Substance Abuse and Mental Health Services Administration.

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SOURCES

  1. United States Department of Labor, Bureau of Labor Statistics. (2012). Police and Detectives. Retrieved on September 9, 2013, from http://www.bls.gov/ooh/Protective-Service/Police-and-detectives.htm.
  2. National Fire Protection Association. (2012). US Fire Department Profile. Retrieved on September 9, 2013, from http://www.nfpa.org/research/statistical-reports/fire-service-statistics/us-fire-department-profile.
  3. United States Department of Labor, Bureau of Labor Statistics. (2012). EMTs and Paramedics. Retrieved on September 9, 2013, from http://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm.
  4. Gallup. (2012). Honesty/Ethics in Professions. Retrieved on September 9, 2013, from http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx.
  5. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (n.d.). Tips for First Responder: Possible Alcohol and Substance Abuse Indicators. Retrieved on September 9, 2013, from http://store.samhsa.gov/shin/content/NMH05-0212/NMH05-0212.pdf.
  6. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. (n.d.). National Take-Back Initiative. Retrieved on September 9, 2013, from http://www.deadiversion.usdoj.gov/drug_disposal/takeback/.
  7. Federal Emergency Management Agency. (2012). Identify Local Partners. Retrieved on September 9, 2013, from http://www.ready.gov/identify-local-partners.
  8. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (n.d.). Psychological First Aid for First Responders: Tips for Emergency and Disaster Response Workers. Retrieved on September 9, 2013, from http://store.samhsa.gov/shin/content/NMH05-0210/NMH05-0210.pdf.
  9. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (n.d.). Psychological First Aid for First Responders: Tips for Emergency and Disaster Response Workers. Retrieved on September 9, 2013, from http://store.samhsa.gov/shin/content/NMH05-0210/NMH05-0210.pdf.
  10. Idaho Department of Health and Welfare. (n.d.). First Responders. Retrieved on September 9, 2013, from http://www.healthandwelfare.idaho.gov/Medical/MentalHealth/ ChildrensMentalHealth/FirstRespondersGuide/tabid/484/Default.aspx.
  11. National Association of State Mental Health Program Directors. (2004). The Damaging Consequences of Violence and Trauma. Retrieved on September 9, 2013, from http://www.nasmhpd.org/docs/publications/archiveDocs/2004/Trauma%20Services%20doc%20FINAL-04.pdf.
  12. Centers for Disease Control and Prevention. (2012). Disaster Mental Health for Responders: Key Principles, Issues and Questions. Retrieved on September 9, 2013, from http://emergency.cdc.gov/mentalhealth/responders.asp.
  13. Substance Abuse and Mental Health Services Administration. (2003). Self-Care Tips for Emergency and Disaster Response Workers. Retrieved on September 9, 2013, from http://www.samhsa.gov/.
  14. Centers for Disease Control and Prevention. (2002). Traumatic Incident Stress: Information for Emergency Response Workers. Retrieved on September 9, 2013, from http://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2002-107.pdf.

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