The influence of organizational support on the life course of
trauma in emergency responders from British Columbia
Adam D. Vaughan, Ciara B. Moran, Laurie D. R. Pearce and Laurie Hearty
Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, New
Westminster, BC, Canada
ABSTRACT
Research has consistently demonstrated that following a response to an emergency incident, first
responders and first receivers, support staff, and civilian responders are likely to experience trauma.
The aim of this article is to explore if the traumatization of emergency responders is influenced by
the nature of organizational support toward the psychosocial recovery of staff and volunteers.
Twenty-two qualitative inter- views were conducted with emergency responders from British
Columbia, Canada. Using content analysis, findings indicate that there are similarities in how
organizational support (or the lack thereof) influences the life course of traumatization. Pertinent
factors include the occupational requirements of each agency, their organizational culture, and the
quality and quantity of policies and practices that place emphasis on well-being. Possible methods
for improving organizational support for emergency responders include providing additional postevent information to responders to permit emotional closure from the event, empowering field
supervisors to provide timely and appropriate treatment options, and lastly, to shift organizational
culture to recognizing and responding to the psychological well-being of staff and volunteers as vital
to the operation of an organization.

Epidemiological research highlights that there is an increased risk of exposure to
trauma when a person responds to a mass casualty or other emergency incident
(Zimering, Gulliver, Knight, Munroe, & Keane, 2006). At times, trauma can be
devastating to the psychological functioning of emergency first responders, with
some reporting symptoms ranging from depression and anxiety through to
posttraumatic stress disorder (PTSD) (Shakespeare-Finch, Smith, Gow, Embelton, &
Baird, 2003). Although not the only psychological response to trauma, PTSD has
been repeatedly shown to be a common psychological diagnosis in police officers
(Haugen, Evces, & Weiss, 2012), firefighters and paramedics (Beaton, Murphy,
Johnson, Pike, & Corneil, 1998), and war Veterans (Orsillo et al., 1996).
In many cases, the impact of trauma has resulted in a reduction in the quality of
occupational performance, increased absenteeism, sleep difficulties, a negative
impact on relationships with others, burnout, and increased sub- stance use, and it
can manifest in psychological symptoms of depression, thought intrusion,
avoidance, and arousal (Sheen, Slade, & Spiby, 2014). The costs for treating or
managing clusters of persons who are traumatized can be exceptionally high for an
employer who may need to provide follow-up services to an individual worker, a
group of employees, and in some instances, their corresponding network of
families and friends (Gorman, Blow, Ames, & Reed, 2011).
The aim of this article is to explore how the traumatization of emergency
responders and other emergency-based personnel (ERs) is influenced by the
nature of organizational support focused toward the psychosocial recovery of staff
and volunteers. Rather than focusing on specific occupations or types of trauma or
events, the intention was to study how organizations provide psychosocial support
to their personnel and volunteers as holistically as possible. The specific focus will
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be to study ERs who respond directly to the needs of casualties or who provide
support services. Although the scale of the event for traumatic incidents often
pertains to natural or human-caused disasters, this study also considers trauma
that emerges from smaller scale or repetitive incidents. A final consideration is to
broaden the prevalent perspective of how trauma is often defined by
organizations. In this article, the definition of trauma is extended from a focus on
specific clinical outcomes to include multiple psychosocial outcomes that may be
caused by direct or indirect traumatization.
Literature review
Impact of trauma—A psychosocial approach
In recent years, the increase in the social and political awareness of the prevalence
and impact of PTSD on emergency responders and military personnel has
generated much discussion regarding the degree of emphasis organizations place
on psychosocial recovery following a traumatic incident. This increased awareness
has led to multiple studies that explore the pathways of trauma within specific
incidents (e.g., post-event responses to natural disasters or terrorist attacks). For
various practical and methodological reasons, these studies tend to focus on
specific groups of responders/receivers (e.g., police or paramedics) as their roles
during an incident are likely to be unique to their profession (Styra et al., 2008).
Recently, researchers have begun to explore the impact of trauma affecting
different service providers, some of whom will be paid professionals, some who
will be volunteers from recognized governmental or nongovernmental
organizations, and yet others who will be responding civilians (Neria, DiGrande, &
Adams, 2011).
When ERs respond to a traumatic event, their occupation or volunteer role can be
rudimentarily placed into three categories: (1) first responders and first receivers,
(2) support personnel, and (3) responding civilians. First responders and first
receivers provide direct support in the immediate aftermath of an event. First
responders consist of police, fire, and paramedics, whereas first receivers are
those who work in hospital settings such as triage nurses and emergency room
physicians.
To ensure that initial and continued emergency services to casualties are effective,
a second group of service providers is often involved. Several examples of support
teams who may be exposed to trauma include persons responsible for clean-up
and repair (Stellman et al., 2008), relief services (Simons, Gaher, Jacobs, Meyer, &
Johnson-Jimenez, 2005), journalism and mass communication (Feinstein, Owen, &
Blair, 2002), health care (Styra et al., 2008), and social work services (Bride, 2007).
Because support teams provide qualitatively different services from first
responders and first receivers, their trauma is likely to be indirect. For example,
trauma may be considered indirect when groups of health care professionals
witness or listen to an account of a traumatic event from an individual or a number
of individuals who have been directly affected (Sheen et al., 2014). Differentiating
between indirect and direct traumatization has its challenges as occupational roles
may vary within a given event or various events.
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A combination of the scale, frequency, and location of the incident, as well as the
availability of resources and trained staff, may lead civilians to emerge as de facto
ERs (Lay, Allen, & Kassirer, 1974). Civilian responders historically have been
effective at providing emergency services ranging from small-scale events
(Venema, Groothoff, & Bierens, 2010) to mass casualty incidents (MCIs)
(Ashkenazi, McNulty, Marcus, & Dorn, 2012). Much like first responder/receiver
counterparts, civilian responders may be physically harmed during the incident
(Harrison, 2006). However, for some civilian responders, there is an added burden
of anxiety, guilt, and depression when their efforts are associated with the
handling of the deceased; when there is large-scale property damage; or when
casualties and fatalities are known to the civilian responder (Perry & Lindell, 2003).
It is thus plausible that civilian responders may be more vulnerable to trauma
because of their dual role as de facto ERs and as residents in the local community.
The context of a traumatic event can also dictate the proportion, population, and
severity of injury to ERs. For instance, the life course of trauma has been studied
following military combat missions wars (Cesur, Sabia, & Tekin, 2013), terrorist
attacks (Neria et al., 2011), natural disasters (McCanlies, Mnatsakanova, Andrew,
Burchfiel, & Violanti, 2014), and health epidemics (Styra et al., 2008). In some
cases, a distressing or critical event may be much smaller in scope and involve
fewer casualties yet result in significantly acute and, at times, long-term chronic
psychosocial consequences for ERs. For instance, paramedics who work in highstress settings have increased levels of anxiety, impaired memory recall, and
physiological increases in cortisol levels (Leblanc et al., 2012). The notion that a
traumatic event (or series of events) can result in a battery of co-occurring
psychological and physical illnesses is of concern as the symptoms can manifest
indefinitely following a traumatic event (D’Andrea, Sharma, Zelechoski, &
Spinazzola, 2011).
Recently, researchers have begun to consider the impact of trauma across
different occupations involved in the same event. Using a meta-analytical
approach, Neria et al. (2011) tracked the prevalence of PTSD among clusters of
first responders, repair crews, support workers, and other persons with high
exposure to the World Trade Center terrorist attacks and who had a high likelihood
of developing PTSD. Findings indicated that those exposed to the event
experienced several other adverse psychological outcomes in the years following
the attack such as major depressive disorder, generalized anxiety disorder, and
severe forms of grief. Neria et al. (2011) also found that the impact of PTSD was
comparable across most ERs that worked following the event, and that ERs had
other psychological symptoms that were symptomatic of PTSD (e.g., invasive
images, being overwhelmed, and difficulty sleeping). Further research indicates
that PTSD can also be associated with other conditions such as substance use,
elevated shame, physiological symptoms, interpersonal problems, tendencies
toward violent behavior, and other psychological disorders such as depression,
conduct disorder, and mania (Javidi & Yadollahie, 2012). Although PTSD is
associated with traumatization, clearly it is not the only psychosocial outcome.
Research indicates that when some first responders are exposed to traumatizing
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events there is a high degree of correlation with worker burnout or cumulative
stress (Mitani, Fujita, Nakata, & Shirakawa, 2006). Similarly, support workers,
Disaster Psychological Support service (DPS) workers, or anyone else who may
experience secondary traumatic stress or compassion fatigue may experience
general burnout and reduction in work quality, increased absenteeism, and staff
turnover (Figley, 1995). Thus, if one sub- scribes to the notion that the cause (i.e.,
indirect vs. direct) and effect of traumatization has some degree of consistency
across ERs, then it is worth exploring how organizational practices influence the
life course of trauma.
Coping with trauma
Responders can be affected either during or after an incident. Jensen (2000)
suggests organizations can reduce the physical and psychological impact by
providing workers with coping mechanisms before, during, and after exposure to
the traumatic incident. Regardless of when the training is implemented, there are
two critical organization facets that need to be considered to maximize the
likelihood for recovery. First, it is important to consider that even in a single event
there will be variances as to what elements caused the trauma, individual coping
mechanisms, and individuals’ previous experiences. These factors will shape how
they interpret the current incident or series of incidents. Second, Jensen (2000)
stresses that mitigation programs need to be supported by rank-and-file staff,
middle-management/supervisors and administrators, as well as by other front-line
staff. Organizations that recognize there are three points in time where they can
provide support for coping strategies to their staff, and that there will be the
variability among the resilience and coping levels of their staff will be, in theory,
better positioned to support and treat their staff when traumatization occurs.
Rather than focusing on the efficacy intervention for pre- and post-event
traumatization, (as has been well studied in the literature), the aim of this article is
to study the role of organizational support, or the lack thereof, as a conduit to the
psychosocial well-being of ERs. As Bloom (2010) indicates, when the workplace is
chronically stressed and there are untreated traumatized staff, frustrated
administrators, and pressured organizations, the occupational setting can be as
toxic as a traumatizing event or series of events. For instance, these organizations
often have significant breaks in communication between staff and respond to
subsequent stressors by becoming more rigid and authoritarian. Bloom (2010)
further indicates that these work environments can lead to unresolved grief,
burnout, and an atmosphere of demoralization and depression. Exposure to a
traumatic incident, coupled with chronically stressed occupational environments,
creates a nexus point that has the potential to generate exponentially high levels
of occupational stress in ERs.
To improve organizational responses, Bloom (2010) proposes an approach known
as the “sanctuary model.” Bloom’s (2010) framework recognizes that to effectively
respond to persons who are individually traumatized, organizations need to be
actively creating and maintaining a therapeutic and trauma-informed culture
within the workplace. To create healthier work environments in which individual
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treatments can be less coercive and more effective, organizations should support a
culture of non- violence, increased emotional intelligence, and open
communication. In addition, Flannery (2015) suggests that treatment methods
should be multifaceted in nature as there is no one standardized and effective
approach. Each person who is affected will require a separate assessment, and
various treatment needs must be grounded in the major tenets of trauma
informed care for ERs.
The degree of organizational support for the psychosocial well-being of staff
before, during, or after an event is likely to vary across and within organizations.
Given the array of tasks associated with responding to an emergency and the
different management styles within each agency, it is reasonable to believe that
there may be a narrative, or series of narratives, that describe the strengths and
weaknesses of how each organization approaches the provision of support services
for those affected by a traumatic event. Therefore, it is posited that creating and
maintaining an organizational culture of respect for the psychosocial well-being of
all personnel before, during, and most importantly, after a traumatic incident, is
crucial in reducing the longitudinal impact of trauma and improving the social wellbeing of workers and volunteers.
Method
This study explores how organizational support affects ERs who recently
experienced work-related traumatization. To enable cross-comparisons to be
made between agencies, a variety of ERs were interviewed to better understand
how their employers responded to their needs before, during, and after a single or
series of stressful incidents. To develop an understanding of how organizations
operate within this domain, paid ERs and volunteers were asked a series of
questions that focused on the life course of their trauma. Because the subject
material may have elicited responses and memories that could trigger a
reactivation of the stress response, a protocol was in place to have the Disaster
Psychosocial Program (Provincial Health Services Authority, 2015) provide
confidential psychosocial support to any participant in the study. Contact details to
these support services were provided in the consent form and through an
information pamphlet that was handed to each participant at the end of the
interview.
To inductively explore differences among organizational response to trauma,
qualitative interviews were chosen as the most appropriate medium of data
collection. Interviews were semistructured to build a rapport between the
interviewer and the participant in order to thoroughly explore the concept of
trauma within the context of organizational support. Table 1 displays the
semistructured interview guide.
All interviews were audio-recorded and supported with notes. In most cases,
interviews took place in-person at the participants’ office during office hours.
Because of distance and scheduling difficulties, some interviews were conducted
via telephone after office hours. Recordings were transcribed verbatim following
each interview and verified before analysis. The precepts of conventional content
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analysis (Hsieh & Shannon, 2005) were used to analyze the data. In the absence of
predetermined hypotheses about participants’ experiences with trauma, the first
author completed a three-stage inductive coding technique to make inferences
about the life course of trauma experienced by and among participants. In the first
stage, all transcripts were read by the first author to capture an overall
understanding of the breadth of data
Table 1. Interview guide.
Introduction (read by interviewer):
I understand that you have experienced a multicasualty incident or traumatic, I’d appreciate you
sharing your best recollection of this event. Our intent is to provide concrete input into research to
increase the knowledge and inform the practices of first responders and psychological personnel
tasked with responding to a multicasualty incident or any other similar emergency incident.
Questions:
What do you remember most from that experience?
Please tell me in a chronological way what happened during this incident. What happened first?
Before this incident, did you have any information or training that would prepare you for it?
What was the most difficult part of the incident for you?
Where did you receive the most support during the incident?
What strengths did you draw on during the incident?
What other supports would you have liked to receive during and after the incident?
What would you like to tell people who respond to multi-casualty incidents about the needs of the
person involved in or impacted by the incident?
What would you like to tell someone who might be involved in a multicasualty incident?
What else would you like to say about the development of multi-casualty incident protocols or the
kinds of supports that should be available to those who are experiencing them?
Is there anything else you would like to add?

contained in the interviews. A series of holistic open codes were identified and
provided to the second author to be reviewed again within the transcripts, line-byline. Once all transcripts had been coded a second time, the two coders convened
to compare notes, themes, and other observations in the data. This was an
iterative process of discussion that also included input from the third and fourth
authors of this study.
Participants
The stigma that often surrounds the discussion of trauma in the ER populations
meant that it would likely be difficult to sample participants using traditional
probabilistic methods. Instead, snowball sampling was chosen as it is traditionally
used to study vulnerable, hidden, or difficult-to-access populations (Palys &
Atchison, 2008). The snowballing process began with the third author acting as the
gatekeeper to several ERs with known experience in high-stress trauma events.
Qualifying events included, but were not limited to, plane crashes, mass shootings,
mass gatherings/riots, and natural disasters, such as landslides, floods, and forest
fires. Other, more commonly occurring events, such as suicides and attempted
suicides, major motor vehicle accidents, and apartment and house fires, were also
included. These initial participants completed a semistructured interview (Table 1)
and at the end of the interview, were asked to identify/recruit any of their
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colleagues who were also employees or volunteers who responded to emergency
incidents and were believed to have had some exposure to a traumatic event.
To ensure that referred participants qualified for the purpose of the study,
participants were asked to self-report their experiences with MCIs, and other
trauma-related events. The nature of the psychosocial impact that resulted from
the incident varied among participants, with some indicating formal psychological
diagnoses such as depression, anxiety, and PTSD, whereas others referred to
challenges at work (e.g., absenteeism, reduced productivity), substance use, and a
variety of social challenges (e.g., difficulties with family and friends) that they felt
were in some way linked to their exposure. Participants identified the sources of
their trauma. The cause and effect of their trauma was not verified by researchers.
For example, if a participant indicated that he or she had PTSD or had difficulty
sleeping after an event, this was assumed to be true as the overall intention of this
study was to better understand organizational support systems and not individual
symptomology.
Snowball sampling resulted in a total of 30 interviews with participants from North
America. In an attempt to analyze responses within a comparative response and
legislative framework, the focus centered on 22 participants from British Columbia.
The final sample consisted of female (n = 11) and male (n = 11) participants: police
officers (n = 8), clinical and social service providers (n = 5), civilian responders (n =
4), fire and res- cue services (n = 1), emergency communications (E-COMM) (n = 1),
ambulance services (n = 1), the media (n = 1), and hospital first responders (n = 1).
Although they may have changed jobs since the traumatizing event, participants
were able to recall the factors surrounding the event and the degree of support
they received. Interviews lasted between 60 and 90 minutes. In some cases,
participants were interviewed a second time to add clarity.
Coding procedure
There were three iterative rounds of coding. Using the original transcripts, the first
round of coding consisted of extracting individual quotations from the transcripts.
These quotes were then categorized into 12 codes based on the number of
questions in the interview guide. In the second round of coding, the first and
second author compared notes and quotes, and it became readily apparent that
the original 12 codes could be aggregated into four broad themes. These themes
were (1) the psychosocial impact of working in a MCI, or a traumatizing event; (2)
organizational and personal approaches to trauma management; (3) current
practices and programs for trauma recovery; and (4) recommendations for
improving trauma management or the recovery process. Individual quotations
from the first round of coding were placed within these four themes. A third round
of coding focused on making connections between the initial codes and the overall
aim of the study, namely organizational support. For all rounds of coding, the data
were analyzed manually using Microsoft Word and Excel.
Results
Using the selected quotations and notes from the first and second round of coding
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the nature of the organizational support participants received emerged as the
overarching theme. Two subthemes of organizational culture and organizational
policies and practices also emerged from this data. This section then compares and
analyzes the results of these findings across the responding agencies.
Organizational support
In one form or another, all participants associated the impact and process of
recovering from a traumatic incident with the degree of organizational support.
Organizations that recognized the importance of providing services to their staff,
or organizations that recognized the need to identify traumatized persons early on,
were more valued by participants than those working for organizations that did
not provide any degree of proactive or reactive services, or where the accessibility
to services was limited or cumbersome. Some ERs suggested that a lack of staffing
and availability of resources may play a role in creating a workforce that is more
likely to be exposed to trauma:
We were short that night and you’re sort of scrambling to figure out who is going to try
answer those calls because somebody has to … take that call and that’s really
stressful. Just making those decisions where you’re like, you know that not all, like, 15 calls
holding are about fire and there’s somewhere another emergency. (P25)

In another example, working a double shift, or shift work in general, was regularly
mentioned as a precursor to negative psychosocial outcomes:
That’s what happened to me in the [name deleted for confidentiality] case, where the
incident was over at 10 o’clock in the morning and then the member was off for two days
and on no sleep. And then you’re trying to process what happened
through social media. That happen [sic] to shift workers. That’s why I think it needs to
change … we are not bankers … now you have a shift worker and, [that is] a
huge thing that affects the way you respond to critical incidents after the fact.... So, a lot of
people, especially newer members, they don’t know how their body’s going to react. You
know, they don’t know mentally how they’re going to react. (P18)

For those involved in media and communications, the manifestation of trauma
may come as a surprise and after a prolonged time of exposure. As the reporter
indicated,
When I was covering [a Provincial Inquiry into a multiple murder case], I was getting pretty
emotional with some of the stuff that I was covering. I couldn’t understand why I was
snapping at my sister on the phone one day and I was, like, oh I didn’t realize I was in such
a bad mood. (P13)

Organizational culture
According to some participants, organizational culture could lead to an increased
likelihood for workers and volunteers to be traumatized. Organizational cultures
that overlook the symptoms of emotional strain were often cited as being
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antitherapeutic:
Cops basically have one of two options – either they can break down and cry or they can
tough it up and laugh it off. There is no in-between with policing when you’re seeing dead
bodies, you’re making death notifications. You know one call, I went to the call, I saw the
person die, I had to tell the other person, the relative that he died. I had to go to the
autopsy. You know throughout all that, sure it’s terrible for me but my choice is: either I
break down and cry or I tough it up and kind of laugh it off or whatever. Where firemen,
they don’t get involved in those things and they’re emotional train wrecks. (P4)

Many participants were unable to share their experiences with their family or even
with their colleagues. The outcome of this approach could strain interpersonal
relationships.
It’s what we call Ambulance-induced divorce syndrome. We call it AIDS, right? But a lot of it
is, you get into those situations with people like that and you’re working around that with
another partner, or the other crew is a member of the opposite sex. Also, you have this
bond, right? And it certainly has affected more than one marriage in this job, you know?
(P2)

In other cases, participants recognized that there was an increased desire to make
their colleagues aware of the potential for PTSD and other adverse psychosocial
impacts associated with traumatic incidents. Though this was not a common
theme in the interviews, one senior police officer indicated:
It’s creating an awareness of the importance of … what a debrief is all about, what critical
incidence is and isn’t, and the fact that post-traumatic stress and emotional trauma don’t
show up as a black eye, as a bruise, as a cut finger, they show up as I need a couple of days
off, or I need five minutes parked up on 12th Street before I go to my next call right? And
the system is so go, go, go, that we tend to forget the importance of that. (P3)

Organizational policies
Job or volunteer requirements tend to constrain how personnel respond to the
incident, particularly when it comes to decisions surrounding safety and security.
As a consequence, these policies can lead to increased anxiety among incident
commanders and trickle down to front-line ERs. Policies surrounding how staff and
volunteers respond to a traumatic incident became a regular discussion point in
the interviews. Participants often perceived policy as important while being limited
in real-world settings:
One of the biggest emotional challenges to an incident commander is, slow down, stop,
let’s make sure what we know before we rush in, or that the worst decision we could
possibly make is “Guys, we’re not going in.” That person is going to be an unfortunate
fatality, but we cannot add to the fatality list … and that’s a very difficult decision that
people have to make. And that’s a very difficult for the public to understand (P24)

In other cases, it appeared that adhering to pre-defined protocols and procedures
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during an incident were paramount to mitigating or reducing trauma. As one police
officer indicated:
The call at [a hotel] where we were dealing with a very acutely suicidal subject was
completely different. The team was operating and functioning at the highest level. There
were many points at that call where I thought we’re likely going to lose this guy because he
seems very committed to dying, and it would’ve been sad, tragic, but I would’ve been ok
with it. It would have been his decision because I was very confident that our team could
not have done anything more, could not have functioned better. (P27)

Policies for follow-up treatment are usually up to the discretion of administrators.
However, the identification of the events and personnel for debriefing and other
support was often the responsibility of immediate supervisors. Participant P5
described an incident where his colleague was providing surveillance on another
vehicle with known criminals “likely wanting to do a drug drop … pulled up beside
the police car … and pulled a loaded firearmand pointed it at [his colleagues] head.
[His colleagues] didn’t want to blow surveillance [so] they just booted out of
there.” After the incident, the participant reconnected with his colleague. As part
of this discussion, he asked his colleague to:
do me a favor and I’m not asking – I’m telling you. I need you to go see one of our
psychologists just to discuss it. Like one session, two sessions, whatever it takes just to
discuss it, get it out in the open. And he actually did and then he came back about two
weeks later and said “thanks for the conversation because I didn’t see it at the time but in
talking about it, I realized everything that was going on.” (P5)

Interestingly, P5 could not force treatment because “the OIC [Officer in Charge]
has to do it.” This phenomenon of relying on upper management was highlighted
by other participants. On the topic of providing more psycho- social support for his
coworkers, a dispatcher indicated,
I don’t really have any sense about how much I should be pressing the battalion chief
because, technically everything is his call. So, you’re trying not to get in the way, and if he
actually has somebody injured the last thing he need is, “is he ok, is he ok” in his ear. That’s
the last thing he needs and we know that, but we can’t tell if he has heard us, if he is taking
it seriously, if he understands what is happening. There’s no button that’s like, “I’m
handling it. I’m on it.” (P26)

Communication staff and front-line ERs commonly reported observing stress and
strain in their colleagues. The ability of some ERs to observe the psychosocial wellbeing of their colleagues and to check-in on them was a remarkable showing of
psychosocial awareness. However, because they lacked the necessary decisionmaking power; observing the impacts of stress and connecting them with the
trauma are often done independently of the formal organizational response to
traumatic incidents. Often times, front-line workers and volunteers felt these peerto-peer approaches were necessary as administrators may have overlooked the
10

emotional issues facing their staff in lieu of other pressing issues such as the
tactical deployment of resources during an emergency.
Policies for information exchange between and within agencies tend to be less of a
concern for agencies that have ownership of the information or those that
disseminate information to their staff in an open and transparent fashion. On the
one hand, police, fire, and ambulance workers all tend to possess key pieces of
information, or have the ability to readily access this information. However, their
ability to disseminate this information may be strained when communicating to
casualties and family members associated with an event:
How do you not say the wrong thing? You may be giving out information that might not
necessarily, or should not necessarily, be given out. It is always in the
back of your mind; you’re always worried about releasing information, so … I continuously
tell new recruits “Don’t do anything that you wouldn’t feel comfortable seeing on tonight’s
news and don’t say anything that you don’t feel comfortable being quoted in the
newspaper” [for]—that adds another level of stress—those are the things that can truly
end a career. (P24)

Support staff may not be provided with timely access to additional information or
processes to correct misinformation about the emergency event. As P26 explains:
One of the guys I work with is still super-traumatized by a death of a guy in a vehicle fire
that was totally not his fault [because the] caller gave him the wrong address. He went
through those tapes a million times which is how we know he’s still not ok, [and he] still
listens to those tapes sometimes.

Perhaps the most obvious group where access to information is extremely limited
is when an emergency incident involves civilian responders. Following a traumatic
incident involving a plane crash with multiple fatalities, a civilian responder was
not affiliated with an emergency organization, and consequently her narrative
highlights the lack of occupational resources available to her immediately following
the event:
I needed closure. I need something to say I could leave, and I don’t even know what that
was, but it just that I was physically stuck there, just this weight of needing to be there until
something else. I don’t know if that was sharing our story, or, it’s not acknowledgement,
that actually makes me cringe. It was literally having to impart what we had just seen, that
there was enough information that we had to share. (P22)

Comparisons across agencies
Notwithstanding the individual differences among various participants in this
study, their occupational responsibilities, and the variability in emergency
incidents that were associated with trauma, several participants in this study
suggested or made direct reference to their employer as playing a substantial role
in the trajectory of their trauma. At the most basic level, it appears that how an
organization considers, or frames, the psychosocial well-being of its employees
11

and volunteers can lead to drastically different outcomes in regards to the
likelihood for exposure to trauma, the severity of symptoms, and ultimately the
duration of trauma. More specifically in this study, how an organization responds
to the psychosocial needs of its staff and volunteers was primarily, though not
exclusively, a result of the occupational demands placed on the agency, the
organizational culture, and its policies. These responses may mitigate, aggravate,
or have no perceived impact on improving the psychosocial well-being of its
employees.
Taking these factors into consideration, rudimentary comparisons between
different organizational support models intended to address the psychosocial
needs of ERs may be made. Table 2 summarizes how participants estimated the
strength of organizational support toward traumatization. Because each class of
EW contained an array of personnel, participant narratives varied. That being said,
the degree of organizational support between groups is intended to illustrate the
variance in levels of support as indicated by the perceptions of participants. The
results here should be interpreted as a guide to give context to other findings in
this paper.
Although there were only three civilian responders in this study, their narratives
reflected limited organizational support following exposure to their traumatizing
event. In the absence of support, civilian responders were left to their own social
support networks and abilities to pursue their own treatment regime. This
approach is understandable as the trauma for the three participants in this study
occurred outside of their place of employment. On the other hand, organizations
with strong support for psychosocial well-being of their staff or volunteers were
coincidentally agencies that actually provided psychosocial services to the ERs
impacted by a traumatic incident. These groups tended to have a culture of
proactively supporting their volunteers and recognizing the symptoms of stress
and strain during the course of their work.
Table 2. Levels of organizational support by class of emergency responder.
Organization or group of participants
Civilian responders
First responders/receivers
Support teams

Weak
X

Level of organizational support
Average
Strong
X
X

X

It is also worth noting that a substantial proportion of volunteers from DPS have
clinical training in social work, psychology, or a related field. Having these skills
embedded in various points of contact in the organization may help buffer the life
course of indirect traumatization and reflect the precepts of three points in time
where organizations can provide support or training to enhance coping (Jensen,
2000). For other supporting agencies, the degree of post-incident support can vary
as the ability to access pertinent information to obtain closure was perceived as a
significant challenge and, at times, resulted in additional stress and strain.
Lastly, a commonality among first responders/receivers was a heavy reliance on
12

debriefing programs and other post-event services. For the most part, participants
did not mention that their organization provided them with pre-event or proactive
services (e.g., resiliency training). In the rare case where prevent services were
provided, these programs appeared to be marginally effective because the
overarching cultural norms within some organizations often do not encourage
recognition and timely response to psychosocial stress and strain.
Recommendations
Given the open-ended structure of the interviews, the participants were asked to
suggest possible methods for improving organizational support for front- line staff
and volunteers who have been, or could be, exposed to a traumatic incident.
Though some of the recommendations made by participants were specific to
typologies of treatment (e.g., increasing the availability of post- event programing),
there were three general recommendations to improving organizational support:
(1) establish closure, (2) empower immediate supervisors, and (3) change the
organizational culture.
Establishing closure
For some ERs, it is vitally important for their psychosocial well-being to be able to
compile all available information pertaining to a traumatic situation they were
involved in, to process this information, and to consult with clinical professionals
and their colleagues to be able to move on from the traumatic event. Closure
proceedings, or initiatives, can be informal such as a peer- to-peer or informal
networks, or formal proceedings:
some workers will be unaware that they have been traumatized or will make attempts to
hide their symptoms. You know during my debrief it came out that one of the fire guys was
holding a rag on the heart. That’s the trained critical incident stress management team
connecting the dots. That’s more practical and you know you’re getting, for the first
responders you’re getting the connection. (P2)

In this example, the debriefing helped the fire department generally, and the
critical incident stress debriefing team more specifically, to identify that a worker
was concealing his traumatization from the incident (i.e., the rag on his heart) from
his colleagues.
The dissemination of relevant information to ERs is also vital to establishing
closure after an emergency incident. Some ERs actively seek this information on
their own, whereas others will demand it from their employer. For some ERs, the
challenge of obtaining this information can be overwhelming:
… from a closure perspective, from a psychological trauma healing perspective, having the
ability to give people information so that they can move forward so, you know, counseling
services and victim services.... But then again, I think that that’s a really important aspect,
so that they’ll take it away and, you know, chew on it too much; but then, there’s also the
being able to get closure. You know, what happened to the person; did the person live, or
die? (P7)

13

Immediate supervisors
The findings in this study appear to indicate that upper-level management, union
support, and health and safety legislation are integral to the amount of
organization support for well-being of staff. However, given the limited recognition
of psychosocial trauma by legislators and administrators, this “top-down” push to
change internal policies will likely be limited for years to come. However, if one
considers the push to changing organizational support as a bottom-up initiative, or
as initiating from front-line staff, then immediate supervisors can be instrumental
in changing the organizational culture. More specifically, supervisors need to know
their team, be proactive at providing services before an emergency incident
occurs, and be flexible in making a variety of services available to staff. How
policies and procedures become formalized is “up to the supervisor. The
supervisor should know his team and how much it affected them. It might take a
day or week to find out was that really a big deal?’” (P4)
Specifically referring to the provision of time away from work to promote recovery
from an incident, the participant added:
[Leave] should be available and flexible [to the ERs]. The best one to authorize it would be
your low line-level manager because they should know their people. The upper guys,
sometimes there’s politics involved and they’re chasing things. But the line managers
usually care for the individuals and they typically were peer people and they’re senior,
more experienced. They’re almost like your dad or your mom, these guys. And they usually
care about their people, and there’s usually a bit of respect there too. (P4)

Proactive approaches were a rarity in this study. However, several participants
indicated that they see a major benefit in developing self-resiliency and improving
the well-being of staff. One suggestion was to encourage ERs to take time off
work/sick leave when they are mentally unwell,
We rack up so much sick hours and we never use them and when we need them at the end
of our career … those sick bank hours just disappear. There’s no reward in
that. I have 2,000 sick hours right now and never called in sick. And yet, I would really
think, if we could do it, it would be so beneficial to take a mental health day and use our
sick bank because I just need to take care of that stress bucket. (P25)

Changing the culture
For some organizations, the culture for recognizing and responding to the
psychosocial well-being of the staff and volunteers was omnipresent not only
during traumatic incidents but also when carrying out everyday tasks. On the other
hand, other organizations appeared to place less emphasis on the emotional wellbeing of their members. Although some organizations appeared to have stronger
support programs in place, there was room for improvements in each participant’s
organization. Cultural awareness and recognition needs to start in recruitment,
continue into training, and carry on throughout one’s career. These shifts in the
focus on the psychosocial well- being of ERs do not need to be dramatic; rather, as
P18 suggested, “in police work you go from those hard-nosed cops 20 years ago to
14

how we are now. Those best practices evolve [and] something that might work
today could work better tomorrow.”
Flannery’s (2015) multimodal model recognizes that psychological trauma affects
multiple domains of mastery (i.e., the capacity or skills to shape and influence daily
events insofar that results are advantageous) resulting in a variety of clusters of
symptoms. Participants in this study also indicate that education, treatment,
preventative programs, and other services need to be multifaceted, made widely
available, and absorbed into cultural practices. However, some ERs were hesitant
to pursue post-event treatment because of the stigma that surrounds some
services. The perception of psychiatrists and psychologists was not always positive,
“I’ve never used a quack or a psychologist. I don’t want to go to psychologist and
sit in his office and talk to him about my feelings. I just don’t feel comfortable with
that” (P4). As a counter argument to this perception of clinical treatment, P4
indicates that consulting with peers was more helpful in terms of providing
information and recovering from trauma as external clinicians are not well
informed of the nature of working as a first responder. One potential way to
address this is to promote, or make available, informal approaches as a way of
breaking down silos of communication about trauma within and between
organizations:
I think a lot of it is facilitating informal networks, not just training. But people, when they
get together like you learn so much by a person by seeing them and having coffee with
them or breaking bread with them, right. I’ve got nothing but great respect for firemen,
even though you know it’s a different job. Same with the ambulance workers, right. So that
was all done informally. (P4)

Conclusions
The results from this study suggest that organizations would be benefit from
creating and maintaining a work environment that recognizes the importance of
the psychosocial well-being generally, while also more specifically helping staff
recover from a traumatizing incident. Exactly what this support looks like will be
unique to each agency. However, to ensure there is some degree of consistency
between emergency organizations, changes in policy (particularly at the state and
federal legislative level) may need to hold organizations more accountable so that
psychosocial rights are considered comparable to other legislated health and
safety policies.
As with any study, the current study is not without limitations. Although the
sample of ERs covers multiple agencies, it is possible that additional interviews
with other workers from other agencies that respond to emergencies in British
Columbia may have resulted in different trauma narratives and associations with
organizational support. As such, the representativeness of the sample used in this
study may not be generalizable to other ER populations outside of British
Columbia. Secondly, the recommendations for improving organizational support
were generalized to all participants in this study. Realistically, some suggestions
will be limited in terms of applicability to different groups of ERs, particularly
15

civilian and other de facto ERs.
The results of this study present many possible avenues for future research, two of
which appear to be a natural progression from the present study. The first involves
a more detailed analysis of the similarities and differences in organizational
support toward psychosocial well-being among ERs. That is, identifying the specific
formal and informal policies that are currently being used in each agency and
calculate the degree of organizational support that exists. The second avenue
would be to test if changes to organizational support through culture shifts,
developing insight and support from middle-management, and overall policy
changes, result in improvements in the psychosocial well-being of persons who
have experienced traumatizing incidents.
Acknowledgments
The authors wish to acknowledge the support of co-principal investigators Colleen
Vaughan from the Justice Institute of British Columbia and Robin Cox from Royal
Roads University.
Funding
This research was supported by funding from the Canadian Safety and Security
Program, Centre for Security Science, Defence Research Development Canada and
Project Champion Health Canada.
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