September 11, 2001, marks the deadliest terrorist attack on American soil. Since this date, terrorist attacks in the U.S. appear to be been on the rise. Terrorist attacks like the Oklahoma City bombing, 9/11, the Boston Marathon bombing and the Orlando Night Club shooting were so horrific we remember them like yesterday.
These domestic terrorist attacks are fresh in our minds because of the continual reporting of stories, sharing of graphic images/video and also because we are still seeking to learn from these horrific attacks to prevent future occurrences. Images capturing desperate people jumping from the Twin Towers to escape immense heat and flames to lifeless children carried from the rubble of the Murrah Federal Building in the arms of first responders are still shared. Video accounts on TV and the Internet, only to be replayed countless times thereafter. They are permanently etched in our minds to be immediately linked to the event.
Side Effects of Repeated Exposure
Repeated exposure to these graphic images, videos and accounts does not affect the social media viewer the same way it does to those who viewed them on the front lines. A once peaceful world is quickly brought into focus once the officer graduates the academy and hits the street. This reality was seen when the Boston Marathon bombing on April 15, 2013, and when Watertown, Massachusetts officers were involved in a shootout with the two bombing suspects on April 19, 2013. MBTA Transit Police Officer Dic Donohue responded as backup and upon arrival, he was shot and critically wounded.
It is not fully known how the aftermath of these attacks will affect our first responders, but there will be both short and long-term effects that are physical, emotional and psychological. In fact, 20 years after the Oklahoma City Bombing, survivors are still coming forward for mental health assistance and “…nearly one in four survivors has markers for PTSD.”
The Critical Incident
Critical incidents are major stressors for law enforcement, according to a 2002 study on “Routine Occupational Stress and Psychological Distress in Police” by Liberman, Best , Metzler, Fagan, Weiss and Marmar published by Policing.
Yet, many officers believe they are fully prepared for whatever the streets throw at them. The truth, however, remains that there is no amount of training, education or life experience that can fully prepare an officer for the critical incident which are, according to Kulbarsh, those “… abrupt, powerful events that fall outside the range of ordinary human experiences.” The critical incident has such a dynamic impact, that regular coping skills no longer suffice, leaving an officer in a downward tailspin. This can seem like a dark, lonely place leaving some to believe they are really losing it or that they may never get better. Often, the officer tries desperately to fix him or herself, often believing they are suffering alone.
First responders are required to deal with death, destruction and human misery. However, there is a difference between dealing with natural versus manmade events, even if both have life-changing outcomes. Terrorists hide behind false narratives, anti-terroristic slogans and deceptive rhetoric. They believe taking the lives of the innocent is justified because of social, religious and/or political injustice. Officer Donohue, like many first responders and survivors of these attacks, are left to pick up the pieces. Sadly, many of our heroes are unaware, at that moment; their own lives have been shattered in some way.
The Aftermath
According to the Occupational Safety and Health Administration the aftermath of the critical incident can present in numerous ways and in varying degrees and severities. This chart below is a compilation of common signs and symptoms associated with critical incident stress. However, this is not an exhaustive list.
| Physical | Cognitive | Emotional | Behavioral |
| Fatigue | Uncertainty | Grief | Inability to rest |
| Chills | Confusion | Fear | Withdrawal |
| Unusual thirst | Nightmares | Guilt | Antisocial behavior |
| Chest pain | Poor attention and decision making ability | Intense anger | Increased alcohol consumption |
| Headaches | Poor concentration, memory | Apprehension and depression | Change in communications |
| Dizziness | Poor problem solving ability | Chronic anxiety | Loss/increase appetite |
The majority of first responders exposed to a critical incident experience signs and symptoms within the first 24 hours following an attack. However, about half will not experience immediate symptomology, but rather, may see noticeable changes days or even weeks after the incident. Some will even experience symptoms years after the initiating event. The lack of immediacy in symptomology can leave many confused as to what is happening or perplexed by the actual cause of the signs being presented.
It has been said that law enforcement must be right every time in regards to terrorist attacks, but the terrorist only has to be right once. The sad reality remains that even one event, like that of 9/11, leaves thousands to suffer. The aftermath still reverberates today. According to the Officer Down Memorial Page, in the 15 years since the 9/11 attacks, 181 officers have lost their lives. Of these, 72 were killed at Ground Zero and 109 have passed away due to 9/11 related illnesses. The number of deaths due to 9/11 related health issues is expected to rise.
Editor’s Note Sept. 11, 2018: According to Dr. Michael Crane, medical director of the World Trade Center Health Program Clinical Center of Excellence at Mount Sinai, the average age of a 9/11 first responder is now about 55. Thousands have died in what are called 9/11-related illnesses. Cancer rates among first responders are 30 percent higher than the general population, as reported recently in the Rockland/Westchester Journal News.
Combating terrorism is a huge undertaking and a fight that will continue for many years. However, we must not forget to protect our first responders in any way we can. Harmful exposure to these attacks can be limited by sound mental health prior to events, training in disaster preparedness, limiting on-scene exposure, maintaining adequate sleep and limiting work shifts, providing critical incident stress debriefings and most importantly providing adequate availability to mental health practitioners and resources.