Photos by Jim Macmillan, Philadelphia Daily News. The photo to the right is an award winning picture of dawn breaking over the ruins of the World Trade Center on 9/12/01.
"Courage is not the absence of fear, but rather the judgment that something else is more important than fear."
Ambrose Redmoon
Rescue Workers
For the purpose of this article, rescue workers are defined as emergency service professionals (law enforcement, fire fighters, paramedics and EMTs, health care professionals and search and rescue teams) who respond to disasters. The traumatic incidents involved in rescue work can be similar to some found in the fire service or law enforcement. However, the way in which rescue workers are being used seems to have dramatically changed in that they respond to many more man-made disasters and remain on site for longer periods of time than those caused by nature.
Thirty years ago, the debris from a disaster or plane crash would probably have been bulldozed, after it was clear that there were no survivors (those in the ocean would have remained there). However, as advances have been made in evidence collection and identification of human remains, so has the response required of rescue workers. In major disasters, following the immediate stages of removing the injured and easily accessible bodies, rescue workers often remain at the scene for months. As they painstakingly search through rubble for evidence and body parts, rescue workers are exposed for extended periods to the most vile and horrific of scenes, smells, etc.
Zettl (1998) found that one of the ways rescue workers balance the traumatic incidents involved in their jobs is through saving and rescuing citizens. In contrast, as rescue workers act as evidence technicians, searchers for body parts, and what may seem at times like garbage collectors, there are few, if any, rescues of survivors. Furthermore, when working disasters, shifts of twelve or more hours, with no weekend breaks, are common. Working a disaster site may also involve travel far from home, which deprives workers of the social support typically available from family and friends. Warning signs that a rescue worker is becoming traumatized by their work include: inability to disengage from the rescue work, irritability, inability to relax and difficulties communicating with others” (NCPTSD, 2002). The reaction of rescue workers during this time have been compared to those of peacekeepers in hostile situations of foreign countries, i.e., increased use of alcohol, problems in sleeping, and increases in anxiety (Mehlum, 1999).
Incidents most likely to traumatize Rescue Workers:
Rescue workers often become very traumatized through working bomb scenes and other disaster sites. Nineteen percent of Rescue Workers serving at sites following the 9-11 attacks have been diagnosed with PTSD in the two years following this tragedy. The following events and quotes have been taken from traumatized Rescue Workers who had worked in numerous rescue efforts . These events, commonly and predictably induce symptoms of PTSD in Rescue Workers.
Witnessing a Death:
If the death was violent/body torn apart:
“I had just gotten to the hotel; it was in flames. The hotel management had locked the doors because of the casino. I found out later there were over 500 people locked inside. They were crawling out the windows, they were running, they were screaming. Suddenly, a giant fireball exploded. I watched it burn the people in the windows into black distorted forms. The people who were running inside were stopped in their tracks. The screaming coming from inside stopped. When I saw the bodies later, they didn’t look human. It was horrible.”
“We were outside the building, when it started to collapse. People started jumping out the windows to their deaths. One fell right in front of me. I saw his face right before he hit the ground. I’ll never forget it.”
If a victim died in their arms:
“The guy ran out of the building; he was burned and bleeding. I held him; he knew he wasn’t going to make it. He looked right into my eyes and said, ‘Promise me you’ll tell my wife I love her’. I promised, but I don’t want to do it.”
If the victim is a peer… a fire fighter; police officer; paramedic:
“We had a kid working with us whose father had been a fire fighter for years. He was just out of high school. He got in the burning building where the smoke was thick and forgot everything I taught him. Instead of crawling on the floor, the kid panicked and tried to run out. The smoke got him. When I saw his body, I started to cry. I had to tell his old man that his son was dead. I trained him; it was my fault he died. I didn’t do my job.”
Finding bodies, pieces of bodies:
Fellow rescue workers who have been killed:
“I was pulling debris off the body. Then I realized it was John. I almost threw up.
If the body is of a child, particularly if the worker has children the same age:
“I saw the bodies of the babies; they were lying there bleeding and pale. My son is that age. How can anyone kill babies? I started thinking, ‘What if I lost my son; what if my son had been killed?’ I drive myself crazy with my thoughts.”
If they know the family/were friends with the victim:
“I had to go into that room and take John’s body out. I didn’t want to go in there, but I didn’t say anything. John and I have been friends for years. He was blown into pieces. The only reason I knew it was him was the spot on the back of his head. I keep seeing his head with his face blown off. I can’t even look his wife in the face.”
Experiencing guilt or shame following the death because:
- The dead person was a peer who had temporarily replaced them on the job.
- They were unable to rescue the person.
- They had a disagreement with the person who died just prior to their death
“I could hear the woman screaming from inside...’Help me; help me’. But we couldn’t get to her. I heard her scream as she died. It was awful! I’m supposed to save people and I couldn’t save her. I couldn’t get to her. I can still hear her screaming.”
The smell and taste of decomposing bodies (no mask filters this smell and taste):
“We were working AirEgypt, shoving out what was left of the bodies. The smell was so horrible; it was the worse smell I’ve ever smelled. I’ve worked on other disasters, but this smell was so much worse. Nothing would get rid of it. It got in our clothes and our hair and in our skin. It wouldn’t wash out. I couldn’t sleep at night because of the smell. I kept thinking, “Why are we doing this?”
“For days after I left the site, I could taste the bodies, I could smell them. I knew it was crazy; I was imagining it...but it was real.”
Bodies of children, adolescents:
“We were digging through the rubble, looking for pieces of the bomb, when I pulled out a child’s hand. Everyone in my group froze. The first day that we were on the site, we had talked and laughed and joked. By the third day, no one talked, no one laughed. No one would take a break to eat; no one wanted to leave to go to bed. We became obsessed. We found pieces of the truck, but we found scalps and feet and pieces that used to be someone that was loved.”
Viewing a body in a particularly unusual way:
“I went into the makeshift morgue. There were pieces of people everywhere; pieces of bodies; I’d never seen anything like it. None of the bodies was in one piece. Then I saw a body that was whole; he almost looked alive. I had seen his picture. For some reason, that’s the one that got me.”
“We pulled out a victim. The body didn’t have any damage, not even a scratch. But the head....the head was smashed like a pizza box. It looked like a cartoon; it was horrible. I keep seeing it.”
Witnessing the pain & grief of the family members of victims:
“I went to so many funerals; I saw so much pain. It didn’t make any sense. I began to feel numb inside. I was supposed to go to more funerals, but I just couldn’t.”
Seeing pain and/or fear that is frozen on the face of a dead body:
“When we pulled Rita’s body out of the rubble, her face was twisted with horror and pain. I knew how she felt when she died. It kept running over and over in my mind.”
Picturing and imagining themselves in the place of the dead comrade and/or imagining the pain of their own family attending their funeral:
“I helped to carry a guy from another station out; he’d run up the stairs to help when the building exploded. I didn’t know him well, but he was my age and I knew he had a wife and kids, just like me. I started imagining that I had died; I saw my wife and mom crying. I saw my kids at my funeral. I knew what it would do to them. It really got me.”
Having a personal relationship with the victim:
“I went into the Embassy and I saw the blood all over the wall. I wouldn’t go in there until they had removed her body, but I knew it was her blood. I knew where she died; I knew her head had been smashed. She came to my house all the time with family; her daughter is crying all the time. My daughter is asking if I am going to die. I feel like I’m falling apart.”
Personalizing the victim. It is easier to deal with a dead body when nothing personal is known about his or her life. Becoming acquainted with their family, their personal life, finding out they had young kids or how much pain their family is in because of the death, can dramatically increase the chances that a rescue worker will be become traumatized.
“I helped to carry the bodies of the babies out of the nursery. I didn’t want to know their names or see their families. I avoided everything that would give me any information about them. Later, I thought I was doing fine. Then, one day, I was at the mall with my wife and some friends. We were looking in the window of a book store. My eyes focused on a newly published book on the bombing. The children I had carried out were there, their names were there. I started to cry uncontrollably.”
“The kids would put little drawings on our cots; they would thank us for helping; they would say they loved us. In one way, in made it better; in another it made it worse. What I was doing became connected with the people who were in pain. In other locations I never put the bodies together with the loved ones; when I did that, it really got me.”
“Every morning the family members would line up at the site and would hug us, as we went in to work. They’d say, ‘Thank you for looking for my daughter’; or ‘Bless you for looking for my mother’. Then we would find a body in really bad condition. The next day, one of the people would be gone. I knew the body we found the day before was their loved one. I knew how much they were going to hurt. I hated it.”
Finding personal items of a victim; this can be just as traumatizing or, in some cases, even more traumatizing than viewing a dead body:
“I was searching the rubble when I found the billfold of one of the Agents who died. I opened it up; there were pictures of his family. It really got me. I knew how he had died; I knew it was horrible. I kept imagining what he must have thought when he died and how his family misses him.”
“I can deal with the bodies, the body parts. I know they aren’t in pain anymore. It’s the personal things that get me. We found a teddy bear of one of the kids who died. Then one of the guys found a pair of pajamas with a fire truck on them; he said his son had the same pajamas. My kids are the same age of the kids who died. It’s the personal items that get me the most.”
Believing One’s Own Death or Critical Injury is Imminent and Certain:
“I was standing on the pile when the whole thing started to collapse. I thought, ‘This is it; I’m dead!’ Somehow the engineers and their machines did something to prop it up. I close my eyes at night and I see myself dying.”
When Something Unexpected Happens:
“We had been pulling body parts up from the ocean; they were lying on the dock. No one wanted to look at them. All of a sudden, one of the parts began to move. I watched in horror; it couldn’t be. Then a crab crawled out of the cavity. There were crabs and fish everywhere. The Red Cross served us lobster for dinner; I’m sure they wondered why none of us ate it.”
Cultural Conditions and Differences When Rescue Site is in a Foreign Country Can Be Upsetting and Even Traumatizing:
“The bodies in the Embassy Bombing were bad, but what really got me were the “throw away” children. They were two and three and four years old…wearing big boots. They were starving and sniffing glue because it was the only way they could reduce their pain. I spent every cent I had buying bread and peanut butter and feeding them. My daughter is three and I kept seeing her face on one of the children. How can anyone throw a child away? How can people in that country walk by them and ignore their pain?”
“We were digging up mass graves for evidence of war crimes. Everywhere we went, children followed us. They watched as we dug up their mothers and fathers. The army had gone through the cities, murdering everyone. I don’t know how they murdered so many people in such a short time. Sometimes they missed a child, or some part of the family was out of town. The children were alone; no one to love them. We nicknamed one kid ‘Velcro’ because he was so dirty that when he hugged us, he would stick to us.”
Working on a rescue site day after day searching for survivors alive but finding only dead bodies:
“The first few days, we hoped against hope we would find some victims alive. We did find two of them, and that made all of the hard work worth it. But, when the medical people said that there was no chance that anyone was alive, it was really hard. All we were finding then was bodies and pieces of bodies.”
“I’m a medic, and I wanted to help save some of the victims, any victim. But the workers didn’t find any one alive; just pieces of people.”
Feeling helpless:
The role of Paramedics, Fire Fighters, Law Enforcement Officers, Health Professionals and Search and Rescue Teams is to help, to rescue, to provide support. When these professionals work in rescue sites where day after day they find only dead bodies, pieces of people or sifting through rubble they often view their work there as meaningless. Although these professionals are routinely exposed to traumatic incidents as a part of their jobs, these are balanced by the positive aspects of helping and rescuing and protecting and feeling they have made a positive difference. Once there is no more hope that anyone will be found alive, a Rescue Worker’s sense of being traumatized can increase. Even rescue dogs become depressed when they find only dead bodies. To counteract this depression, the trainers of the cadaver dogs alternate the dog’s finding of dead bodies with live volunteers, who hide so the dogs can find someone alive to rescue them.
“Someone is probably alive under all this rubble, but we’ll never get to them. I keep imagining that people are keeping themselves alive by believing we will get to them in time, but we can’t”
Guilt: Rescue workers may experience survivor guilt because they lived and others died at the scene and/or working on rescue teams can trigger guilt associated with previous incidents:
“I was supposed to be in the building, but John took my place and ran up the stairs. I had gone back to the truck to get my glasses when the second plane hit; John never made it out. I should have died in there; not John. It’s my fault he’s dead and not me”.
“I kept running in and out of the building, finding victims and getting them out as soon as I could. Some of them died before I could get them out. I should have run faster; if I had run faster, more would have lived.”
“I was desperate to get home to my family. I hugged my wife and kids; I didn’t want to let them go. I am so glad that I didn’t die; I had so many friends and co-workers who did die. I feel guilty that I am so happy to be alive. I don’t think I can continue to be a fire fighter; I want to quit, but I feel too guilty to tell anyone that because so many people died doing the job they loved.”
Lack of support from management:
“The bomb went off and I flew into the air. I thought I was going to be really hurt, but the shrapnel had missed me and killed some citizens. I had an officer from another agency helping me. His people came in immediately, gave him support, and took him off-scene. My agency left me there for 48 hours...no sleep, no support, nothing.”
“Fairfax County sent their Search and Rescue Team over. There were about 77 workers, with five counselors for the workers and two for the dogs. They had two counselors for their dogs but my agency didn’t send any counselors for us until months later.”
“My supervisor ordered me to go to the other office to help with the rescue efforts. My baby was just two months old. I had to stay there for nine months, away from my husband and baby. I was sick. When I returned, I found my husband was having an affair and he left me. He said he didn’t want a wife whose job would send her away with no concern for our baby.”
“Someone decided since we had just been hired and had no experience in evidence collection, they’d put us in the morgue. I’d never seen that many dead bodies before. They kept running stories on the news about the crash and showing the families standing vigil. I haven’t slept through the night since. I can’t have sex with my wife; I don’t want to do anything. No one talked to us to tell us how to handle this; they just acted like it was a normal part of life.”
“The big boss came to the scene. We had been finding bodies of children all day; we were all falling apart. He saw that we had broken something and he screamed: ‘who in the hell is going to pay for this?’ He never said anything supportive, like: ‘I really appreciate what you’re doing; I know it’s hard. Let me know what I can do to help you.’ He never put his arm on our shoulder or shook our hands. He had come to the scene so he could talk to a television reporter and be on the news; looking important...he didn’t give a damn about us.”
Citations for research available on-line in the bibliography of Multi-Sensory Trauma Processing
© 2007 Dr. Davis gives permission for this article to be duplicated and used for training and/or educational purposes provided she is acknowledged as the author.