Witnessing the death of a fire fighter or EMT/paramedic or viewing their body at the scene, especially a friend or partner. Trauma is often increased if the fire fighter or EMT/paramedic believed he or she should have protected the person who died, trained the dead peer or if the dead fire fighter or EMT/paramedic was temporarily serving in their place. Trauma is increased when a fire fighter or EMT/paramedic imagines him or herself as the one who died, then visualizes the impact that their death would have on those they love. Survivor guilt increases the impact of the traumatic experience.

A reasonable belief that their death or critical injury is imminent and certain, such as being in the middle of a burning building as the structure collapses.

Viewing the body of a child, particularly if the fire fighter or EMT/paramedic has children and even more so if their child is the same age and sex of the dead victim or if the child victim is similar in some other way to their child, such as appearance, clothing, toys, or school. The impact of this experience is often increased if the child’s body is badly burned, or dismembered through the fault of someone like a drunk driver at an accident scene who seems unconcerned about killing a child or if a child dies because of the carelessness of parents (for example, drowning in a swimming pool after being rescued from the same pool in a prior call).

Hearing a citizen (particularly if the citizen is a child) scream for help from inside a burning structure and being unable to save their life because of the fire is too involved.

A fire fighter or EMT/paramedic is blamed or told he or she is responsible for the death of a citizen, particularly a child victim, by his or her department, family members of the victim, or the media. Guilt, such as feeling responsible for violence or death, whether irrational or based on fact, usually intensifies symptoms of PTSD. Events such as exchanging shifts with another fire fighter or EMT/paramedic who is killed while working the exchanged shift or responding to a call minutes after a fire fighter or EMT/paramedic is killed can intensify symptoms of PTSD when the fire fighter or EMT/paramedic blames him or herself for the event. ("It’s my fault he/she is dead; I should not have taken sick leave." or "If I had been there, he would not have gotten killed.")

When a dead victim becomes personalized, rather than just an unknown body, through interaction with grieving family members or friends, or from information gained in numerous ways from the scene, news reports, and so on. Continued association with the pain of survivors through investigations (and often long after) also can personalize the dead victims. When a victim dies in the arms of a fire fighter or EMT/paramedic, or on route to the hospital, particularly when the victim is a child or adolescent.

The terror of being caught in a violent riot and feeling trapped, particularly when the crowd is focused on killing or injuring the fire fighter or EMT/paramedic.

Particularly bloody or gruesome scenes. Viewing victims with severe burns. Horror of the scene and/or the suffering of the victims. Length of exposure to crime or accident scenes that involve bleeding and dismembered bodies and family members who are screaming and intense grief over the death of other family members or loved ones.

Observing an event involving violence or murder, but not being able to intervene (i.e., "I watched him kill her. She was screaming for my help but there was nothing I could do.")

Feeling personally responsible for someone’s life, such as those administered by an EMT/paramedic at the scene or on route. When a victim dies on route to the hospital. Symptoms may occur even when victims are rescued or survive, as a result of the stress hormones released during long rescue operations.

When citizens at the scene threaten the fire fighter or EMT/paramedic with violence unless the scene is brought under control in a specified way or a patient being treated by the paramedic does not die.

Involvement in a very traumatic incident which is followed by lack of support by management.

Being referred to as a "Hero" after being involved in an incident where other fire and rescue service professionals died or were critically wounded. Being labeled a hero when fellow fire fighters died at the scene can dramatically increase feelings of guilt and PTSD symptoms.

These incidents were compiled from research and from the stories of the hundreds of law enforcement officers treated by Dr. Davis.
Citations for research available from Dr. Davis or are listed in her book, Multi-Sensory Trauma Processing, a Manual for Understanding and Treating PTSD and Job-Related Trauma.

© 2003 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.