The following technique can help to process job-related trauma; it is one aspect of treating PTSD, explained in: Multi-Sensory Trauma Processing; a Manual for Understanding Post Traumatic Stress & How to Treat it, by Nancy Davis, Ph.D.

This manual is near completion. The manual details five levels which require increasing skill & training to use. At this point, the success of Level One has been observed after using it successfully with traumatized adults; there is no research to support its effectiveness. A research project, testing the effectiveness of Level One in foreign cultures, will begin before the end of 2001; subjects will be rescue workers who worked the Kenya Embassy Bombing. Because there are hundreds of rescue workers who have been and will be working at the World Trade Center, Pentagon and Pittsburgh plane crash sites, Level One is being offered for use with this population, prior to the completion of this research.

Rescue workers who worked at sites such as OK Bomb, (in which the victim count now seem small in comparison), were often much traumatized; many of these workers have remained traumatized for years following their work. Since more people lost their life on September 11, 2001, than on D-Day and the number of rescue workers who worked at these sites (and are still working at them) is high, it is reasonable to predict that many of these rescue workers are experiencing symptoms of post traumatic stress related to job-related trauma. In addition, because so many coworkers were killed, many of these rescue workers are also experiencing intense levels of grief.

Level One has been included as a part of this website, because it is easy to follow and it has been successful with numerous individuals traumatized by job-related trauma. Over 400 fire fighters and law enforcement officers gave their lives, in these terrorist acts, in an attempt to rescue strangers. The caring nature of these professionals, who risk their lives for people they do not know, clearly makes them more at risk to be traumatized by their rescue work. They deserve to be offered every technique available to help them process their traumatic memories.

Level One is not therapy, the person tapping the shoulders, is given structured questions that direct the rescue worker in talking about his/her experiences. It is similar to debriefing, with the added bonus of helping the rescue worker process traumatic memories. I have not found that using Level One leads to an increase in symptoms or to additional problems, especially when used with adults who had stable jobs prior to the job-related traumatic experience. However, should Level One result in anyone becoming more upset or having an increase in symptoms, he/she should be referred to a mental health professional skilled in treating PTSD.

Because there is no research that supports the lack of problems related to using this technique, it is recommended that a mental health professional use this technique with the Rescue Workers. Keeping records of symptoms occurring in the day or two prior to using Level One and three days following its use would be helpful in determining how successful this technique is when used with Rescue Workers. The author would appreciate communication from other mental health professionals who have used Level One with Rescue Workers indicating if the positive and negative impact of its use. A list of questions that can be used to evaluate the symptoms unique to Rescue Workers is included.

Multi-Sensory Trauma Processing For Rescue Workers
Level One: has been designed to be used by non-therapists, after research exploring its effectiveness. This research project has been funded, and will be carried out in the next six months.

Level One is proposed because it is clear that there will never be enough therapists and mental health workers to treat every traumatized person in the world. Although it is preferable for mental health workers to deal with traumatized individuals, this is not possible, particularly in other cultures where mental health services are rarely available. Furthermore, many professions are notoriously resistant to therapy, and therefore, may avoid getting any help to process the traumatic aspects of their work.

Level One is not intended to clear all traumatic memories from a rescue worker’s past; however, it seems to help with a single incident trauma, such as the World Trade Center, Pentagon and Pittsburgh plane crashes.

Level One is for use with rescue workers who were involved in some part of the crashes and sites which was very upsetting, stressful or traumatic. Level One is only to be used for rescue workers who were stable and employed prior to the bombing. It is not to be used, except by an experienced mental health professional, with anyone who has a past history of poor emotional functioning, psychiatric hospitalization or therapy for emotional disturbance. This technique can be used in a small group setting; this helps rescue workers realize that they are all experiencing similar reactions. It is probably best to group rescue workers from similar backgrounds, i.e., fire fighters, law enforcement, medical personnel, since each group tends to react a little differently to rescue work. If used in a group setting, no one should be allowed to be an observer, rather than choosing to participate, because of the personal nature of the questions and the inhibition this would have on the group.

Level One may be used in a group setting (like in debriefing), or individually. If the person using Level One is not a therapist or mental health worker (once the success of Level One has been documented), he/she should be a professional individual employed in the fire service, law enforcement, medical field or the same profession as one of the teams of rescue workers. EAP counselors, chaplains, peer support counselors and/or individuals trained in debriefing could be appropriate. The nonprofessional and the professional must be someone trusted by the participants, since trust and feeling safe are essential to treating those with symptoms of PTSD.

Level One should only be used when their role in the rescue effort is concluded, since it is impossible to move a memory into the past when a rescue worker is continuing to work the rescue scene. Therefore, wait until the rescue worker has served his/her rotation to use Level One.

Steps:

1. The helper explains, that the stress hormones that occur during traumatic events, appear to cause the brain to freeze the memory of the traumatic event in one section of the brain…apparently the present memory. When this happens, the frozen memory can lead to flashbacks, problems sleeping, and a number of other symptoms that continue long after the event are in the past. Tapping, while talking about what happened when the event was experienced, seems to help the brain process the memory and move it into the past, perhaps by bouncing the information back and forth between both hemispheres of the brain. When this happens, the brain appears to recognize that this information belongs in past memory, and moves it there. Traumatic memories then seem to become less powerful and symptoms are reduced or eliminated. This technique will not change positive memories, nor will it get rid of grief, which is a normal process. The brain knows which memories are “stuck” and responds to move these memories where they belong, in the past. The helper explains that this is a biological process and that the memory will be processed more effectively if, while being tapped, the rescue worker uses all senses to recall as many details as possible.

2. The helper reads all questions that will be asked of each group member or of a single rescue worker, before beginning. The helper explains that talking about the event may be stressful; however it is the reviewing of the many aspects of the event, in their mind and memory, while being tapped, that is important to processing it. The helper indicates that this is a process to give relief, so that if being tapped becomes distressing, to the point that he/she wants the tapping to stop, he/she should raise a hand, and the tapping will stop. This rescue worker should then be seen individually by a peer counselor who can refer this worker to a mental health professional skilled in treating post traumatic stress disorder.

3. The helper asks for and receives permission from each participant to tap their shoulders and ask questions about the event.

4. When the individual or all members of the group have given permission, the helper stands behind the rescue worker, tapping the shoulders alternately, keeping hands flat. (Right, left, right, left). The tapping should be firm, but not to the point that it could be painful, when done repeatedly. The helper should ask the rescue worker being tapped to report if the tapping is painful. Thin individuals may have very bony shoulders and may more comfortably be tapped on the circular part of their shoulder, where it attaches to their arms. The height of the chair in which the rescue worker sits is important, since chairs at some heights will result in the person doing the tapping becoming uncomfortable. Test the height of the chair for comfort, before beginning.

5. The helper asks: “Explain the difficult things you have experienced, from the point at which the first plane hit the World Trade Center, until today?”

If the rescue worker skips around in the story (as is common with trauma), the helper can ask: “What happened next?” Or “What happened before that?” as a way of structuring the story, in order to get as many details as possible. It appears that the transfer of the traumatic event from present to past memory is increased when details, feelings, thoughts, images, smells, sounds and body sensations are included in the details the individual gives about their rescue work. For example, the smell of dead bodies, the burning sensation of the jet fuel, the taste of the dust, the sound of the plane hitting the building and the building collapsing.

When the rescue worker has told his/her story, the helper asks the following questions:

6. “Have any parts of your rescue work stayed with you, repeatedly replaying as pictures or images in your mind? Do you have smells or tastes or feelings or thoughts related to your rescue work that keep coming back?

7. “What was the worse part of these plane crashes and rescue effort?”

8. “Did anyone you care about or work with die in these bombings? How has this personally affected you?”

9. “During the time you were working at the World Trade Center (or Pentagon), did you think you would be seriously hurt or die because of the instability of the building or some event that occurred?” (This does not need to be asked for those who worked the crash site near Pittsburgh).

10. “Did you see any dead victims or body parts? Did you see anyone die? If so, “Did you think of family members or someone else you love, when you saw these bodies or body parts?”

11. “If anything about this rescue effort caused you to feel guilty, review that in your mind and let me know when this is complete by nodding your head up and down?”

12. “How has your body responded to being involved in this rescue effort? Have you had any illnesses, stress reactions, or pain because of it?

13. “Given that these terrorist attacks did occur, and you cannot change this, is there anything positive that you have learned from being involved in this rescue effort?”

14. “Now, as I continue tapping your shoulders, review the plane crashes and everything traumatic that followed, from the time you heard about what was happening, until today. Ending with anything positive that you have learned from being involved in this rescue effort. Take all the time you need, when you are finished with this review, nod your head up and down.”

15. When the rescue worker indicates that he/she has completed the review, continue with the next individual (if this is done in a group setting). Otherwise, continue to 17.

16. When all rescue workers have been questioned and tapped, the helper can ask for any comments about the experience. After hearing these, the helper explains that the tapping helps the traumatic parts of working as a rescue worker to process and move from present to past memory. In some individuals, this may take several days. Some people say that during the first night, ideas and images seemed to pop up and then to disappear. Others found that they slept soundly; a few said they had trouble sleeping the first night, but slept soundly after that. The helper should indicate that, if this tapping and review of the traumatic event causes anyone to become distraught or depressed or in any way increases their symptoms, they should contact the helper, who will refer them to a mental health professional for individual help. For those familiar with computers, explaining that the alternating tapping seems similar to “De-fragmenting your hard drive” is a metaphor which can be understood. Anyone who seemed particularly traumatized, prior to the tapping and questions, should be contacted in the days which follow, to see how he/she is doing.