No matter how hard she tries, Julie Bridges cannot forget the train accident that dismembered a Simi Valley man three years ago.
Bridges, a Ventura County paramedic in 1987, combed the railroad tracks searching for the bloodied parts of his torn body--first one leg, then the other, next the torso and finally the man's head.
"I couldn't close my eyes that night because I kept seeing body parts," said Bridges, who is now the assistant administrator for the Ventura County Emergency Medical Services Division. "I keep remembering it, and I suppose I'll have a long-term problem with it."
Bridges is one of many emergency services workers--such as paramedics, firefighters and police officers--who have suffered psychological trauma that lingers long after witnessing particularly gruesome accidents or troubling death scenes.
Now, as part of her duties, Bridges is coordinating with agencies throughout Ventura County to set up a program that would be open to more than 1,700 rescue workers. The teams would be on hand to counsel workers immediately after disturbing events so they are not debilitated by them.
The proposal for a Critical Incident Stress Debriefing Program, which would make teams of psychologists and peer-counselors available to treat emergency workers 24 hours a day, is scheduled to come before the county Board of Supervisors in the next two months, Bridges said.
Some counseling is available to various agencies in the county, but Bridges and others believe that a critical trauma debriefing team could make help more widely available.
Such teams are commonplace in the wake of nearly every major disaster, arriving on the scenes of earthquakes and hurricanes to counsel emergency services workers. And they are becoming increasingly prevalent in local fire and police departments, with more than 125 communities in the United States running their own teams, according to the Critical Incident Stress Debriefing Foundation in Ellicot City, Md.
Critical Incident Stress Debriefing is a relatively new psychological specialty designed to treat workers who have been exposed to incidents deemed unusually traumatic--such as deaths of children, major disasters such as air crashes, accidents in which more than three people are killed, prolonged rescue situations and deaths or suicides of co-workers.
"I think that the majority of emergency services workers need some kind of help like this," said Jeffrey Mitchell, co-founder of the Critical Incident Debriefing Foundation and associate professor of emergency health services at the University of Maryland, Baltimore County. "Most have experienced at least some of the stress symptoms at some point in their careers."
If not treated immediately, the short-term problems could fester and develop into long-term behavior disorders, Mitchell said.
The police officers, firefighters and paramedics who witness such events might seek solace in alcohol or drugs. Some will avoid their friends and families. Their health might suffer as they develop problems sleeping, eating and relaxing, Mitchell said.
Mitchell coaches psychologists across the country on how to counsel the workers who often are mired in the belief that they do not need help because they are the helpers.
Also, Mitchell said, the machismo associated with law enforcement and rescue professions frequently precludes admitting emotional problems.
But the problems--and need for help--are definitely present, according to county emergency service workers.
Firefighters say they are haunted by the taste and smell of some accident scenes three weeks later. Police officers remember how their guts wrenched the first time they saw a dead body. And paramedics recount stories of conversations with people who keeled over dead in mid-sentence.
"Sometimes I start recounting all the fatalities I've been on," said one county firefighter, who asked not to be identified.
The man said he is still disturbed by a Casitas Springs fire that killed an elderly woman in a mobile home in April, charring her body beyond recognition.
"It's depressing to see human life destroyed like that," he said.
The Ventura County Fire Department has two chaplains on call who respond to fires and provide some counseling for firefighters and witnesses. But some firefighters believe that the chaplains do not have the expertise to deal with their psychological needs.
Keith Kraetsch, president of the Ventura County Professional Firefighters, a labor organization that represents the county's 375 firefighters, said that additional psychological services are imperative.
"I think the county has a moral obligation to provide them to us," Kraetsch said.
Lt. Arvid Wells of the Ventura County Sheriff's Department said the program would be well received by the 143 volunteers he commands on the sheriff's search-and-rescue team.
The volunteers are shocked when they first retrieve a decaying body. They must be made to realize, he said, that it is normal to feel upset--and even physically ill--when first seeing a dead body.
"Finally people are realizing the fact that rescue workers see more death and destruction than other people," Wells said. "The days of the macho, 'I can view anything and do any job,' are over."
The idea for the Ventura program was sparked when 17 Ventura County firefighters became distressed after they were overcome by fumes during a fire at a chemical manufacturing plant in Saticoy on April 10, 1989.
The men were taken to local hospitals for treatment after being exposed to the poisonous gases at Pacific Intermediates.
But no psychological counseling was provided for the men, who were worried about what future effects the exposure would have on them, Bridges said.
"There was a feeling of general panic that they didn't feel they were getting the support that they needed," Bridges said.
The proposed Ventura program would provide support for county emergency services workers facing such incidents. The county also may try to contract with private ambulance and police departments countywide, Bridges said.
The Ventura program would be made up of three- or four-member teams of mental health professionals and peer counselors. Depending on the circumstances of a case, the team would head out to talk to the workers at scenes of incidents or arrange for a more formal therapy session up to a week later, Bridges said.
Start-up costs for the program, which Bridges hopes to see in effect by November, would be about $15,000. That money would pay for the training and salary of a part-time program coordinator, computer and telephone costs and materials for team uniforms or identification, she said.
Bridges said she hopes to negotiate with private hospitals to put up another $5,000 to train the psychologists and peer counselors.
Already, 20 psychologists have applied to volunteer their time to the program. Also, Bridges said, she hopes clergy will go through the training and help in the program.
Other agencies involved in developing the program include the county Sheriff's Department, Fire Department, Emergency Services department, coroner's office, Mental Health Services department and St. John's Regional Medical Center in Oxnard.
The Ventura County Fire Department now relies on two chaplains to provide counseling at fire scenes. The Ventura County Sheriff's Department has its own psychologist with an office at department headquarters in Ventura. The psychologist is on call 24 hours a day. And county employees can see psychologists through the county's Employee Assistance Program.
The five police departments in the county each contract with psychologists for emergency services as well.
Bridges, however, said the Critical Incident Debriefing team would give workers an option about whom to see.
Three of the five county supervisors contacted said they support the idea, but Supervisor Madge Schaefer said she believes that such a program was needed only for the county Fire Department. She said other county agencies already are adequately served.
Similar programs in Los Angeles and Orange counties have helped workers through trying times.
The Los Angeles County Fire Department, with 2,300 firefighters, was the first California agency to implement its own Crisis Incident Stress Debriefing Program, program coordinator Marguarite Jordan said.
The team was started in an effort to cut down on people retiring because of stress-related ailments, Jordan said. It is now mandatory for firefighters exposed to any incident deemed traumatic to undergo counseling with team psychologists, Jordan said.
The team first swung into action during the 1986 Cerritos air disaster, when firefighters and emergency workers went to rescue victims and found only mangled bodies.
The team provided on-site counseling. As a result, Jordan said, no one in the Fire Department took early retirements or filed stress claims citing the disaster, Jordan said.
In Orange County, the program was kicked off in 1985 and is run by the Red Cross. Workers there term it "emotional first aid," Donna Gamble of the Red Cross said.
"It eases us back into normal life," she said. "It gets us over our period of adjustment much quicker."