In World War I, it was known as shell shock; in World War II, battle fatigue. As referred to here, traumatic stress is a person's overwhelming response to direct exposure to actual or threatened death or severe injury. It happened to me first when I was 19 and it has happened to me since. In retrospect, each event was remarkably matter of fact: time slows down, emotions take a back seat to practical considerations, and the gravity of what you've been through sinks in later.

Circumstances obviously influence the response. If a police officer has responded to traffic accidents where she has seen dead bodies, this exposure may be upsetting but not traumatic because it is part of ordinary experience. If, however, that same officer is also a mother who responds to an accident where she finds a dead boy the same age as her son, that exposure might be traumatic.

Another important contributor is the perception of control. Law enforcement officers who fire their weapons and kill a suspect for the first time may find that experience unsettling. No amount of preparation can anticipate how quickly a shooting occurs and how it feels to have no choice but to fire. Officers want to save lives, not take them. Being put in the position of using their weapon to take life, no matter how clearly justified, is contrary to feeling in control.

Stress responses to trauma exposure vary widely. Some are mild and tolerable. If they are severe, they may require professional intervention. Some responses are immediate and some are delayed by weeks or months. Symptoms may include: hypervigilence, irritability, anxiety or panic, insomnia or hypersomnia, nightmares and night sweats, recurrent and intrusive memories of the event, headaches, eating too much or too little, and poor concentration or memory.

Some experienced law enforcement folks have told me that debriefing is a waste of time. In some cases, they might be correct, particularly if the debriefer isn't experienced. However, an agency or employer has a need to look after its own. Debriefing should only be run by a trained and experienced professional, not a grief counselor. Debriefing is not counseling. If it is conducted like group therapy, it may do more harm than good.

Debriefing is a structured meeting that occurs within a few hours or days after the trauma. The debriefer briefly reviews the circumstances of the trauma then facilitates a discussion about the current and future responses of participants and ways to deal with them, ways for participants to support each other, deal with family and friends, and how to handle public inquiries and those from the press regarding the incident. The goal is simple: to prepare people exposed to deal with their experience in healthy ways.

Referring personnel to individual grief counseling on an as needed basis if they have a stress response might be a big mistake. It's possible that individual grief counseling for people exposed to trauma does not benefit them, and in some cases, it may do them harm. Counseling is not for everyone and not every problem can be helped by counseling. If someone exposed to trauma has an acute stress response, help is indicated. Their stress reaction is not a result of a character flaw or weakness. In one sense, it might be described as an overwhelming physical response that is emotionally painful. It's a normal reaction to an abnormal event. Debriefing is the first step - and maybe the only step they need to take.

Some people have a stress response to vicarious exposure. 911 dispatchers, personnel who work a case who were not directly involved at the time of the incident, and even debriefers, may have a stress response as a result of being involved indirectly or after the fact. This response may be influenced by previous life experience. It is insidious because it may be minimized as an overreaction. A stress response is a stress response, vicarious or otherwise. I have worked with first responders who experienced a painful reaction as a result of reading a newspaper article that reminded them of a trauma exposure in their past.

If a person's stress response persistently interferes with work and activities of daily living, or is particularly painful, working with a trained professional to assist with desensitization and cognitive behavioral techniques may be helpful. Occasionally, a medication evaluation is indicated. The good news is that advances in research have provided professionals with a number of effective tools that assist people through the tough spots of a stress reaction. A person having a stress response to trauma exposure doesn't want it. Instinctively we run from the suffering. What we all want is a quick fix, so alcohol and other things that numb the mind are a temptation. The temptation is strong because it works, but only temporarily.

I am a certified Red Cross Disaster Mental Health Tech with 40 hours of professional debriefing training and 10 years of experience as a debriefer. As a result, I do believe debriefing is a waste of time - if it's done poorly. It's easy to do harm and people who have been exposed to a trauma must be handled with care. Personally and professionally, I've been there. The bad news is that it doesn't go away, even if you close your eyes. The good news is that it does get easier if you get help.

To assist first responders and others who want to develop additional skills to cope with a stress response that go beyond debriefing, I wrote an education program called Mastering Traumatic Stress. Click here to find out more.