Lots of support for Humboldt Broncos first responders, but risk of PTSD can be long-term, experts say

First responders who helped the victims of the Humboldt Broncos bus crash in Saskatchewan say they have been receiving lots of supportsince they arrived at that horrific scene on April 6 but a long-term approach will be needed to prevent andaddress symptoms of post-traumatic stress disorder, experts say.

"The funny thing about PTSDis that you never know when it's really going to strike," said Dr. Manuela Joannou, an emergency department physician in Perth, Ont., and founder of Project Trauma Support a group treatment program for first responders and military veterans.

"People can be doing very well after a difficult call for weeks, months years even and then something mighthappen that will kind ofbring it all back and willstart people ruminating about what happened."

Sixteen people, including players, coaches, an athletic therapist, team broadcaster and the driver were killed after the team bus collided with a semi-trailer. Thirteen others were injured.

The magnitude of the devastation, coupled with thefact that most of the dozens of paramedics, police and firefighters (including many volunteers) were from local communities, could add to the trauma they experienced,Joannousaid.

"When you're in a small town area, you know, chances are it's going to be somebody that you know that's going to be involved," she said. "Andwhen there's a mass casualty, it's just really, really difficultto get in and organize the scene and get your priorities and do your triaging."

"There's just so many emotions that you're trying to work around and trying to maybe hold back so you can do your work professionally, but those things are going to come back to, you know, try toget your attention at some point."

In the two weekssince the crash, first responders have been taking part in the first phase of support, known as critical incident stress management (CISM), that emergency services provide after first responders work a particularly traumatic event.

CISMis triggered by certain types of accidents, including those involving kids or mass casualties, said Matthew Hogan, a flight paramedic with Saskatchewan's STARS air ambulance service.He was not on the scene of theHumboldtBroncos bus crash, although some of his colleagues were.

Although the nature of an air ambulance service means its paramedics and pilots are accustomed to treating the most critically ill and injured patients, and must deal with deaths on a regular basis, "there are incidents that stick with you more than others," hesaid.

In addition to having 17 years of experience as a paramedic, Hogan is also a member of the critical incident and peer support team at the STARS Saskatoon base.

The first stepof the CISM process isdebriefing the crew that responded to the event,he said.

"You want to go through it, find out their point of view, and just have a chance to kind of talk out the whole call. That really seems to help a lot." he said.

But unlike an organization like STARS, rural communities such as Tisdaleand Nipawin, Sask. where many of the first responders came from don't have the in-house resources to conduct critical incidentdebriefings. The Saskatchewan Volunteer Firefighters Association sent nine "fellow firefighters" trained as peer counsellorsto do thatwithin 24 hours of the crash, association president Doug Lapchuk told CBC News.

The association is also sending accredited instructors from Regina to a peer counselling session this weekend in Nipawin, he said.

Ensuring that being from a rural community isn't a barrier for first responders getting the help they need, not only now but in the weeks and months to come, is critical, said Julius Brown, the head of Operational Stress Injury Canada (OSI-CAN),based in Regina.

"One of the things about the rural communities istheir first responders, a lotof them, don't have the kind of insurance that supplies for going to see apsychologist," he said.

OSI-CAN, ajoint non-profit project of the Canadian Mental Health Association's Saskatchewan Division and the Royal Canadian Legion, provides both individual trauma counselling and peer support groupsforveterans and first responders.

The organization plans to set up local support groups in Tisdale and other communities"for the long-term help that comes after a tragedy like this,"Brown told CBCNews.

As a starting point, staff from OSI-CANwent to a lunch organized by the Royal Canadian Legion in Tisdalefor the first responders a few days after the bus crash. More than 60 first responders and hospital staff attended, according to the legion's past-president, Sheridan Ellington.

Several of the first responders who attended that day have already contacted the organization seeking support, Brown said.

Another organization that provides post-traumatic support to first responders, Wounded Warriors Canada, is also offering help, said executive director Scott Maxwell.

As of Wednesday evening, an online fundraising campaign it started with partner organization TEMAConter Memorial Trust, had raised more than $110,000 for Humboldt first responders.

That money will help ensure that they can get whatever help they need, fromindividual counselling toresidential group support, at any time they may struggle with PTSD in the future, said Maxwell.

"When the adrenaline fades, and the story of Humboldtwill not be on the news all day, every day," said Maxwell, "they need to realize that they're not alone, that help is available."

"Just because you received some care early on doesn't mean that that's all that you may need. And that's OK."

Some signs of post-traumatic stress:

Dr. Manuela Joannousays it's important for family and friends of first responders affected by trauma to be aware of the signs that their loved one may be experiencing distress, because they can often "hold it together" at work but then behave differently at home.

• Irritability.
• Difficulty sleeping.
• Restlessness.
• Nightmares.
• Flashbacks.
• Intrusive thoughts.
• Increased self-medicating with alcohol or drugs.
• Isolation.
• Lack of willingness to go out to social functions.
• Withdrawal from family and friends.