Be a Survivor: Trauma Resiliency to Tragedies for First Responders

10 Stages of ATSM for First Responders

Guest Editorial by Vincent J. McNally, MPS, FAAETS

First Responders should have the “tools from the toolbox” to maintain their own resiliency to primary traumatic stress, secondary traumatic stress, post traumatic stress and burnout. 

(Courtesy of BlueLine Patriot with credits to the original authors and creators of the pictures, and videos used. If you or someone you know is in need of help, remember that you are not weak. You are experiencing things a normal person would never understand or be able to comprehend. Please talk to someone, you are worth more than you can possibly imagine. tel: 1-800-273-8255)

Also, it is necessary to get a better understanding of the skills and knowledge necessary to effectively intervene during traumatic events through the ten-step program of Acute Traumatic Stress Management (ATSM). 

Early intervention reduces negative post traumatic effects to the survivor, families and the first responder.

Adapted from Janina Fisher

In order to effectively “deal” with disasters, tragedies, and other critical incidents training should be afforded to all members of emergency services as follows:

1. Appreciate and understand the prevalence of critical incidents, trauma, post traumatic stress and secondary stress has on the victim.

2. Understand the dynamics of compassion fatigue and burnout.

3. Acquire the knowledge necessary for developing and maintaining resiliency from primary traumatic stress, secondary traumatic stress, burnout, post traumatic stress, and compassion fatigue.

4. Understand the 10 Stages of Acute Traumatic Stress Management (ATSM), as outlined below.

(The Vicarious Trauma Toolkit includes tools and resources tailored specifically to the fields of victim services, emergency medical services, fire services, law enforcement, and other allied professionals, to help organizations mitigate the potentially negative effects of vicarious trauma, the exposure to the traumatic experiences of other people. Courtesy of Office for Victims of Crime and YouTube. Posted on Apr 6, 2017. For more information, please visit

10 Stages of Acute Traumatic Stress Management (ATSM)

1. Assess for Danger/Safety for Self and Others

  • Upon arriving at the scene of a terrorist attack, assess the situation in order to determine whether there are factors that can compromise your safety or the safety of others.
  • You will be of little help to someone else if you are injured

2. Consider the Mechanism of Injury

  • Form an initial impression of those impacted by the event.
  • In order to understand the nature of an individual’s exposure, it is important to assess how the event may have physically impacted the individual – that is, how environmental factors transferred to the person.
  • Direct exposure to a gruesome scene can compromise your ability to help others.

3. Evaluate the Level of Responsiveness

  • It is important to determine if an individual is alert and responsive to verbal stimuli.
  • Does he feel pain?

4. Address Medical Needs

  • It is imperative that life-threatening illness and injury are addressed prior to psychological needs.

5. Observe and Identify

  • Observe and identify those who have been exposed to the attack.
  • Very often, these individuals will not be the direct victims.
  • An awareness of the emotional, cognitive, behavioral and physiological reactions suggestive of traumatic stress is important.
  • Carefully look around you.
  • Anyone, including you, may be a direct or hidden victim.
  • This observation and identification stage of ATSM may be viewed as the first traumatic stress specific stage.

6. Connect with the Individual

  • During a crisis situation, introduce yourself and let people know your role (e.g., “My name is Ron, I’m a paramedic and firefighter with the Melton Fire Department.”).
  • If the individual is not physically injured and has been cleared by emergency medical personnel, move him away to prevent further traumatic exposure.

7. Ground the Individual

  • The individual may still be “playing the tape” of the event over and over in his mind.
  • By reviewing facts, you may disrupt “negative cognitive rehearsal” (i.e., repetitive, potentially destructive thinking), help the individual to function, and help him to deal with the circumstances at hand.

8. Provide Support

  • Factual discussion and the realization of a terrorist attack, particularly when the event is unfolding, may likely stimulate thoughts and feelings.
  • This is often the time when individuals who are exposed to trauma need the most support.
  • Developing empathic listening skills is an area that should be addressed prior to a crisis.

9. Normalize the Response

  • Normalizing and validating an individual’s experience will help him to know that he is a normal person trying to deal with an abnormal event.

An important component of the normalization process is to begin to educate the individual by helping him to know how people typically respond to traumatic events.

  • Discuss the emotional, cognitive, behavioral and physiological reactions that people frequently experience.
  • Remember, these reactions do not necessarily represent an unhealthy or maladaptive response.
  • Rather, they may be viewed as normal responses to an abnormal event.

10. Prepare for the Future

The final phase of the ATSM process is aimed at preparing the individual for what lies on the road ahead.

  • It is helpful to
    1. Review the nature of the traumatic event
    2. Bring the person to the present, and 
    3. Describe likely events in the future.

The educational process initiated during the previous Normalization Stage should continue during this final stage of ATSM.

(ATSM should not be viewed as counseling or psychotherapy and, in and of itself, ATSM is not a comprehensive crisis response plan. Rather, ATSM provides a road map that can guide individuals through times of crisis, keep people functioning and mitigate long-term emotional suffering.)

(First responders in New Hampshire are confronting the state’s opioid crisis on a daily basis, and officials said the high-stakes, stressful situations are taking a toll. Courtesy of WMUR-TV and YouTube)

About the Author

Vince McNally has provided over 100 workshops, seminars, and keynotes throughout the world. He is an author, lecturer, and consultant.

A Navy Investigator in Vietnam, and a volunteer in training the Iraqi Police in Baghdad in Hostage Negotiations he continues to research the area of Post Traumatic Stress in returning veterans and contractors in Iraq.

After 31 years as an FBI Agent has conducted and led investigations in general criminal violations, espionage, terrorism, white-collar crime, organized crime, and drug violations.

He is also an instructor in Crisis (Hostage) Negotiations.

Vince retired after serving as Unit Chief of the Employee Assistance Unit (EAU) of the FBI in Washington D.C. after being the Program Manager for the FBI ‘s Critical Incident Stress Management teams at the FBI Academy in Quantico, Virginia.

In September 2001 Vince and others responded to New York City. He continues to assist first responders throughout the United States.

He also directed and provided FBI Employee Assistance to TWA Flight 800 and numerous responses throughout the U.S..

Vince serves on the Board of Scientific & Professional Advisors of the American Academy of Experts in Traumatic Stress (National Center for Crisis Management).

He is a Compassion Fatigue Specialist, Board Certified in Acute Traumatic Stress Management (ATSM), Board Certified in Emergency Crisis Response (B.C.E.C.R.) and is a Certified Member of the Green Cross Academy of Traumatology.

He is also a Certified Employee Assistance Professional (CEAP).

Vincent J. McNally, MPS, FAAETS

His focused presentations on stress and have been shared with thousands of emergency service personnel.

His expertise and reputation as a speaker has found him presenting to the military in Switzerland and most recently as a presenter on hostage negotiations for the cruise industry addressing piracy on the high seas as he is a Certified Ship Security Officer.

He has completed a year as the Security Manager at Honolulu Airport overseeing law enforcement.

Specialties: Security Director, Trauma Specialists, Police Instructor, hostage negotiator, Employee Assistance Professional, Ship Security Officer, Investigations, Law Enforcement, government liaison