Jim Ramsey stood before an Oklahoma City judge last December a few days before Christmas, nervously awaiting his sentence on nine felony counts, yet another face in an anonymous parade of drug defendants.
The 35-year-old had been charged with drunk driving, possession of cocaine with intent to distribute, breaking and entering, and escaping from police custody, among other counts stemming from a string of arrests in 2003 and 2004. Years in prison loomed if the judge decided to be harsh.
But Ramsey was no ordinary drug criminal. He was a former cop and the recipient of the Oklahoma City Police Department’s highest citation for bravery, awarded for his role in rescuing two women trapped on a precarious 7th-floor ledge of the Alfred P. Murrah Federal Building after the bomb went off on April 19, 1995.
For Ramsey, the road from decorated police hero to convicted drug felon ran straight through the smoking ruins of the Murrah building, with stops along the way for gambling, drinking and divorce. Yet, spectacular as his descent was, Ramsey’s case was far from unique: Scores of other Oklahoma City police officers, firefighters and emergency workers followed similar routes.
There’s a dark underside to the heroics performed by rescue workers that is little noticed by the citizens they protect: Long after the smoke clears and the last bodies are retrieved, massive disasters and terrorist attacks routinely claim additional casualties among the first responders who rush in to help, only to succumb to alcoholism, broken families and post-traumatic stress disorder (PTSD).
No amount of experience, it turns out, was enough to armor firefighters against scenes of Murrah building office workers impaled on rods of steel rebar who bled to death before they could be reached. No training could have prepared police evidence technicians to have to slit open the tiny fingertips of dead children so they could press their own fingers inside the skin to obtain clear prints.
The delayed suffering of emergency first responders is a phenomenon that researchers and trauma experts are only beginning to understand–and are deeply divided over how to prevent.
But one thing the experts do know is that some of the most serious troubles tend to surface three to five years after a traumatic event–which means that the thousands of New York City police and firefighters who responded to the Sept. 11, 2001, attacks are only now heading into their most dangerous and vulnerable post-disaster period.
“Probably, yes, the worst is yet to come,” said Dr. Frank Dowling, medical adviser for the Police Organization Providing Peer Assistance in New York City, a mental health support agency, who noted that two-thirds of the city’s police officers are currently reporting stress-related symptoms. “I can’t tell you that all of a sudden at year five, we’re going to have a hundred suicides,” Dowling added, but officials are concerned.
Despite the enormity of the Oklahoma City attack–it was, at the time, the worst act of terrorism ever to strike the United States–few rigorous studies of the bombing’s psychological aftereffects on civilians and emergency workers were ever conducted.
Only one study attempted to quantify the occurrence of PTSD and its attendant nightmares, withdrawal and depression among Oklahoma City firefighters who responded to the bombing, and its conclusions were actually optimistic. Three years after the bombing, PTSD was diagnosed in only 13 percent of the firefighters, compared to 34 percent of bombing survivors, suggesting a particular resilience among rescue workers.
But the psychiatrist who led the study, Dr. Carol North, a nationally recognized PTSD expert at the Washington University School of Medicine in St. Louis, noted that the 181 firefighters interviewed were not randomly selected and were not diagnosed by experts. Both factors could have skewed the results.
Officials of both the Oklahoma City Police and Fire Departments, hoping to avoid stigmatizing their employees, said they collected no data on adverse aftereffects among rescue workers.
Many other measures, however, indicate that the fallout from the Oklahoma City bombing was severe.
Project Heartland, a five-year counseling program set up to help Oklahomans affected by the bombing, provided services to 363 first responders, according to the program’s final report. The Fire Department chaplain said he conducted nearly 80 suicide interventions among firefighters.
A police officer and an assistant prosecutor committed suicide.
Alcohol abuse among firefighters, already endemic among half the department before the bombing, may have worsened after it, but by how much is not clear, according to North’s study.
The divorce rate doubled in the Fire Department and tripled in the Police Department in the years after the Oklahoma City attack, according to Diane Leonard, who coordinated three-day crisis-debriefing sessions to help first responders.
“They were just there to help us, to help get our people out of the building, and as a result of helping us they ended up with these huge horrible situations,” said Leonard, whose husband, Don, a Secret Service agent, was killed in the bombing.
Traumatic aftereffects from the bombing were scarcely limited to professional rescue workers. Project Heartland counselors provided services to more than 8,800 individuals, and the Red Cross and the Oklahoma City Community Foundation are still paying for regular therapy sessions for several dozen bombing survivors and relatives of those who died.
Yet as tragic as it was, the psychological suffering of civilian victims caught up in such a catastrophic event was not unexpected by trauma experts. Quite apart from extraordinary terrorist attacks, about 3.6 percent of U.S. adults will suffer PTSD during an average year as a consequence of accidents, crimes or natural disasters, according to the National Center for PTSD.
Experts are more alarmed by the torments experienced by rescue workers–the men and women who are the nation’s front-line response to domestic terror attacks, whose training and experience presumably inure them to catastrophe.
Oklahoma fire and police officials say they did everything they could think of to help.
They activated a crisis-response protocol popular with police and fire departments across the country known as Critical Incident Stress Management, in which first responders are gathered into small groups for intensive debriefing sessions where they can share their experiences among their peers. They made attendance at the sessions mandatory. They gave out phone numbers for crisis hot lines.
Everything was aimed, the officials say, at overcoming the instinctive reluctance of police and firefighters to admit they might be having psychological problems as a result of what they encountered at the bombing scene–an admission many in the hypermacho rescuer world equate with weakness.
It’s harder for cops
Police officers actually have it harder than firefighters, said Kathy Thomas, a psychologist who specializes in treating first responders.
“Firefighters have sort of a built-in mechanism for informal debriefings: Back at the firehouse, they’re sitting around, they’re eating, they can talk about it if they want,” she said. “But the police officers are [largely] by themselves.”
Police chaplain Jack Poe said his department was sensitive to that problem. “I think anybody that came forward, the department tried anything in the world they could do to help them,” Poe said.
Yet some police officers angrily disagree. They say supervisors stigmatized those who reached out for help and questioned their fitness for duty. They assert that the counseling they got was perfunctory.
“My retort to Mr. Jack Poe is: Show me what you did,” Jim Ramsey said. “You didn’t do anything.”
Ramsey is a particular sore point for the Oklahoma City Police Department because of his high profile as a decorated rescuer. Officials will not comment on his case, other than to say that he was offered help to deal with his problems.
On May 11, 1996, Ramsey walked across an Oklahoma City stage to a standing ovation as he received the Police Department’s Medal of Honor for rescuing two women in the Murrah building in the face of grave danger and despite his profound fear of heights. Yet even as he accepted the award, Ramsey was already deeply troubled.
He had begun a gambling addiction that would ultimately cost the $60,000 he and his wife had saved for the down payment on a house.
And just hours earlier, Ramsey had attended the funeral of his close friend, Police Sgt. Terrance Yeakey–the fellow police hero who committed suicide.
“I buried him at 10 o’clock in the morning . . . 7 o’clock at night I received the Medal of Honor,” Ramsey said. “How am I supposed to accept that award?”
Beset by nightmares of the bombing and intrusive memories of carrying out the bodies of children and laying them on the grass, Ramsey soon began spiraling out of control. He turned to petty theft and kiting checks. He started having affairs. He began using cocaine and then dealing it. His wife divorced him.
“I was a good cop. I never got in any trouble,” Ramsey said. “And then all of a sudden, it hits me like a ton of bricks . . . [I was] medicating myself for my fear and my feelings and my pain.”
In 2003, after 13 years on the police force, Ramsey quit rather than fight a charge of bad conduct stemming from his check kiting. He fell even further, racking up the felony arrests. Finally, last summer, he enrolled in a three-month addiction rehab program.
A psychiatrist diagnosed him with post-traumatic stress disorder and bipolar disorder, and alcohol and drug dependence.
When Ramsey got out, a sympathetic businessman gave him a job managing a chicken restaurant in Oklahoma City. His ex-wife was among more than two dozen friends and family who submitted supportive testimonials to the judge hearing Ramsey’s case last December.
The judge, Virgil Black, believing Ramsey’s attempt at rehabilitation was sincere, gave him a 5-year deferred sentence–if Ramsey stays clean, the felonies will be erased from his record. Atop the 10-page pre-sentencing report on Ramsey’s life history and crimes, Black scrawled “Good Luck.”
Ramsey says he has been off drugs and alcohol since July. He knows he has been granted a precious second chance, and he thinks he can stay sober.
“My life has changed,” he said. “I can deal with the pain.”
Textbook case
Ramsey exhibited a textbook case of PTSD, a debilitating malady that can drive its sufferers into major depression, substance abuse and autoimmune disorders, as well as suicide, according to the National Center for PTSD.
Telltale symptoms include traumatic nightmares, recurrent intrusive thoughts, intense feelings of helplessness or fear, psychic numbing and avoidance of people, places or stimuli that might trigger traumatic memories.
But how to help first responders like Ramsey avoid PTSD after their repeated exposures to catastrophic events is a subject of growing debate in the psychiatric community.
Small group stress debriefings conducted soon after a traumatic event have been the preferred approach for first responders since the early 1980s.
During the debriefings, specially trained counselors lead participants through a detailed recounting of the event to help alleviate feelings of guilt, blame or helplessness. Any participants who exhibit extreme reactions are screened for further counseling, while the rest return to their jobs.
Yet scientific studies in recent years have concluded that the debriefings do no good and may actually harm some participants by forcing them to relive their traumatic experiences.
“There is no current evidence that psychological debriefing is a useful treatment for the prevention of post-traumatic stress disorder after traumatic incidents,” wrote the authors of one influential study, published in 2002 in the Cochrane Database of Systemic Reviews, an international scientific clearinghouse. “Compulsory debriefing of victims of trauma should cease.”
Dr. Bryan Bledsoe, an author of several paramedic training manuals and a critic of the debriefings, says the practice is popular because it appeals to an intuitive sense of what ought to work, even in the absence of scientific data supporting it.
“We have this need in Western society to do something for everybody,” Bledsoe said. “But sometimes the best thing is doing nothing.”
So what does work for first responders? Some experts recommend simple palliatives, such as making rescuers comfortable when they come off a shift at a disaster scene. Where necessary, cognitive behavioral therapy may help–a form of psychotherapy in which patients are taught to redirect their traumatic thoughts.
In other words, there may be no quick fixes. North concedes that researchers don’t have any definitive answers.
“In order to speak intelligently about any kind of intervention and how effectively it worked, you need to do a randomized control trial,” North said. “In a disaster setting, that’s very difficult to do. It’s chaos.”
