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For emergency workers, a day on the job can bring a lifetime of nightmares.
They are the police officers, firefighters and paramedics who are the first on the scene of bloody crimes, accidents and natural disasters. They must deal with the dead, the mangled, the bewildered and stunned.
"There's no training in all the world that can lower the impact of walking around body parts," said Jeffrey Mitchell, considered by many to be the leading expert in the specialized field of emergency-related stress management.
"It's hard to disengage. You get out there and you get your eyeballs stuck on those body parts. The horror stories are unbelievable and without number."
And often it is the children who leave the most searing impressions.
"I've seen an awful lot of dead bodies," said Joseph Grubisic, commander of the bomb and arson section of the Chicago Police Department and a police officer for 34 years. "When it comes to kids, it really bothers me."
Don Harrington, a firefighter-paramedic in Hanover, Mass., says, "You can almost always justify in some way adults doing each other in because they're adults responsible for their actions. But children are innocent."
As psychology has advanced, so has the study of how emergency workers cope, said Mitchell, a former paramedic who went back to school to get a doctorate in psychology and heads the International Critical Incident Stress Foundation in Ellicott City, Md.
Mitchell's organization teaches emergency personnel how to deal with job stress and offers a 24-hour hot line for workers suffering critical stress.
"These are normal people who have normal reactions to totally abnormal events," Mitchell said.
When the emotional state of an emergency worker...