Life is hard for everyone.
But it’s particularly hard for those whose jobs put them on the front lines in emergencies, having to make instant decisions with life-and-death consequences while staring pain and loss and terror straight in the eye.
The statistics are grim: First responders are six times more likely to commit or attempt to commit suicide than the general population. More police officers die from suicide than in the line of duty.
What can be done?
Here in North Jersey, help for the rescuers is coming from an unusual source: Israel.
Natal is an Israeli organization founded 21 years ago to help Israelis cope with trauma in the face of bus bombings and other terrorism. (Natal is the acronym of nifga’ei trauma al reka le’umi — victims of national trauma.) But for the past two years, its staff has been training North Jersey firefighters, police officers, and emergency medical technicians in how to identify, prevent, and respond to work-related trauma — and how to train their colleagues in these skills.
Those trained by the program range from firefighters in Jersey City to EMT managers in Valley Hospital in Ridgewood. This week, Natal was scheduled to train students in the Morris County Fire Academy. But Natal’s impact is felt not just in the classes it has run directly for hundreds of North Jersey first responders, but in the classes run by the students it trains. And the impact is only beginning.
Richard Sposa heads the Emergency Medical Service department at Englewood Health. He is a graduate of the Natal program
“It’s a long overdue thing in our industry,” Mr. Sposa said. He and two colleagues took the Natal training course and, starting in the fall, he will roll out an 18-hour curriculum that eventually will train all 120 members of his department.
Natal’s founders weren’t thinking about American emergency services when they started the program in 1998. In the previous four years, Palestinian suicide bombers had killed 160 Israelis. The trauma of war was spreading to civilians standing at bus stops, and Israeli society didn’t have a good response. “There were so many people who were falling through the cracks,” Maya Tadmor-Anderman said. Ms. Tadmor-Anderman is the director of U.S. programs for American Friends of Natal, which brought the Natal training to New Jersey.
“There was no nonprofit organization dedicated to trauma victims,” she said. “There was such a stigma about seeking help that the veterans didn’t want to go back to the military. People who came out of a terror attack and didn’t lose a limb — why should they even complain? But inside, people were breaking.
“The government didn’t know what to do with us. The military didn’t know what to do with us.”
Natal started by helping people cope with their trauma. Its hotline remains an important part of their work in Israel. (It also has brought it to American veterans in Florida with the Wounded Warrior Project.) It has hundreds of therapists on staff. But as Natal gained its footing in helping Israelis who had undergone trauma, “we realized we could not wait until the event” to address it. Could Natal figure out how to make Israelis more resilient, so that when a traumatic event happened, they’d be better able to cope?
“We started with the school systems,” Ms. Tadmor-Anderman said. “We tried to do as much as we could in training the educators and the students” to become more resilient.
Then Natal moved on to Israel’s first responders.
“They’re exposed day in, day out to a huge amount of stress,” Ms. Tadmor-Anderman said. “We think they’re superheroes, but they’re human. We came in thinking we had to address their trauma from war and terrorism. Working in hospitals, we understood that it’s enough to be a first responder to need our help. If you’re a nurse or a firefighter, you have enough stress on your shoulders that it takes its toll.
“It’s a never-ending cycle. There’s secondary traumatization, by being exposed all the time to people who are suffering. There’s compassion fatigue. There’s an immense amount of stress based on their job.
“We give them all the gear to be safe, but they don’t know how to take care of themselves on the emotional side.”
And thus was born the sort of resiliency training that Natal has brought to New Jersey.
“It’s our duty to help them deal with trauma,” Ms. Tadmor-Anderman said. “Before the early ‘80s, none of us wore seatbelts. Now it’s a given. How do we help our first responders put their seatbelts on?”
Natal figured out how. “Israel’s national police came to us and said, ‘We need your assistance.’ That means a lot has been done on the stigma.” Over the past six years, Natal trained 20,000 first responders in Israel.
The training in New Jersey grew out of a trip to Israel for health care professionals organized by the Jewish Federation of Northern New Jersey.
“We were introduced to the program by some individuals from Valley Hospital who went with the federation on a trip to Israel,” Rachel Tkatch said.
Ms. Tkatch is a program manager for the Northern New Jersey Urban Area Security Initiative — a federal government program funded by the Department of Homeland Security to help the region prepare for catastrophic events. Its initial focus on preventing, responding to, and recovering from acts of terrorism in the wake of 9/11 since has expanded to include “all mass casualty planning,” Ms. Tkatch said. “We plan for active shooter activities and weather events like hurricanes. We work with law enforcement, firefighters, and hospitals throughout our seven counties. We work as a region if we need to move resources during big events.”
It’s not easy for a federal program to bring in trainers from Israel as contractors. “We had to prove that no other company in the U.S. could deliver a similar program,” Ms. Tkatch said. “We put out a bid. We only got one response — Natal. That proved that nobody else could do it.”
The mission: “They are training our first responders to be more resilient. They’re helping them identify stress and the causes of stress and how the pileup of stress over time will affect them physically and behaviorally. They’re helping them find the tools to cope with stress at different phases of the cycle.
“Let’s say they’re a firefighter and they receive a call. When they’re driving the truck — how should they prepare for the stress that is to come? While they’re there, what should they be doing? They go through the process of how they could cope with each phase in the operational cycle.”
This is more than just adding another item on a checklist when the fire truck departs. “We’re trying to change the culture within the fire departments and EMS agencies,” Ms. Tkatch said. “The general perception is they have to be tough, that they’re not allowed to express all the reactions they’re going to have. The course teaches how you talk to a peer after you’ve been to an emergency scene. What’s the emotional process you go through?
“It’s preventative. The goal is helping responders recognize that some of the traumatic situations they face can pile up over time, and they need to be able to recognize when they need to take a step back, to use coping methods, or rely on their peers, so it doesn’t lead to post- traumatic stress disorder.”
So far, the New Jersey program has trained hundreds of first responders, and it has prepared many of them to train their peers. The Natal curriculum is being added to local academies that train EMTs and firefighters and police.
While some of the stresses are specific to the first responders — firefighters living in fire houses, for example, have problems adjusting their internal clocks so they can sleep — “the principles can apply to anybody’s personal life as well as to their professional life,” Ms. Tkatch said. “I took the course, and I’m not a first responder.”
It would be great, at this point in this story, to be able to summarize the big ideas in a little list you can cut out and tape to your computer monitor at work. But there’s a reason the training lasts 18 to 24 hours.
One big-picture takeaway is the importance of not bringing your work stress home. “How do you separate your work life from your home life? We spent half a day on managing that transition,” Ms. Tkatch said.
How do the students — remember, these generally are professional first responders — react to the course?
“My life would have been so much different if I had done this in the beginning of my career,” Theresa Reiss said. Ms. Reiss is the emergency management coordinator for the Valley Health Center. After training with Natal’s Israeli instructors, she taught the curriculum to three groups of students.
“The last class I led in Mahwah — a mix of Valley Health people and volunteer responders — met once a week, for four hours, for six weeks straight.
“At the end, they asked, ‘Can’t we have another one? Isn’t there more?”
Ms. Reiss has been a medic for 28 years.
“When I went through EMT school, I got like a paragraph on how to manage stress,” she said.
“On emergency calls, you’re walking into a person’s worst day. Nobody has given you the tools to handle what is put on you on a daily basis. We’re going to send you out on all these really bad calls, we’re going to damage you to a certain extent, and then we’re going to try to fix you afterward — send you to therapy to treat PTSD.”
She explained the philosophy of the Natal program: “Why don’t we give people tools at the beginning of their career so they can handle the stress of the job, so maybe they won’t have to handle so much on the back end?”
She was able to give some of these tools this summer to students at Bergen County Emergency Medical Services Training Center in Paramus.
“Four of us taught a three-hour class,” she said.
Ms. Reiss said the core of the program is “a little bit of meditation and a lot of self awareness. Realizing that there’s different things in your life that you actually rely on, and how you rely on them.”
Ms. Reiss has found the training useful in her civilian capacity.
“I have teenagers,” she said. “Having teenagers is its own stressor. I find myself using the techniques to get information from them — that whole empathetic response. Some of the stress management techniques for when people are having anxiety attacks, when you need to tell someone really really bad news — I find myself using that.”
Mr. Sposa of Englewood Health agrees that this sort of training “is a long overdue thing in our training.” He has arranged for space to run the program at the Kaplen JCC on the Palisades in Tenafly. “We’re going to start some time this fall and just run it continuously until everyone is trained,” he said.
Mr. Sposa has been a paramedic for 24 years; he has headed his department for three. “We see untold trauma every single day,” he said. “But up until the development of a course like this, we didn’t have a way to address it.
“We see people hurt, people sick, people dying, every day of our careers. To be exposed to it day in, day out can get trying. In the course, we talk about the basis of trauma. Methods to help with personal resilience and team resilience. Different methods to de-stress and to process trauma.
“I’ve taken a bunch of the lessons and applied them to day in, day out life, to work, to relating to my children and family and friends. It’s a way to put yourself into a better mindset and put yourself into a clear mind and focus on the issues at hand, rather than the emotions.
“There was a profound statement that stuck with me throughout the whole class. It was something they brought into the class from AA. A really simply line: Nothing changes if nothing changes. If we want to expect change, we have to do something different. This is something different. We’re trying different. We’re excited to put this into motion.”