Witnessing a traumatic event

Being there when someone is badly hurt, even a stranger, can bring on strong stress reactions. The suddenness and helplessness are a big part of why it hits so hard.

Many people who stop to help, call 911 or give first aid later replay what they saw. That is a common, human response.

Witnessing violence at home, at school, at work or in the community can leave people feeling the world is unsafe. Families who live with community violence often feel that harm could come at any time.

Seeing a sudden death, whether of a loved one, a coworker or a stranger, can bring shock and grief together. Images from that moment may come back for a while.

If you lost someone you knew, the “Grief: understanding loss” guide in this app can help alongside this one.

After the 2013 Boston Marathon bombings, people who took in six or more hours a day of news about it were about nine times more likely to report high acute stress than those who saw very little.

In that study, heavy media exposure was more strongly linked to acute stress than being at the scene. The researchers noted that repeatedly showing graphic images may keep distress going.

Firefighters, EMTs, police, nurses, security staff, transit workers and others may witness traumatic events as part of their job. The “Helpers and first responders” section in this guide is for you.

You might notice

• A racing heart or sweating
• Headaches when you think about it
• Stomach problems
• Trouble falling or staying asleep
• Feeling tired all the time

Your body went into alarm mode to protect you. It can take a while to settle down again.

Common feelings

• Anger or irritability
• Feeling helpless
• Feeling nervous or on edge
• Guilt or self-blame
• Numbness
• Sadness

WHO notes that almost everyone affected by an emergency feels some distress, and that it usually improves over time.

You might notice

• Avoiding the place or anything that reminds you
• Being easily startled
• Feeling constantly on guard
• Problems at work or school
• Trouble concentrating or making decisions
• Upsetting memories or dreams

Pulling away from others is a common reaction after trauma. Connection with people who care is one of the key things that helps people recover after a crisis.

Gentle first steps

• Keep a simple daily routine
• Limit news and videos about the event
• Move your body a little each day
• Notice small moments that feel okay
• Talk to one person you trust

When something is frightening, the brain stores it strongly so you can avoid danger in future. That is why reminders, like a siren or a smell, can bring the scene rushing back.

A 5-4-3-2-1 grounding exercise

1. Name 5 things you can see
2. Name 4 things you can feel, like your feet on the floor
3. Name 3 things you can hear
4. Name 2 things you can smell
5. Name 1 thing you can taste, or take one slow breath

The VA says good coping takes practice, and taking direct action to cope with stress reactions helps you feel more in control.

Try this

1. Breathe in slowly through your nose for a count of 4
2. Breathe out gently through your mouth for a count of 6
3. Repeat 5 times
4. Notice anything that feels a little calmer

Heavy exposure to coverage of a traumatic event has been linked to more acute stress. Researchers suggested people limit news viewing soon after a major trauma.

Healthier habits

• Avoid replaying graphic videos or images
• Check the news once or twice a day, not constantly
• Ask friends not to send you clips
• Turn off autoplay and notifications for a while

If memories, nightmares or fear are not easing, or are getting in the way of work, sleep or relationships, talk with a counselor or doctor. Good treatments are available.

The PTSD guide in this app explains flashbacks and trauma-focused therapies.

In a sudden crisis, people freeze, run or help, often without choosing. These are automatic survival reactions, not decisions.

Looking back, it can seem obvious what you “should” have done. In the moment, you had seconds, partial information and a body full of alarm.

Questions to ask yourself

• What did I actually know at that moment?
• How much time did I really have?
• What would I say to a friend who did exactly what I did?
• Who else, or what else, played a part?

People who called for help, gave first aid or stayed with someone can still feel guilt if the outcome was bad. Doing your best does not guarantee a good outcome.

Guilt after witnessing often comes from caring deeply and wishing things had gone differently. You can honor that care without punishing yourself.

Ideas that can help

• Do one kind act in honor of the person
• Talk it through with someone you trust
• Use the “Untangling ‘I should have done more’” worksheet
• Write down what you would say to a friend

If someone died and you survived, the Difficult life experiences guide has more on survivor’s guilt.

For example

• Bystanders who gave first aid or called for help
• Clergy and chaplains
• Firefighters, EMTs and police
• Nurses, doctors and hospital staff
• Rescue, recovery and relief workers
• Security, transit and school staff

Watch for

• Feeling emotionally numb or shut down
• Drinking more or other unhealthy coping
• Irritability or snapping at people
• Pulling away from friends, family or fun
• Sleep problems or body aches

What helps

• Check in with a buddy after hard calls or shifts
• Have a routine that marks the move from work to home
• Protect sleep, food and movement
• Take real time off
• Use peer support or employee assistance programs

Many responders worry that asking for help will make them look weak or unfit for duty. Seeking support early is a way of staying well enough to keep doing work that matters.

The “Your job and your mental health” guide in this app has more for people in demanding jobs.

You might notice

• Acting younger, like bedwetting or clinginess
• Bad dreams or trouble sleeping
• Fear of being apart from you
• Playing out the event again and again
• Stomachaches or headaches
• Trouble focusing at school

The VA notes that PTSD looks different in children of different ages. Most children recover, especially with steady support.

Helpful things to say or do

• “Something scary happened. You are safe now, and I’m here.”
• Ask what they saw or heard, and gently correct rumors
• Answer questions simply and honestly
• Let them know all feelings are okay
• Give extra hugs, time and reassurance

Ideas

• Keep meals, bedtime and school as normal as you can
• Keep news and graphic videos away from young children
• Make time for play and calm activities
• Watch what older kids see on social media

Talk to your child’s doctor, school counselor or a child therapist if reactions are not easing, are getting worse, or are getting in the way of school, friends or sleep.

If a child is being harmed at home, call 911 if they are in danger. To talk through what to do, call or text Childhelp at 1-800-422-4453.

Children take cues from the adults around them. Getting support for your own reactions is one of the best ways to help your child.

Anyone working with survivors of trauma and violence is at risk. Risk can be higher for people with their own past trauma, people who are isolated, and people newer to the work.

Family members who hear about a loved one’s trauma, and people who see graphic content online, can also feel secondhand effects.

Possible signs

• Difficulty managing emotions
• Feeling emotionally numb or shut down
• More irritability or unhealthy coping
• Sleep problems or physical complaints
• Withdrawing from friends, family and things you enjoy

Ideas

• Build a clear routine between work and home
• Get enough sleep and movement
• Keep daily life predictable
• Stay connected with people outside of work
• Talk about it in supervision or with peers
• Use peer support, employee assistance or professional help

Helpers can also draw inspiration from survivors’ resilience. A sense of meaning in helping others, called compassion satisfaction, can help protect against the harder effects.

PFA core actions

• Making contact in a calm, caring way
• Safety and comfort
• Helping people steady themselves if needed
• Finding out what people need right now
• Practical help
• Connecting people with family, friends and support
• Sharing information about coping
• Linking people with other services

Researchers identified five elements that support people after mass trauma. They can guide anyone who wants to help.

The five essential elements

• A sense of safety
• Calming: soothing and steadying people
• Belief in yourself and your community’s ability to cope
• Connectedness: strong social ties
• Hope for the future

Simple ways to help

• Help them reach family or friends
• Help with practical needs like water, a phone or a ride
• Listen if they want to talk, without pushing
• Make sure they are away from danger
• Stay calm and speak gently

The National Child Traumatic Stress Network and the National Center for PTSD developed a PFA guide for responders. WHO publishes a PFA guide for field workers.

Try saying

• “That sounds really frightening. I’m glad you’re safe.”
• “You did what you could in that moment.”
• “Do you want to talk, or just have company?”
• “There’s no right way to feel about this.”

Try not to say

• “Just don’t think about it.”
• “At least you weren’t hurt.”
• “Why didn’t you do something?”

Ideas

• Bring food, help with chores, or give a ride
• Gently check in over the next few weeks, not just the first day
• Help with calls, forms or time off work if needed
• Keep them company the first nights if they want

If their reactions are not easing after a few weeks, or they seem hopeless or are drinking more, gently encourage them to talk with a doctor or counselor.

Connectedness and a sense of community coping are two of the five elements that support recovery after shared trauma.

Ways communities help

• Check-ins for coworkers who saw an incident
• Gatherings or memorials, if people want them
• Sharing information about local support
• Teachers giving kids space to talk and ask questions

Run by SAMHSA, it offers crisis counseling for emotional distress after natural or human-caused disasters, including mass violence. It is open to survivors, loved ones, responders and relief workers. Press 2 for Spanish; interpreters are available in over 100 languages.

The 988 Suicide & Crisis Lifeline is free and open 24/7 by call, text or chat. Crisis Text Line connects you with a trained crisis counselor by text: text HOME to 741741.

Your primary care provider can check how you’re doing and refer you to a trauma-informed therapist. Trauma-focused talk therapies help many people.

Find A Helpline lists free, confidential support lines in over 175 countries. The International Association for Suicide Prevention points people to it too.