LEWISBURG, W.Va. - During a Sept. 11 presentation on the campus of the West Virginia School of Osteopathic Medicine (WVSOM), a husband-and-wife team used a common household situation to illustrate how stress can affect emergency medical technicians, firefighters, law enforcement officers and behavioral health professionals.

"Think about laundry," said Kari Mika-Lude, Ph.D., a licensed professional counselor who specializes in trauma in first responders. "You throw one shirt on the floor next to the hamper. No big deal. But then you keep throwing shirts, pants and socks on the pile and soon you have several loads of laundry to deal with. It's the same way with trauma. It's not one specific call that gets to you. It can be the cumulative effect of years of calls."

The presentation, "Code Grey: Finding Calm in the Chaos," was sponsored by WVSOM's Center for Rural and Community Health (CRCH) and Marshall University's Center of Excellence for Recovery and was attended by about 37 first responders who received continuing education credits.

The goal was to make workers more aware of their stress reactions and the impact they have on wellness. Recognizing these signs before they become problematic is critical in reducing burnout, post-traumatic stress disorder or other mental health conditions, and suicide - issues known to be more common in first responders than people in other professions.

Brian Hendricks, Ph.D., executive director of WVSOM's CRCH, said offering education and opportunities to hear from members of this community is an important part of tackling the mental health crisis.

"Communities need to come together to offer opportunities, like the one today, to encourage the people who watch out for us each day to preserve their health," Hendricks said. "The CRCH is committed to serving the state of West Virginia and helping to address the health inequities our rural communities and people experience."

Mika-Lude's husband, Allen Lude, a West Virginia-based firefighter and emergency medical technician, worked with the Transportation Security Administration in the years following the attacks on Sept. 11, 2001, which the presentation served to commemorate. Lude said first responders need healthy ways to cope with the relentless procession of traumatic situations they face.

"Whether you're a 911 dispatcher or working in an emergency room, you're getting constant trauma, and that affects the body. But there are ways to de-escalate those effects," Lude said.

Mika-Lude, whose doctoral dissertation centered on emergency personnel, spoke about the impact of first-responder culture and how public perception and the profession's internal expectations can result in dehumanization - the idea that emergency workers are somehow superhuman and don't need down time or help with mental health.

"First responders are often compared to heroes," Mika-Lude said. "But the term 'hero' unintentionally deprives first responders of humanness and a need for care, and perpetuates the idea that they must be all things to all people, regardless of their own needs. According to my research, dehumanization, regardless of whether it's coming from the public or the organization itself, is strongly linked to burnout and suicidality."

Lude recounted an incident from his own early career that left an indelible mark. While he was working with the fire department in Davis Creek, W.Va., at about age 20, his team was called to assist with a truck rollover accident.

"We were the first on the scene, and I knew it was going to be a bad call because the cab was crushed. But even at a young age you have a sense of duty, so you respond. It was a male patient, but I didn't look at his face because I knew there was a good chance I would know the person," he said. "I did what I could do to save him until the medics arrived, and then we needed the driver's license to do the report. That's when I realized it was my uncle. I had to call my mom to tell her to go to the hospital. She asked, 'Is he going to make it?' And as much as I wanted to say yes, I knew he wasn't going to."

Lude's subsequent feelings of guilt prevented him from telling his co-workers he was related to the victim and eventually took a toll on his emotional health that nearly ended his career - and, he said, could have ended his life.

"No matter how many times I tell this story, it still hurts. I'm telling it because everybody here has a story. You might think you're Superman or Wonder Woman, but the fact is you're human and you feel pain. That's why we often try to disconnect and not be human while we're on these calls, because it hurts. That's why it's important to establish a process ahead of time to find help when you get to that point. There's always a reason to live to see the next day," he said.