Emotional trauma after violent events such as shootings can have a ripple effect -- it doesn't just affect the victims and witnesses, but also their families and those who rushed in to help.


Mental-health providers say they have learned a lot in the past decade about the best way to help those who were first on scene.

One important lesson is that "talking about it" doesn't work for everybody. In fact, it can be harmful for some people.

In the '90s, an approach called "debriefing" became very popular. First responders had to discuss what they had seen and lived through with mental-health professionals or in groups. The debriefing would happen within days or hours of an incident.

University of Pennsylvania psychiatrist Steven Berkowitz says studies later showed that this actually caused symptoms in some people who were doing OK. For others, it was inefficient.

Today, he says, the approach is giving people information.

"So we really focus on providing education and coping skills, rather than asking for what happened," said Berkowitz.

Berkowitz was involved in creating crisis response protocols after 9/11. He says those affected by tragic events should first learn to identify when they're having trouble and then get some practical guidance.

"To teach some basic coping skills, how to manage some of these reactions, how do you manage what is irritability and tension, helping with sleep and sleep hygiene," he said.

Berkowitz says mental-health professionals have developed and distributed protocols to make sure people use the most effective approaches in caring for those affected by tragedies.

He says another important aspect of care is a clear command structure where providers are not rushing in and tripping all over each other in an effort to help.