Direct assistance to victims in rescue operations as a risk factor for post-traumatic stress disorder in police officers: The experience of the Toulouse disaster in 2001


  • Nelly Agrinier, MD
  • Artus Albessard, MD
  • Valerie Schwoebel, MD, PhD
  • Eloi Diène, MD
  • Thierry Lang, MD, PhD



post-traumatic stress disorder, police officers, rescue workers, industrial disaster, cross-sectional study


Objective: The aim of this study was to describe the prevalence of symptoms consistent with post-traumatic stress disorder (S-PTSD) in police personnel involved in rescue operations after the AZF chemical plant explosion in Toulouse, France, on September 21, 2001, and the relationship between S-PTSD and the type of rescue operation.
Design: A cross-sectional survey was performed, using a mailed questionnaire.
Participants: Six hundred and thirty-five out of 1,500 rescue operations police officers participated in the study. All were involved with the explosion site after the industrial disaster.
Main outcome measure: The outcome variable was the presence of S-PTSD.The explanatory variables were the level of exposure during the rescue tasks.
Statistics: Logistic regression was used to calculate the adjusted odds ratios (OR).
Results: The prevalence of S-PTSD among policemen was 4.1 percent [95% CI: 2.1-6.2]. Policemen who had immediate health consequences (OR 4.6; [95% CI: 1.3-16.4]) and those who provided medical assistance to the victims (OR 5.7; [95% CI: 1.6-20.2]) had a higher prevalence of S-PTSD.
Conclusions: Providing medical assistance to the victims was a major risk factor of S-PTSD for police officers. Training police officers to take part in medical activities at the time of the disaster might lead to a reduction of SPTSD incidence in this group.

Author Biographies

Nelly Agrinier, MD

Centre Hospitalier Universitaire de Toulouse, Service d’Epidémiologie, Toulouse, France.

Artus Albessard, MD

Centre Hospitalier Universitaire de Toulouse, Service d’Epidémiologie, Toulouse, France.

Valerie Schwoebel, MD, PhD

Cellule Inter-régionale d’Epidémiologie de Midi-Pyrénées, Toulouse, France.

Eloi Diène, MD

Institut National de Veille Sanitaire Toulouse, Toulouse, France.

Thierry Lang, MD, PhD

(for the Scientific and Operational Committees for follow-up of the effects on health of the AZF plant explosion), INSERM, U558, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d’Epidémiologie, Toulouse, France.


Lang T, Schwoebel V, Diene E, et al.: Assessing post-disaster consequences for health at the population level: Experience from the AZF factory explosion in Toulouse. J Epidemiol Community Health. 2007; 61(2): 103-107.

Renck B, Weisaeth L, Skarbo S: Stress reactions in police officers after a disaster rescue operation. Nord J Psychiatry. 2002; 56(1): 7-14.

Koenen KC: Developmental epidemiology of PTSD: Self-regulation as a central mechanism. Ann N Y Acad Sci. 2006; 1071: 255-266.

Schooler TY, Dougall AL, Baum A: Cues, frequency, and the disturbing nature of intrusive thoughts: Patterns seen in rescue workers after the crash of Flight 427. J Trauma Stress. 1999; 12(4): 571-585.

Epstein RS, Fullerton CS, Ursano RJ: Posttraumatic stress disorder following an air disaster: A prospective study. Am J Psychiatry. 1998; 155(7): 934-938.

Marmar CR, Weiss DS, Metzler TJ, et al.: Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. J Nerv Ment Dis. 1999; 187(1): 15-22.

Marmar CR, Weiss DS, Metzler TJ, et al.: Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents. J Trauma Stress. 1996; 9(1): 63-85.

North CS, Tivis L, McMillen JC, et al.: Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002; 159(5): 857-859.

Fullerton CS, Ursano RJ, Wang L: Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry. 2004; 161(8): 1370-1376.

Chang CM, Lee LC, Connor KM, et al.: Posttraumatic distress and coping strategies among rescue workers after an earthquake. J Nerv Ment Dis. 2003; 191(6): 391-398.

Dyregrov A, Kristoffersen JI, Gjestad R: Voluntary and professional disaster-workers: Similarities and differences in reactions. J Trauma Stress. 1996; 9(3): 541-555.

Rivière S, Schwoebel V, Lapierre-Duval K, et al.: Predictors of symptoms of post-traumatic stress disorder after the AZF chemical factory explosion on September 21, 2001, in Toulouse, France. J Epidemiol Community Health. 2008; 62(5): 455-460.

Weiss DS, Marmar CR: The impact of event scale—Revised. In Wilson JP, Keane TM (eds.): Assessing Psychological Trauma and PTSD. A handbook for practitioners. New York: Guilford Press, 1997: 399-411.

Creamer M, Bell R, Failla S: Psychometric properties of the impact of event scale—Revised. Behav Res Ther. 2003; 41(12): 1489-1496.

Huizink AC, Smidt N, Twisk JW, et al.: Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA. J Epidemiol Community Health. 2006; 60(10): 887-889.

Perrin MA, DiGrande L, Wheeler K, et al.: Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007; 164(9): 1385-1394.

Galea S, Vlahov D, Resnick H, et al.: Trends of probable posttraumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol. 2003; 158(6): 514-524.

Lepine JP, Gasquet I, Kovess V, et al.: Prevalence and comorbidity of psychiatric disorders in the French general population. Encephale. 2005; 31(2): 182-194.

Verger P, Dab W, Lamping DL, et al.: The psychological impact of terrorism: An epidemiologic study of posttraumatic stress disorder and associated factors in victims of the 1995- 1996 bombings in France. Am J Psychiatry. 2004; 161(8): 1384-1389.

al-Naser F, Everly GS Jr: Prevalence of posttraumatic stress disorder among Kuwaiti firefighters. Int J Emerg Ment Health. 1999; 1(2): 99-101.

Bryant RA, Harvey AG: Posttraumatic stress reactions in volunteer firefighters. J Trauma Stress. 1996; 9(1): 51-62.

Guo YJ, Chen CH, Lu ML, et al.: Posttraumatic stress disorderamong professional and non-professional rescuers involved in an earthquake in Taiwan. Psychiatry Res. 2004; 127(1-2): 35-41.

Clohessy S, Ehlers A: PTSD symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol. 1999; 38 (Part 3): 251-265.

Ozen S, Sir A: Frequency of PTSD in a group of search and rescue workers two months after 2003 Bingol (Turkey) earthquake. J Nerv Ment Dis. 2004; 192(8): 573-575.

Beaton R, Murphy S, Johnson C, et al.: Coping responses and posttraumatic stress symptomatology in urban fire service personnel. J Trauma Stress. 1999; 12(2): 293-308.

Brewin CR, Andrews B, Valentine JD: Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000; 68(5): 748-766.

Kessler RC, Sonnega A, Bromet E, et al.: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995; 52(12): 1048-1060.

North CS, Tivis L, McMillen JC, et al.: Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. J Trauma Stress. 2002; 15(3): 171-175.



How to Cite

Agrinier, MD, N., A. Albessard, MD, V. Schwoebel, MD, PhD, E. Diène, MD, and T. Lang, MD, PhD. “Direct Assistance to Victims in Rescue Operations As a Risk Factor for Post-Traumatic Stress Disorder in Police Officers: The Experience of the Toulouse Disaster in 2001”. Journal of Emergency Management, vol. 7, no. 3, May 2009, pp. 59-67, doi:10.5055/jem.2009.0012.