Emergency and Medical Services providers, or EMS, are first responders to virtually all traumatic events. These professionals respond to tragic events either just after they occurred or as events are still unfolding. At these moments it is most important to assess the cause of the trauma and where possible remove or attempt to resolve the cause of the trauma first and then to move victims to safety. Often, individuals are in shock and not very coherent during or immediately after traumatic events. This can make it seem like they are unaware of events or individuals around them. While individuals may appear unaware, they are very sensitive and hyper emotional. Often, individuals experiencing tragedy will express extreme emotional responses. EMS personnel must exercise great control of their own emotional responses and try to project as much calm and control as possible to keep victims stable.

Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary according to age:

Children 5 years of age and younger reactions may include

• Fear of being separated from the parent,
• Crying, whimpering, screaming,
• Immobility and/or aimless motion, trembling,
• Frightened facial expressions and excessive clinging
• Returning to behaviors exhibited at earlier ages (regressive behaviors), thumb-sucking, bedwetting, fear of darkness.

Children 6 to 11 years old may experience

• Extreme withdrawal,
• Disruptive behavior, and/or inability to pay attention.
• Regressive behaviors,
• Nightmares, sleep problems,
• Irrational fears,
• Irritability,
• Refusal to attend school,
• Outbursts of anger and fighting
• Complain of stomachaches or other bodily symptoms
• Depress

Adolescents 12 to 17 years old may exhibit

• Flashbacks, nightmares,
• Emotional numbing,
• Avoidance of any reminders of the traumatic event,
• Depression,
• Substance abuse,
• Problems with peers, anti-social behavior.
• Withdrawal and isolation,
• Physical complaints,
• Suicidal thoughts,
• School avoidance, academic decline,
• Sleep disturbances, and confusion.
• Extreme guilt over his or her failure to prevent injury or loss of life
• Revenge fantasies that interfere with recovery from the trauma.

• Set appropriate boundaries and be consistent in both rewards and punishments
• Talk to each child's parents and teachers, and where appropriate physicians, and other service providers to know what is happening
• Listen to them, but don't force them to share; let it come naturally.
• Give honest information about the tragedy and deaths based on the child's maturity level. Always be truthful.
• It's okay to tell a child that you don't have all the answers to his or her questions
• Like adults, children grieve at their own pace. Respect where they are in that process