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Steve Kaufman has accepted the possibility that the image of the accident victim's face may never leave his mind entirely.

The image that repeatedly comes back to the retired Steamboat Springs volunteer firefighter like a flashback is the expression of horror and fear on a dead man's face. It is more poignant because Kaufman was acquainted with the victim of the crash.

"I don't think I'll ever forget the incidents I've responded to that involved a death," Kaufman said.

However, for people such as Kaufman, who are first responders to emergency scenes, the risk of emotional trauma is an occupational hazard.

The 13 months that ended in January were particularly tough in Northwest Colorado for emergency first responders. They saw an unusual number of violent highway accidents, they coped with the extrication of the bodies of people killed in backcountry skiing accidents and they lost three of their own when an air ambulance went down near Rawlins, Wyo., in January.

Emergency responders in--clude law enforcement officers, firefighters, emergency medical technicians, search and rescue volunteers, hospital personnel and dispatchers. For those people, the sights, sounds and smells of accident scenes can suddenly come back to mind 10 or 15 years later, and it's as if they were happening at that moment, said Darrell Levingston, longtime Routt County Search and Rescue member and a member of a group that tries to help first responders cope with emotional trauma.

"The first responders have the awful visual trauma," said social worker Carla Portigal of Steamboat Mental Health Center. "I hear about it, and I'm affected. These people see it, they touch it. We need to understand this is a very difficult thing they do -- emotionally, psychologically, spiritually. I don't know how some of them cope with the things they see."

Portigal, too, participates in the local group that tries to help first responders process such emotional trauma.

The Timberline Critical Incident Stress Management team doesn't convene after every emergency or accidental death. But when it does come together, it does its best to involve everyone who responded to an accident scene, Levingston said. The purpose is to conduct a debriefing intended to help those first responders understand their feelings and deal with them.

"Red flags for us are anything involving a child, or a death in the line of duty," Levingston said. "We try to get everyone together, usually within 24 to 72 hours. Sometimes, we move that up."

In addition to a professional counselor such as Portigal, the Timberline team includes 10 emergency responder peers who have been trained in the process. They come from Steamboat Fire and Rescue, Routt County Search and Rescue, Yampa Ambulance, West Routt Ambulance and Yampa Valley Medical Center teams. All 10 have had at least two days of training about how to hold an effective CISM meeting.

CISM was started by a paramedic in Baltimore, Md., who was pursuing his doctorate in psychology, Levingston said. He recognized that there were parallels between some of the behaviors and symptoms exhibited by emergency first responders to those of post-traumatic stress syndrome suffered by Vietnam veterans.

The symptoms of emotional trauma displayed by emergency first responders can include altered sleep patterns, a lack of appetite, irrational anger, and alcohol and drug abuse. Relationships suffer, and some people exhibit suicidal tendencies.

Coping mechanisms can come to the forefront. Some people display a stoicism that belies the emotional pain they are feeling. Outsiders who hang around first responders for a time may notice they seem to delight in a form of "gallows humor."

"Sometimes they try to wall it off," Portigal said. "But you can only do that for so long and then it's going to affect you."

The mutual experiences of first responders bind them together, Levingston said. Portigal added that, often, spouses and partners can't possibly relate to what their loved one has experienced.

By bringing everyone together and asking them to discuss what they experienced at an accident scene, Levingston said, there is an increased chance that people will tap into their emotions.

"It gives everyone a chance to digest and process what they've seen and what they did," Levingston said. "Everything is confidential. We go through a chronological reliving of the situation. We relive it -- the facts, the thought processes."

The debriefings can become very emotional, Portigal said, and that's a healthy thing. Even if just one person breaks through and lets their emotions spill out, it can be beneficial to the other people in the room, she said.

"It's important that people talk about their feelings, because in that way, they help other people," Portigal said.

She recalled a debriefing during which one of the participants was "falling apart with pain."

"His willingness to share his pain was so important for the other 40 people in the room," Portigal said. "It forced them to feel their own pain. That's so important."

Kaufman said the debriefings raise the question, "Are you willing to admit it's giving you a problem and you need to get some help?"

Portigal and Levingston agree that CISM is not a quick fix for the emotional effects of what is experienced at an accident scene. But it starts people on the path to understanding their feelings.

Kaufman said he's certain the experiences of military veterans are much more emotionally traumatic than what emergency first responders in Northwest Colorado go through. And he knows that firefighters, law enforcement officers and paramedics in large cities see many more disturbing scenes, month in and month out, than their counterparts in small towns. But there's something about working in a small town that makes the role of the first responder more difficult.

"Every time you get a call you think, 'Gosh, I hope it's not someone I know,'" Kaufman said. "Unfortunately, there were times when it was people you knew. It's times like that when you think, 'Is that really something I want to do?'"

Last year, area first responders dealt with an unusual number of tragic events, Portigal said. And they have emotional needs as a result.

Even adults have a portion of their psyche occupied by the innocent child they once were, Portigal said.

"It's a part of us that's very vulnerable," she said. "It's the child part of us that feels the pain."

-- To reach Tom Ross call 871-4205

or e-mail tross@steamboatpilot.com