title: Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 - a cross-sectional study.
abstract: BACKGROUND
  Norway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS).
  
  
  METHODS
  This cross-sectional study investigated the degree of perceived peritraumatic strain among police officers, fire-fighters, and ambulance personnel, as well as the prevalence and predictors of PTSS. A questionnaire was completed by 89 ambulance personnel, 73 fire-fighters, and 76 police officers working close to the terror sites, 8-11 months after the event. PTSS were assessed using the PTSD Check List (PCL-S).
  
  
  RESULTS
  Merging all groups, 68% reported to have witnessed injured/dead people, but only 5.7% reported this as very/extremely strainful. The PCL-S scores were low and not significantly different among the three professions (Median = 19-20, range 17-64). The prevalence of possible PTSD (cut-off > 50) was 1.3 %, and 2 % had scores indicating sub-threshold PTSD. Dissociation predicted higher PTSS-level in all groups (β 1.6-5.1), witnessing injured/dead among ambulance personnel (β 2.5) and feeling overwhelmed among police officers (β 1.2).
  
  
  CONCLUSIONS
  First responders were exposed to deaths, injuries, and destruction, but few reported this as highly stressful. The prevalence of possible PTSD was low in all occupational groups, and symptoms of dissociation were found to be the most important predictor.
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway. laila.skogstad@ous-hf.no.
authors.forename: Laila
authors.initials: L
authors.lastname: Skogstad
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway. anja_fjetland@hotmail.com.
authors.forename: Anja M
authors.initials: AM
authors.lastname: Fjetland
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway. oiek@ous-hf.no.|Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway. oiek@ous-hf.no.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Ekeberg
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016495:Police / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D023481:Terrorism; D014505:Urban Population; D055815:Young Adult