Post-traumatic stress disorder, or PTSD, is a condition closely associated with the battlefield. But Michael Ferrara developed PTSD without going to war — he spent three decades living and saving lives in Aspen, Colo. as a search-and-rescue man, ski patrol officer, paramedic and firefighter.

After several years, horrific images from those rescues started playing over and over in his mind.

“Little by little, it just started to build, and then one day, the slideshow that was all these events started running in my head and I couldn’t control it,” Ferrara says. He was seeing “an eviscerated man from an automobile crash;” burned, dismembered bodies; and climbers that had fallen 2,000 feet.

Therapy was able to help bring him back, but Ferrara says such rescues are very difficult, especially when his good friends are killed, which has happened numerous times.

“The last one was a very close friend of mine in December of 2008 who had been killed in an avalanche,” Ferrara tells NPR’s Audie Cornish. “I was at bottom at that point.”

Ferrara says he handled it by isolating himself. “I didn’t leave the house,” he says, “and I had begun using Percocet that had been prescribed for physical ailments for my emotional trauma.”

‘Why Would You Be Fine After That?’

Ferrara isn’t alone in his experience — other rescuers and first responders have had to cope with their own post-traumatic stress. Hampton Sides, a writer for Outside, covered Ferrara’s case and other cases of civilian PTSD in the January issue of the magazine.

“It’s only recently become apparent that PTSD is rampant among the community of first responders,” Sides says. “I think that the last community that has come to recognize this has been these mountain communities — these people who essentially get to do what they love to do, and yet they come across this trauma. They see these horrible things — often people that they know.”

Sides says that part of the reason for the lack of diagnosis of PTSD is the culture of the responders themselves. “There’s the kind of ‘he-man’ quality to this,” he says. “These guys don’t like to recognize when they’re hurting.”

Ferrara recounts the story from several years ago of a young man riding his motorcycle on a mountain road who was hit by an 18-wheeler.

“He was conscious when I got there, begging me not to let him die,” Ferrrara says. “He died on me, in my arms. And I talked to psychologist afterwards, and she said ‘How are you doing?’ And I said ‘Ah, I’m fine.’ And she said ‘Why would you be fine? You’ve just had a man beg for his life die in your arms. Why would you be fine after that?‘”

Changing The Culture

But with increasing focus in the military on the effects of PTSD, Sides says that awareness for and treatment of PTSD in civilians will become much more widespread. That begins with education.

Sides says that paramedics and ski patrollers, after an incident on the mountain, will have debriefing sessions where they will talk about the rescue — and that’s usually all they do. But he says more and more people are beginning to recognize first symptoms of PTSD and things that can be done preventively.

“I think now, with the lead that the veteran’s administration has given us in terms of dealing with and talking about this condition, now it’s okay for first responders and all other situations to come forward and try to deal with it before it becomes acute, like it did in Michael’s case,” Sides says.

“We have to recognize that having this stuff mess with your head is not abnormal,” Ferrara says. “You’re not supposed to see stuff like this. And what we need to do is break through the culture by someone like myself stepping up and saying, ‘Hey, it happened to me,’ and I’m going to ask you: ‘Are you okay?‘” Copyright 2010 National Public Radio. To see more, visit http://www.npr.org/.