In the Line of Fire: Trauma in the Emergency Services. Cheryl Regehr & Ted Bober. New York: Oxford University Press. 2005. 304pp. £19.95 (hb). ISBN 0195165020

To my mind, there is at present quite an explosion of writing on the subject of trauma, from a range of perspectives. The events of 11 September 2001, so graphically played out (and replayed in an almost psychopathological manner) in the world's media, have served to focus our minds on the emergency services and the trauma they suffer in lessening traumatic effects on others. In this book we learn that the United Nations records some 500 disasters per annum.

In the Line of Fire is written by two professionals who have an impressive amount of experience of working with front-line emergency services in Canada. They have been co-directors of the Critical Incident Stress Team at Pearson International Airport in Toronto for over 15 years. They use this book to draw together evidence that is based on local and international events. They use case histories to bring to life the stressful events that emergency staff experience and refer to research evidence that convincingly builds a model that they refer to as a ‘trajectory towards health or illness’. This gives us encouragement that many parts of a range of interventions may nudge those exposed to traumatic events towards healthy coping.

Thus, although emergency service workers are exposed repeatedly to traumatic events and a quarter show severe symptoms of stress, they may cope far better if their organisation is a ‘healthy’ one that does not focus excessively on blame. It is pointed out that employers suffer high costs if their staff do develop severe symptoms – in terms of both lost working days and compensation claims. If these workers have a good and supportive home life, they will cope better.

I was particularly interested in the chapter on the effect of inquiries to which emergency workers (in the same way as mental health workers) may be exposed. The impact of inquiries on individuals depends to a notable extent upon the reaction of the organisation that employs them. Is there management support or not? The authors note (albeit in a different chapter) that child protection staff have higher levels of stress-related symptoms than do emergency workers such as firefighters. The implication is that the firefighters have a healthier workplace.

The book concludes that teams such as the authors’ own Critical Incident Stress Team, which can support traumatised front-line emergency staff, their families and locally affected communities, have a valuable role to play – either directly or by ensuring referral of staff for mental health specialist input. The authors openly acknowledge the need for careful evaluation of the impact of trauma response teams.