The horror of the Orlando nightclub shootings carries a wide range of mental health issues for both first responders and the community at large — something understood with particular clarity by those who endured the 2012 Aurora theater shootings.

While city officials have reached out to their counterparts in Florida to offer support, some witnesses to the theater tragedy also have sought help processing the mass shooting that took place nearly 2,000 miles away, a reminder of how such incidents span both time and distance.

“Trauma comes to us now live and in living color, every gruesome detail,” said John Nicoletti, a Lakewood-based expert in crisis intervention and trauma recovery who helped guide the Aurora response. “When you watch on TV, you retraumatize yourself, so use restraint. Part of you is curious, but each time you do that, you activate your psychological footprint.”

Although the impact may be most direct for those closest to the violence, Aurora learned that trauma can seep broadly through its populace, requiring a response to match the variety of experiences, said city manager George “Skip” Noe.]

Aurora enlisted the help of former Denver Broncos quarterback John Elway. It accepted an offer of assistance from the 9/11-tested New York Fire Department. It reached out to workers on a street resurfacing project near the theater. It parlayed a private donation and available public space into the Aurora Strong Resilience Center, which still offers wide-ranging services to anyone in the community.

Even as Aurora made itself available to Orlando as a resource, the city reached out once again to its own employees. Noe and Police Chief Nick Metz, among others, sent out reminders for managers to be extra vigilant in monitoring workers’ mental health.

“We remind people that these events have their own triggers,” Noe said. “Everybody handles things differently, grieves differently in their own way. Our responsibility isn’t over because it’s been four years since the incident.”

Kirsten Anderson, a psychologist, disaster coordinator and division director at Aurora Mental Health Center, notes that those trauma triggers vary with each individual and can cover a range of senses — sights, sounds and even smells. And dealing with them can be a long-term proposition.

Addressing those long-term needs became the impetus for services provided at the Aurora Strong Resilience Center that include wellness classes, yoga, tai chi and massages.

“One of the most effective things is that there are people impacted by trauma actually delivering services,” Anderson said, noting that massage services are performed by a theater shooting survivor and tai chi is taught by a survivor of the Columbine school shootings. “It’s empowering to give back and be part of other people’s healing.”

Nicoletti points out that Aurora cops who responded to the theater carnage, like those who answered the call to the Orlando nightclub, can acquire triggers specific to their experience — such as the repeatedly ringing cellphones of the dead, whose friends and relatives desperately hope to find them safe.

“For people who have to be there, it’s too much, too ugly, too long,” he said. “Later, a cellphone ring, even when you’re awake, can trigger flashbacks.”

Aurora’s decision to use police vehicles to transport the wounded — a tactic also employed in the Orlando shooting aftermath — produced a type of trauma outside officers’ normal experience he terms “too much, too ugly, too different.”

But driving those casualties to emergency rooms also eventually helped some deal with the psychological impact of the shootings, adds former Aurora police chief Dan Oates, now chief in Miami Beach. He credits his sergeants for organizing trips to the hospitals for officers to visit with survivors.

“A couple of days later, it was cathartic for those officers to go back and see people saved, cleaned up, even speaking to them, hugging them,” Oates said. “That was very affirming and helped them cope. I think the organization was proud of how we responded that night. The cops could take from that that they made a difference.”

Oates recalls trying a lot of ideas aimed at addressing the mental health of his officers, from inviting Elway to address them to having Nicoletti explain normal reactions to trauma to what he calls “the big debate: Do you make cops go see a shrink?”

“We decided not to,” he said. “We said, ‘This is available to you, and you should spend an hour with one of the police psychologists over the next weeks or months.’ In the end, nearly everybody did that.”

For some, it took a prodding phone call from Nicoletti, who kept a list. Oates personally appealed to those who were particularly reluctant to seek help. Eventually, the chief talked to every officer who had worked the theater that night.

“I did it largely because I wanted to hear their story, but I also felt that I could send a signal to them I was invested in their personal experience that night,” Oates said. “I also did it as a check on my own read of the cop, how they were coping. That was tremendously telling.”

Mental health protocols have evolved over years of mass shootings, Nicoletti explains, leading to Aurora’s more proactive posture. “Because a lot of times,” he said, “the people who need help are the ones who say, ‘I’m fine, I don’t need to talk to anybody.'”

Those who have faced intense trauma can talk — or write — about their experience until thoughts at the forefront of their awareness recede to memories.

“Best case, they go from thinking about it to remembering it,” Nicoletti said. “It becomes a memory, not a thought that consumes them. Now, looking at the outcome of first responders of Columbine vs. Aurora, there’s been a huge improvement of the process. But even in the best case, you’ve got to be prepared to have something wake up the ghost again.”