The massacre Sunday night on the festival grounds outside of Mandalay Bay on the Las Vegas Strip has been difficult for everyone in Las Vegas.

Everybody is trying to understand how something like this could have happened.

But for those who were at the scene, the effort to understand, to process and to heal is much different and much harder.

And for those who ran towards the scene to help instead of away to escape gunfire, there is another layer of difficulty.

That is where Dan Ficalora steps in. He is a counselor who has been talking to Las Vegas area police and firefighters who ran to the danger to help people in need.

Ficalora told KNPR's State of Nevada the people he has spoken to were both on duty that night and off duty and were there just to enjoy the concert.

“There were people who were there just enjoying themselves as spectators of this concert and suddenly they found themselves thrown into the first responder role, which they were trained for, but they were also surrounded by their family members,” he said, “So, they were caught between protecting family members and then also protecting the community at large.”

Ficarlora said the reactions he has seen run the gambit from extreme grief to numbness, but he says all of them are valid ways to deal with the tragedy.

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“Anything is a normal reaction at this point,” he said. “Because really, nobody in our community is okay right now. Everybody is hurting.”

The mental health community around the Las Vegas Valley is working to help people deal with those emotions in a kind of “psychological first aid” in hopes of staving off bigger problems down the road.

“The true effects of a traumatic events if not processed immediately can linger,” he said, “The symptoms of post-traumatic stress disorder really don’t appear for 60 to 90 days after a traumatic event.”

He said getting people to start to talk about the event and improving their coping skills will help to reduce the likelihood that they will develop PTSD.

“The next wave of this response is going to be months from now as our first responders, as people that were at the venues begin to really process and understand what they went through and that’s when we start to see the typical PTSD symptoms,” he said.

Ficarlora said some of the PTSD symptoms include flashbacks, heightened anxiety, social isolation, high vigilance, and aggression. He also said friends and family should look for behavioral changes like new or increased substance use, obsession with the news, or a large change in their personality for example from being outgoing to being quiet and isolated.

For police officers, firefighters, paramedics and emergency medical technicians, working through the impact of a traumatic event can be especially difficult, Ficarlora said.

They are both victims of the event and they’re expected to be our heroes.

“They’re very heroic in the tasks that they completed. The people that they saved. The way that they responded running toward the fire when everyone else was running away but at the same time they were afraid for their life. They were under fire. Many of them thought that this was it, this was how they were going to go,” he said.

He said police, firefighters, paramedics, and EMTs are in a difficult balancing act now between caring for family, working a 12-hour shift and dealing with their own mental health.

Ficarlora said it is a process and it will take a long time to find a way through this.

“The goal of trauma work is to have the victim be able to talk about, think about the experience in a way that is not continually hurtful,” he said, “Not that it is ever going to be a positive experience but that the negative emotions, the hurtful emotions, the emotions that are impairing their functionality decrease over time.”

He said improving people’s calming and coping skills will go a long way to helping them process the ordeal.

He said it is also important for everyone to find their role in the community.

“We’ve seen an outpouring of volunteerism and altruism throughout the community that’s a really, really great way, an effective way to help cope and help process this event is by going out and helping somebody else,” he said.

Obviously, we’re not all police officers and firefighters putting on protective gear to help the community, he said, but in our own way in our spheres of influence we can do our part to help heal the Las Vegas Valley.

For mental health services:

Trauma Intervention Program: Las Vegas

Optum’s Emotional-Support Help Line has been opened to those affected by Sunday’s mass shooting. The toll-free number is 866-342-6892.

Additional resources are available online at liveandworkwell.com.

FirstMed in Las Vegas is also offering free medical and support services, counseling and prescription review and refills for individuals impacted by the attack.

The Nevada Psychology Association has information on free and reduced services for counseling on its disaster resource page.

MGM Resorts International is also offering help for guests and employees call 702-692-2300 or toll-free at 888-634-7111.

Culinary Union members can also get free mental health assistance at 1-800-363-4874.