By MICHAEL J. ASKEN, PH.D.

Over 2 million motor vehicle accidents (MVAs) involving personal injury occur yearly in this country. Three million people, or about 1% of the population, are injured in these accidents. The total cost of MVAs is estimated at $70 billion to $137 billion a year.

Emergency responders are well-acquainted with the physical extrication that is often required at the accident scene. Perhaps not so obvious, but just as significant, is the "emotional extrication" or psychological recovery that many MVA victims must under go when facing the aftermath of their accidents.

MVAs are the most frequent trauma for females. Some experts believe the emotional distress from MVAs may be as great or greater than other types of trauma. MVAs are the leading cause of post-traumatic stress disorder (PTSD) in the civilian population.

And, while there are several important types of psychological reactions to MVAs, post-traumatic stress disorder is perhaps the most significant. From 5% to 45% of persons involved in MVAs may develop PTSD. Emergency responders who are aware of critical in cident stress will also be familiar with PTSD.

PTSD is the result of being exposed to or witnessing an event that involved actual or threatened death or injury to that person or others and where the individual experienced intense fear, helplessness or horror. There are several types of symptoms that are part of PTSD. First, individuals re-experience the event one or more ways such as nightmares, intruding pictures or images of the event, or flashbacks. Second, there is an attempt to avoid things associated wit h the event and there may be "numbing" of feelings and responses. Examples include not wanting to talk about the event, not wanting to read or hear news reports about similar events, avoiding the scene of the event or having decreased interest in usual ac tivities.

The third set of symptoms include increased arousal or sensitivity such as having trouble sleeping, being more irritable, having difficulty concentrating or just being more "jumpy." The last indicators of PTSD are that the symptoms distress or impair the person's usual function and that these symptoms last more than one month. This length of time is very important, for as many responders know, some or many of these reactions can occur for a brief time after a bad call as a normal response; if they last lo nger than a month, their nature is much more serious.

The impact that these reactions have on victims can be seen in comments that have been reported by persons involved in MVAs. The re-experiencing of the event has been described as a "nightmare that can't be stopped" and "like a rerun of a movie that won't stop."

The experience of numbed feelings has been described as "I live in frozen watchfulness" or "emotionally neuter-ed. Zombie-like." And the hypersensitivity has been described as being an "emotional jack-in-the-box," "an emotional yo-yo" and "I feel like I a m caught up in a tornado."

Even if an MVA victim doesn't develop full-blown PTSD, there can be a partial PTSD with many, but not all, of the symptoms. Even those victims without full or partial PTSD can experience some of these symptoms, which can be distressing. And as if it weren 't uncomfortable enough to experience these feelings, their presence can impact and affect the person's work, leisure and driving activities. Further, if a person has chronic headaches or pain from the accident that should have long ago gotten better, it may be that unrecognized post-traumatic stress is a factor in the ongoing discomfort.

There are other reactions that a person can experience after an MVA. Acute stress disorders also involve a traumatic event and re-experiencing, avoiding, numbing and excessive sensitivity. However, there may be fewer avoidance and numbing symptoms and the re must be or have been present a sense of depersonalization. This means that the person felt as though the event wasn't real, was not happening to them or as if they "weren't really there." The other major difference is that acute stress disorders occur within the first month of the event.

Some people may develop an accident phobia. Here, the person experiences anxiety and avoidance because of fear of repeating the accident. The fears get worse when in driving situations either as a driver or passenger. There may be a specific driving phobi a which involves complete or almost complete cessation of driving. Driving reluctance is a milder form where there may be only avoidance of certain sites or conditions (nighttime, rain, etc.) Such effects can last years after the accident.

Fortunately, just as with general PTSD, there are good and effective treatments to help people who need emotional extrication from the psychological impact of their accidents. There are medications which can be very effective in reducing the intruding tho ughts, nightmares and fears that victims experience. Hypnosis has been found useful to help with recurring thoughts, and other types of supportive psychotherapy can help victims cope better.

Behavioral therapies can help victims overcome fears that hold them back from fully engaging in their usual activities, including driving. Teaching relaxation skills and biofeedback can help reduce hypersensitivity. Stress- inoculation training can help w ith intruding thoughts and avoiding situations as can a technique called "flooding," which helps with the phobias.

Emergency responders can be helpful in letting victims and families know that psychological reactions to MVAs are not unusual and that effective help is available for those who need emotional extrication.