My husband was diagnosed with prostate cancer 27 months ago. The shock and awe of hearing, “yes, it is cancer” is the most powerful, helpless feeling we’ve ever had. Paul’s cancer was a Gleason 7 score on a scale of 1-10. For forty-five minutes the doctor talked about options, and what he would do if it were him, what comes next, etc.,. We didn’t hear a word. We were in shock. Paul’s too strong, too healthy, too big for cancer. This can’t happen to us.
Paul had robotic radical prostatectomy surgery by the best. Dr. Tuerk at Saint Elizabeth’s Hospital in Boston. We knew there most likely would be side effects of the surgery, but all we wanted to hear was that he got it all. The surgery was successful, but he requires blood work every 3 months and is unable to perform the duties of a firefighter due to the effects of the surgery. When the realization of his not being able to return to the job he loved so much began to set in, it was a heart-wrenching chapter in our lives. This was not the way Paul was supposed to leave the job. He lived for this job. His crew from Worcester (MA) Fire Department, Rescue 1 gave him the best retirement party possible. Full of skits, awards, and his ax. But it was ten years too early.
I couldn’t understand how a guy like my husband, who was so fit at 55 that he boasted about being “only one of two guys on the job that can climb ‘UP’ the 3 story fire pole”. With two brothers and multiple male first cousins, with no prostate cancer history, how could someone so healthy get cancer? I started researching firefighter cancer. This was around the same time the Boston Fire Department came out (here) with their video about guys they had lost to cancer. It was shocking how prevalent it was. We’ve been in this for twenty-eight years. We knew a lot of guys with cancer. That video led me to start researching the gear itself. I guess that’s where the rabbit hole opened.
I came across hundreds of articles about firefighters with cancer. Many studies on firefighters with cancer, dermal absorption studies, biochemical studies of firefighters with cancer, University studies of dirt deposits of turnout gear, IAFF supported studies, many personal stories, articles on the recommended actions all firefighters should take; washing gear, etc. I read as many NFPA 1971 Structural Firefighting PPE reports as I could find. What I found in those reports was concerning to me. Of 16 voting members of the committee, 9 are manufacturers themselves. That didn’t sound right to me
but what do I know. In the Report of Proposals from the NFPA meetings, I read how the Special Experts would question the manufacturers and protest certain aspects like their testing methods or particular standard tests all firefighters should perform on the gear, then everyone votes and the manufacturers seem to win more challenges than losing in my opinion. There should be a better balance in the committee. We’ve gotten too close and trusting of the manufacturers. Remember, their first obligation is to their shareholders.
A couple of months back, I was contacted by someone very well known in the environmental field, (as I had reached out to her some eight months earlier). She had clusters of firefighters with cancer. My reply was “I’m sure you do, every station has a cluster.” She asked one question about the gear, “does the gear have PFOA or PFOS?” I never heard the word before. I said I would check and let her know. After countless hours of research, I was able to find that PFOA is a component of the fire gear itself. The fabric is made with Terephthaloyl Chloride and p-Phenylenediamine. It has the chemistry formula C8, H4, Cl2, O2. The C8 is the problem, PFOA. Perfluorooctanoic Acid.
So why the heck is C8 a component of fire gear? If firefighters sweat and stew in these suits, surely it must be absorbed through their skin? What I found was an even deeper rabbit hole. The C8 is needed to meet the minimum Thermal Protective Values (TPP) that protect firefighters from the thermal dangers of the job. It also makes the gear very strong. It is the same material used in bulletproof vests for the military as well as an additive to aqueous film forming foam.
But, just a quick Google search will show the many toxicity issues, human and environmental, surrounding PFOA. The EPA has given it the designation of ‘Contaminate of Emerging Concern.’ Sounds wishy-washy when you read the studies showing the actual scientific evidence from around the world. The problem here in the US is the Toxic Substance Control Act hasn’t changed in years. There is lobbying against any changes in the current structure in favor of the chemical giants.
More searching led to this article from 2006 entitled ‘EU Chemical Law Passed Amid Controversy’:
EU chemical law passed amid controversy
By Emilie Reymond and Louise Prance, 18-Dec-2006
EU lawmakers have approved a new chemical law aimed at making producers and importers of chemicals, used in goods such as personal care products, prove that the substances they put on the market are safe for consumers.
It also states that the lobbying group American Chemistry Council is working hard to ensure that restrictions do not happen there in Europe or here in the US.
After a search of the European Chemical Registry’s site, I saw that firefighter PPE was on the list of textiles for restriction by the European Chemistry Agency or ECHA, as it had determined it was an SVHC or Substance of Very High Concern. The gear is made with the chemical C-8. The chemical companies stated in the ECHA ‘comments in response to proposed regulations’ that the alternative C-6 costs them exponentially more to make.
That led to the search of what firefighters in Europe are doing about it. I came across the 2015 announcement of a PPE & Duty of Care Forum 2016. It covered *Managing a potential transition to non-PFOA PPE. Europe is aware and already on the path to transition to something safer for their firefighters.
They didn’t want to use the alternative C-6 in Europe as it costs more to make. Affecting their bottom line. Keeping us in the dark for as long as possible, while lobbying against changes to the Toxic Substance Control Act here in the US, will save them money. The chemical companies are beholding to their shareholders to show them growth and profit. The manufacturers are using the American Chemistry Council to lobby against change in our chemical standards in America.
The chemical/textile giants were asking for a ‘derogation’ for the items of Firefighter PPE, military style vests, and some medical equipment. The ECHA declined to derogate the FF PPE, but it did give the manufacturers until 2020 to come up with a product not more than 25 ppb of PFOA. That would require the manufacturers to rework the chemical component of the gear. That is up from the original request of the ECHA’s of 2ppb. This paragraph, page 37, shows the ECHA ruling:
“A goal is replacement of C8 chemistry by less hazardous chemicals (fluorine-free alternatives are
said to be available by one stakeholder), or reformulation of C6 chemicals to resist
heavy duty washing. Available information suggests that C6 alternatives that can resist
washing and outdoor exposure are increasingly available.
Overall, given the critical human health/life protecting functions of the C8 chemicals,
and the above consideration on cost and effectiveness of substitution by C6 chemicals,
SEAC proposes an extended transitional period of 6 years after entry into force for
textiles for the protection of workers from risks to their health and safety.”
Keep in mind, part of the process in Europe was to notify the manufacturers and give them an opportunity to comment or protest these changes. That was in 2014. The actual comments were published in 2015. It is almost April of 2017 and we still have not been told that PFOA is such a concern in Europe it is changing the way the textile giants make the gear.
This past January I began asking whether or not we were making those changes here. I couldn’t get
an answer from anyone official or otherwise. No one had heard of it. It wasn’t in a discussion on any of the countless popular firefighter websites, not on any government websites, or the IAFF site. Zero information or discussion about Non-PFOA Firefighter PPE anywhere.
What really bothered me was that it wasn’t discussed at any of the NFPA 1971 Structural Firefighter PPE meetings that I read the Report of Proposals from, back to 2006.
The manufacturers sit at the table with our people and don’t say a word about the restrictions they are facing in Europe. The PPE manufacturers all still printing slick, glossy ads about their gear and the dangers of cancer in the job. They are reinforcing to firefighters the standard safety protocols of washing and inspecting your gear and your body, of not contaminating your families, of wearing all your gear during overhauls, keeping your gear out of UV light, but the discussion of the toxin PFOA and what they are being required to do in Europe does not come up.
There is no justifiable reason to not discuss it. It is as important as knowing about the soot on the gear, or washing your hoods, or washing your bodies and all the other cancer precautions relative to your job. With the money that firefighters pour into these manufacturers and the faith that we entrust them with, it is outrageous that this discussion is omitted.
Weeks ago I began posting about this on my personal Facebook page and sending this to over 200 Facebook firefighter pages. Thankfully, one lone Local Union President, Jason Burns L1314, of Fall River, MA asked if I would send him the information I gathered. He had recently lost two young members to cancer.
During the IAFF Legislative Meeting in Washington, D.C., March 3-8 2017, IAFF L1314 President Burns brought the matter to the attention of IAFF’s Patrick Morrison, the Health, Safety and Medicine Assistant for General President Schaitberger. At this time he is awaiting word from this officer.
This past Friday my husband advised me that Senator Ken Donnelley was a firefighter and a cancer survivor. Paul had met him in 99 as a family liaison during the Cold Storage Warehouse fire. He said I should call him. I did, and spoke at great length with his Chief of Council, David Swanson who advised he will be speaking to the Senator and Chief of Staff. By Monday the reply came from David Swanson, both Senator Donnelley and Mr. Swanson are looking into this issue. IAFF L1314 President Burns advised me that he will also be in communication with the Senator.
It’s very concerning, the cumulative effect of putting on the gear day after day, year after year. In addition to added absorption rate, a firefighter faces as their body temperate rises. In Europe the response of one manufacturer regarding dermal absorption of the PFOA to a group of firefighters
Was, ‘it’s not really that much.’ Wonder how many days, months, and years he’d like to wear that suit.
We need legislation to force the chemical giants to act immediately. To produce the same standards here as are now being used in Europe. These manufacturers should be under a requirement to advise when their materials sold here in the US are restricted in another country. This has gone on for too many years. The arms of the American Chemistry Council are long and reaching. That alone is a problem.
To share the knowledge of what is happening in Europe as well as studies and reports, I created a Facebook page titled, ‘Your Turnout Gear and PFOA.’ It will be updated with any information I can pass along. Link: https://www.facebook.com/Your-Turnout-Gear-and-PFOA-1808869939437081/
Like many firefighters, I spend part of my day searching the internet, Facebook, and various other forums reading articles and trying to stay current with recent advancements, news, and techniques in the fire service. It seems like a big point of contention recently has been between “safety sallies” and “aggressive interior attack” camps. While this has many parts to it, nowhere is this seen more so than on the topic of transitional attack. I don’t like to see our brothers tearing other fire companies down on the internet over a short video clip without asking themselves, “Why was (or wasn’t) this tactic performed?” I would propose that there is always a time and a place for either tactic. I would also say that it should be up to the troops on the ground to go with what they think will work the best for the situation presented to them.
Transitional Attack is not a recent invention. It has been around for years just without the fancy name. Looking back at many company histories, especially before the invention of SCBA, numerous photos can be found of this tactic. Before SCBA, this method was performed more out of necessity than choice. The atmosphere inside a building had to be able to support firefighters before an advancement could have been made. As technology has improved, we have been able to push farther into buildings, to a degree, even without improving the conditions directly in front of us. Whether you fall into the “Transitional Attack at every fire” group or the “never Transitional Attack” group, is there not room for compromise? Can we say some fires (and some fire companies) that there is room to go either way? Depending on your point of view, experience and local knowledge all will come together to help you decide if it is an appropriate tactic at that particular time.
One of the first things to point out is that Transitional Attack will take place at some fires, just due to common sense. If the fire is blowing out the entry way that you have to go into, it has to be extinguished before you can go any further. But what about the fires that can go either way? What about the fire on the second floor of an occupied residential building with fire venting from the second-floor windows and the status of occupants in the house is unknown?
To the safety sallies:
Understand that the crew you are watching stretch a handline in without first knocking down the visible fire might understand the building layout ahead of time and have information that is not known to you. They might have adequate staffing with a second-due engine and truck company right behind them. They might have the training and tools to attack this fire, in this manner, successfully.
To the aggressive interior firefighters:
I would ask you to understand that not every company feels exactly like you do about the “correct” tactics to utilize at a fire. They might have local knowledge of the circumstances that make this a viable and necessary tactic at this fire. They also might not be as well-staffed or equipped as you are also.
I have also seen fires fought by the same company with similar circumstances at two separate fires, fought two different ways. It could’ve been based on something as simple as the time of the day that affected their manpower. In the middle of the day, with two people and no second-in companies in sight, they might perform a Transitional Attack while they gather resources. However, later that same night, if that same fire were to be fought, they would stretch a line to the interior of the building.
Could there be a gray area where the officers on scene could apply the best tactic, without later being berated by their brothers on social media? Maybe a place where both tactics could simultaneously exist…
Paul Brutto Jr. has been a firefighter for the last 17 years and an EMT/Paramedic for the last 14. He is currently a Lieutenant/Asst. Ambulance Chief at the Citizens Fire Co. No. 2 in Mahanoy City, PA and works as a Paramedic for the neighboring ALS service.
As the Editor-in-Chief of Station Pride, I’ve gained an interesting perspective on the American Fire Service. From our follower’s, there have been numerous debates, discussions, arguments, inappropriate comments, judgments, learning moments, and praise. I’ll be forever grateful for the experience Station Pride followers provide and additionally grateful for the support of our movement. Processing, and sometimes engaging in, discussions has been a far-reaching educational experience for all of us here. We all come from some place different and we’ve each learned a special nugget of information unique to our firefighting environment.
As a fire service, we collectively live the same values; the preservation of life, property, and the environment. From that basic statement evolves an entire mission taken on by men and women who believe that cause to be a righteous one. The execution of that mission happens in every which-way possible. Effectively meaning that 27,198 fire departments in the United States, are all executing the same mission just a little bit differently than each other.
There is a myriad of valid reasons for the oddities between departments. One obvious difference among fire departments is geography, California tackles its fire problem different than New Jersey because each geographic location has a different fire problem with different fire needs.
What’s less obvious is the nuances. The small things that make us all different even if we are the same.
Have you ever experienced that moment, while visiting a different fire department, that causes you to cock your head to one side? You think to yourself, why are they doing things this way? It’s awfully archaic, or progressive, or bizarre, you might even think what you’re seeing is stupid. That hose load looks weird, I’ve never seen a tool like this before, why is there a homemade such and such. When you find yourself in those moments of noticing a strange difference between what you know and what you’re seeing, you’re actually witnessing the process of individual fire service evolution.
Every fire department starts off somewhere small. They’re born from one station, perhaps growing to two and even many as time passes and the population grows. Like children, each department grows up becoming who it was meant to be. All the guidance, helping hands, tough lessons, discipline, and difficult choices along the way, help to shape and mold what that department has become today. Every fire department is the hero of its own story.
As part of this evolution we end up with different rank structures, some fire departments have sergeants, crew chiefs, lieutenants, engineers, chauffeurs, and driver operators. We call vehicles Engines, Pumpers, Wagons, Ladder’s, Trucks, Rescues, Ambulances, cars, command vehicles, buggy’s. Rhode island calls Ambulances “Rescues” and they call a Rescue Truck a “Heavy Rescue.” On the Westcoast it’s flys in and on the Eastcoast, it’s flys out. Once again, every decision, whether thoughtfully made or culturally driven, is a small piece of each department’s evolution.
Fire service evolution has spawned new tools like the Boston rake, the San Francisco hook, the New York Roof hook, the Cleveland load, the Denver hose pack, triple load, and much more. Each tool, hose load, process, strategy, tactic, and norm was solidified by decisions and solutions found and executed for individual challenges by individual departments. Some departments are aggressive with tactics, others are more reserved and cautious which is a direct cause of fire department cultural evolution.
As a fire service, we have a few guiding lights of standardization. We have standard training materials provided by IFSTA, and an industry standard provided by the tireless efforts of the NFPA. Handfuls of national efforts to further standardize response efforts include First Net, Presidential Directive #5, NIMS, and FEMA’s EMI. But none of these have had much effect on individual fire service evolution. The way we do things is all different, yet the same.
Fire service evolution can’t exist without fire service leaders steering the ship. With every cultural norm, equipment purchase, solution based decision, strategic plan there is a firefighter, fire officer, or fire chief right there directing the evolution of the department. Evolution can be reactionary or intentional.
What is your department evolving into? Is it a premeditated evolution or a reactionary evolution. One of them you are in control of, the other one controls you.Are you even paying attention to it? Do you have a 5-year, 10-year, or even 20-year plan? With that plan, do you have a path laid out for achievement? Envisioning a long term plan is sometimes overwhelming. It’s imperative that you piece it out into manageable chunks.
A great example of controlling a fire department’s evolution is Boston, Kansas City, and St. Paul Fire taking the reigns on cancer prevention. Cancer prevention measures have wide-reaching affects on the quality of life for their firefighters. Not today, but tomorrow and for the rest of their lives. Is it perfect? No, but it’s an effort to swing the pendulum and control the evolutionary and cultural process. By developing processes and operational procedures, leaders are steering the evolution of their fire departments.
All specifics aside, it’s important we refrain from judgment when we see fire departments doing things we don’t quite understand from our own experience. Each department has evolved to solve the same problems in a way which works for them. It may not be what you’re familiar with but if it works for them, than what’s the big deal right? That old adage, “there are more ways than one to skin a cat” comes to mind. (Even though I’m not certain why anyone would, apparently our ancestors had an aversion for cats.)
The alarm pierces through the good time you and Scarlett Johansson are having in your dream, telling you it’s time to get up and shower. Your alarm is the house-tones from a popular TV show from the 70’s and 80’s about paramedics and firefighters. You mock other people that have that as a ringtone while secretly loving the nerdiness of it. You hit the snooze once trying to convince your soul and brain that it is a good idea to go through the next 24 hours of what you have to do. You silence the alarm again and make your way down the steps to the bathroom, motivated by something, but you are not sure what.
You stand in the shower as the drops of water hit you, each telling you that the day is real; the day has started and that it’s time to drag your heart, your mind, and your soul through the mire of emotions that you know you will have today. Like dragging a brand new coat through a mud puddle, just so you can take the coat back home to wash it and make it clean again. You look forward to getting in this shower when you get back home. It makes you feel like, if you have the water hot enough, you can wash the day off; the negative emotions off of your heart and the bad things out of your brain.
Before you know it, the shower is over. You shave so your SCBA mask will fit tight on your face. You know you probably won’t need it since you are on the medic today, but you do it anyway. You brush your teeth so that when you kiss your sleepy significant other goodbye, you leave them with the memory of your fresh breath and your clean body and cologne to get them through the 24 hours without you. “I love you, and you smell great,” they whimper through sleepy eyes. That’s all you need to light a fire in your soul that burns until you get back home the next day.
You get your stuff together and get to the car. You get in it and sit for a minute trying to remember which place you are working at today since you work a couple of different departments to make a living. You tell yourself you do it to make your work experience “well-rounded, ” but you know deep down that it’s because your inner EMS nerd can’t get enough of the work. You check the schedule to see who you are partnered with on the medic today and decide whether that person will make it a long, frustrating day or a fun-filled one. It’s someone that you work well with, so you have that going for you. It should be fun, but it will still be long.
You get to the firehouse at your usual time. You make your way in and survey the rig line-up to see what rig you are riding in today. It’s the big piece of shit medic. Your department just got some new medics, but the one from this station is out for repair already. Not a big surprise, since the dwindling tax revenue over the last decade has crippled the infrastructure of the city. The roads are shit; the water mains are shit; the city is decaying around you. It beats up the rigs as they traverse the streets, so things need to be repaired often.
You take in the smell of the apparatus bay. Yep, they had a fire. You can smell the burnt plastic and wood. You see the wet hose hanging up to dry. You can tell the engine ran a lot because it’s dirty. You know the crew washed it before supper last night, they always do. But it’s dirty again, so it went out at some point during the night. The medic is dirty too, so you know what kind of night they had.
You make your way to the kitchen and get the coffee going. You turn on the TV to catch up on the events on the news and see if anything newsworthy happened in the city last night. Yep, there’s the fire. A garage fire. It looked pretty simple. You scan for last names on coats so you can rib the guy that wasn’t able to hide from the cameras. It’s the new guy of course. The rest of us are like ninjas. We hide behind trucks and chiefs to keep from being seen. We’ve bought enough ice cream over the years. The new guy can have his turn. His mom will be proud of him anyway, so that washes out the ribbing he will get from us.
The rest of your crew makes it in. You sit and discuss the problems of the world and have them all hammered out by the second pot of coffee. Yesterday’s crew stumbles out of their bunks to go home. You sit with them and review the last 24 hours. You hear what got done and what didn’t. You get an apology for the fire truck being dirty. We all know why it was so it’s no big deal. It happens to all of us. The previous crew heads home, and you go out to check the rigs.
Nothing big is missing from your medic. You straighten up the supplies and cabinets. Have a quick review with your partner about what you need, so you can dig through the supplies at the station or get it from the hospital. Everything checks out except there is no shoreline power to the back of the medic. You have seen this 100 times before, and you quickly resolve the issue. You put it on your mental list of things to watch throughout the day.
The first call is banged out. Off to the nursing home for something easy. The staff at the ECF didn’t want to wait for the ambulance service to transport the patient to the Emergency Department for the abdominal pain they have had for three days, so they called you. You load the sweet old lady onto the cot and get the vague info from the staff. You have a mental check list. It looks kind of like a bingo card. You put a dot on the square that matches what the ECF “nurse” tells you in the report. “I just got here,” one dot! “This is not my patient,” another dot! “She was fine the last time we checked on her,” three dots! If I use the gingivitis “free” space, you only need one more to win. You covertly ask a few more questions to get the last space. And then she lays it on you……”her pulse was 50/20, so the doctor wants her to go to the ER” BOOOOM!!! You win with the vital signs that make absolutely no sense!!! The prize looks a lot like me not hating you for being incompetent. She doesn’t look like she feels the winning. It must be your smile and polite comments that are throwing her off. You have become a master at passive aggressive, sarcastic customer service by now, so you keep your opinions to yourself and share them with the ER staff when you get to the hospital. Everyone chuckles, but you know the loser in this scenario is the little old lady who is in the care of those nursing home idiots most of her day.
You clear the hospital and catch a few more calls. Nothing major. You and your partner trade call-for-call to even out the patient load. Shortness of breath, a fall, abdominal pain, back pain, shortness of breath again. Nothing gets you that adrenaline rush you used to have. You are good at what you do, so nothing scares you. You see the new guys with all of their enthusiasm and yearn for your younger days.
Your front row seat to the decay of society keeps you busy all day. You grab food when you can. The hours pass by. You get a full arrest around supper time. That gets you going a little bit, but they seem easy now. You and your partner along with the engine crew have worked together for a while, so the run flows well with not a lot of talking. Just working…IV, intubation, meds, shock, shock, shock. You call Medical Control to get the OK to terminate efforts, and they say “Yes.” Then you get a faint pulse back. You know it’s a waste of time and fuel, but you scoop the patient up and head to the ED. You call the ED and let them know things have changed. The nurse on the other end of the phone is super psyched that you are coming (sarcasm). You look forward to surfing the cot while doing CPR (it’s the little things) and you deliver the patient to the ED. You know you bought the family just enough time to say goodbye. The patient will die in the ED. You knew that before you left the scene.
You catch an overdose call as you leave the hospital. Those have been moved to the same category as the abdominal pain and shortness of breath. You do so many of them now that it is just another “thing” you do. The scenario plays out just like you knew it would. “What did he take?” “We don’t know,” the people watching TV in the other room say. You know what it is because you revived the guy in the recliner last week. You carry a MAD (Mucosal Atomization Device) in your pocket now because you do these so often. Oh look, he’s breathing four times a minute. Oh look, the Narcan brought him around after a few moments. I’m a life saver! Before he wakes all the way up, you pick out what lie he will tell you when he comes to. You have a short list; let’s see what he goes with. Wait for it….”I didn’t take heroin,” he says. Ahhh, come on! That’s the most boring one there is! You wish they would be more creative. “I was riding a pterodactyl into the Superdome, and the talking meerkats told me to heat up the magic brown sugary powder in a spoon and shoot it into my body.” At least that would be funny to everyone in the room and would give me a story to tell. “I didn’t take heroin….” Work on something better and have it ready for me when I wake your dumb ass up the next time. There will be a next time.
You finally get supper and a few minutes to relax at the station with the rest of the crew. They left the food out for you. You shovel it in case you have to bounce out again. They do stuff around the station and tell you to finish eating, but it makes you uncomfortable. You should be helping, but the food is good, even though you had to microwave it. Before you know it, they have washed your rig. You start the dishwasher. There, I contributed. I don’t feel as awkward.
Another overdose and a few more easy calls come in. You and your partner continue to volley them to each other. You are getting tired now. You want a nap. You remember a time, ten years ago when you could pull the “all-nighters,” but you were younger then. You had more energy. You weren’t overweight with high blood pressure then. Your mind wasn’t tired, your knees didn’t hurt, and your back could still take the jarring from the crappy streets. You were in better shape mentally. You didn’t see as much darkness in your work as you do now. You didn’t realize yet that you were just hauling freight, essentially. You didn’t understand that people need the hospital more than they need you. That, even though you do great things in the field, the end game is to get them to definitive care. You know why it’s called prehospital care now. You are collecting these people for the hospital since they don’t do it themselves. You know now that you are working for an EMS department that fights fire, on occasion. You were a dragon slayer once, at least you thought you were. You see skills being taken away from you because they don’t do anything in the field. You see what the future of this job is because you have the past to look back on. You see what people have done to each other. You have seen behind the curtain. You know that nothing happens when you die. You have watched countless people stop being people and become objects that need to be dealt with. You have watched people die. There is no quiet last breath in the company of family for most of them. There is me or someone like me hovering over them, poking, prodding, intubating, breaking ribs, managing puke and smelling the shit. You know what dying is. You have made friends with it. You feel like a recruiter for the grim reaper. Somewhere in the dark corner of your brain, you want their death to be horrible for them because you feel horrible dealing with their death. You want them to feel what you feel, but you get robbed every time. They are just an object. You might as well talk to the ground.
You make it back and crawl in bed for an hour or so. The ceiling witch wakes you up for an “unknown problem” at a location you know well. It’s either a shooting or a maternity if it’s up there, you tell yourself. You stage for the police and ding ding ding; it’s a shooting. You enter to find blood everywhere. You chuckle a little because it looks staged or like a movie set. You find your patient sitting on the couch holding his arm. Yep, they got him. A half a dozen times from what you can see. He is weirdly calm for being shot that many times but you dismiss it. He’s as used to people being shot as you are probably. You load him quick and jet out of there. He needs a surgeon; not you. You do your usual stuff. Trauma is easy for you. You work like a robot and roll up at the trauma center. You unload and meet the blue gown mafia in the trauma room. You shout out your findings and your treatments. You ask the trauma doc if she needs anything else from you and you hand off the patient to her with a “Good luck!”
You spend the next 45 minutes doing your report. You try to piece together the timeline. The first few minutes are a little fuzzy because you weren’t completely awake yet. You review the report several times so that you can maybe not get raked over the coals by the QA/QI people later at the trauma review. Your partner figured out how to get coffee out of the new coffee machine in the EMS room, so he’s the real hero this morning! You leave out of the ED awake because the adrenaline comes late for you. It floods in after the call is over. You are on autopilot during the call, but afterward, that chemical floods in and wakes you right up! You fool yourself for a minute by saying “I can do this until I’m 65.” You’re an idiot. You will be washed out or dead by then.
You catch a call coming back. You walk into the home of an elderly couple with the blood from the last guy on your boots. You figure out what is wrong. The gentleman has had pain for a while and just can’t bare it anymore. You load him up on the cot and get him in the rig. You come back in and collect his wife of 65 years and help her up into the front seat of the rig. Your partner has this one, so you make the short trip to the ED. The wife is concerned so you make polite conversation to ease her mind. They are on a new adventure this morning, but you are finishing up the long day you have had. For a second you think about that shower. You can feel the water warming your back. You can’t wait. But first, you have to finish the adventure you are on with these total strangers. You unload your cargo, and your partner rolls the cot in by himself. You help the wife out of the rig and walk with her as she shuffles along. You reunite them in the ED room. You accept the 100 “Thank you’s,” that you get from them. It feels good for a minute until you remember something you should have done on the shooting. You go from gracious to grumpy.
You put the rig back together and help your partner stay awake to finish his report. Hey, look, more coffee! You head back to quarters with 30 minutes to go. The new guy from the oncoming shift is always there early, so you know at least one of you will get home on time.
You back in the station and tidy up the rig for the next crew. Nothing else happens until shift change, so you get out of there after another world problem-solving session at the kitchen table.
You load up the car and head home. You pull in at home not knowing how you got there. Your brain was processing the shifts events all the way home because it didn’t have time to do it while the day was unfolding. It sorts through the stuff it wants to keep and the stuff that it will put in a box and shove in the dusty corners of your brain, never to be opened again. There are a lot of boxes filling the corners and one day all the boxes will fall over to spill out all of what’s inside. You don’t think about that very long. It’s the thing that lurks in the minds of all of us in this line of work. Is today going to be that day? Will a 10-second scene in this movie be the thing that knocks over all of those boxes like the school yard bully that doesn’t get his way? Will I be crying, loudly, in this theater? We wonder what will happen on that day. We try to put it off as long as possible. But it is not up to us.
You make your way inside to an empty house. That’s OK with you. You did enough “people-ing” during your shift. You welcome the opportunity not to have to explain something or interact with someone. You shed the blue Superman suit. You are sick of blue. You make it to the shower, the moment you have looked forward to. You wash off the day. You get warm. You relax. You fight the memories of the shift and what you could have done differently. You finish separating out the hours from the last 24 that you want to keep and the ones you box up. You try to decide if you are going to try to take a nap or stay up. Your significant other will be at work all day, so you have the house to yourself. You make some coffee and mull it over. Yes, more coffee.
You go back to the “keep and pack up process” because your brain just can’t get it done today. You look at each hour of the last 24 and decide if this is the moment I choose to quit doing this or is it the moment I decide to stay in it for another few years, months or shifts. It’s a weird decision, and you make it after every shift. You wonder if your lawyer dad or school teacher mom ever sat and thought about their job the same way. I’m not sure their jobs were as intertwined into the very fibers of who they are. This job is. This job violates spaces in your brain you didn’t know existed. It works into the spaces; between the spaces. You wonder and drink coffee.
The nap idea wins. You lay down and go blank. You wake up to a text from your significant other asking how it went and that they love you. You respond that there wasn’t much to talk about. “Just the usual,” you say. They will dig deeper when they get home. By then the sorting process will be complete. You won’t tell them about what you put in the boxes. You will talk about what you kept. The sweet old couple from the end of the shift will play well with your significant other. It’s more palatable. You won’t mention the blood on your boots. That’s for you to deal with. They know there is more, but they won’t push. That’s why you love them as much as you do.
So you had 24 reasons to leave or stay. You are the only one that can decide what you will do. Will you stay? I always do. It’s what I want to do right now.
Someday that won’t be the case. I will be OK with that.
Here is some valuable information providing a differentiation of services available to Firefighters. Is there a difference between counseling and therapy? Is a Psychologist the same as a psychiatrist? How do I know which on I need? What can I expect? FireStrong provides the answers to your questions… here.
What is Counseling?
Each therapist is different, but they all are trained to help you with your issue. Look up different therapists using your insurance to ensure they are a licensed therapist. In order to find the right therapist for you read reviews online.
The initial thought of therapy can be intimidating, especially for those who have never really been into talking about their “feelings.” Finding a therapist that you mesh well with is a major key to success in getting the help you need. While searching for a therapist it is important to have a conversation with them beforehand. A phone call can help you determine if they are able to help you with your personal issues. If the conversation is awkward or does not feel natural at all, then that therapist might not be the best fit. It is completely normal for people to contact a couple of different therapists before picking the best one for them!
Therapy sessions are all about making sure you are comfortable with sharing your thoughts and feelings in a safe, protected, and relaxed environment. The ultimate goal of a therapy session is to have you leaving feeling more at ease every time prior to your previous session. While you won’t be lying down on a couch like you often see in commercials, you can often expect to be sitting on a comfy couch in a warm and inviting room.
What to expect when going to see a therapist:
Each therapist has a unique style, and a large part of therapy is the rapport between you and the therapist. If you don’t feel you can achieve this with the counselor you are seeing, you can always try out a new one. Most therapy can help and start to improve your life in less than 10 sessions (you have 30 sessions to work with!) The process of talking to a stranger about our issues/problems is foreign to many of us, but once you reach your comfort zone and start express yourself you can feel the weight of anxiety being lifted off your shoulders!
One therapy session won’t cure all of your problems overnight. Often in life we have to remind ourselves that good things take time! When first starting therapy, it is okay to feel lost or not even realize what some of your issues are. Once you start opening up about your hardships in life it will be easier to connect with your therapist and pin-point some events that might have triggered some personal issues. Sit back and be patient with this new experience.
3 Common Types of Talk Therapy:
•A therapist will help you change harmful ways of thinking. If you tend to see things negatively, it teaches you how to look at the world more clearly.
•Example: You drop by to see a friend, but he says he doesn’t have time to talk. Your first thought is that he’s angry with you. This makes you feel worried and anxious. Soon you are trapped in a flood of negative thinking.
•Cognitive therapy can help you focus on your reaction to your friend’s behavior. Perhaps what he said has nothing to do with you. Maybe he was having a bad day. Perhaps he was late for an appointment. Thinking of other reasons for his actions help you see the event in a more positive and accurate way.
•Helps you learn to relate better with others. You’ll focus on how to express your feelings, and how to develop better people skills. Might be helpful with strengthening relationships.
•Example: You and your wife are not getting along. The fighting seems to be getting worse, but you can’t break the cycle.
•Interpersonal Talk therapy can help you see your wife’s point of view and vice versa. Perhaps she feels you don’t spend time with her anymore. Finding new ways of talking to your wife may help you both feel better.
•Remember that talk therapy doesn’t have to be difficult. The simple act of discussing your feelings allows you to gain new insight and perspective. Talk therapy can also help to enrich your life by bringing the people that you love closer to you.
•Helps you change harmful ways of acting. The goal is to get control over behavior that is causing problems for you.
•Example: You were on a pediatric drowning, and now you are terrified of taking your family to the pool. This paranoia starts to affect your family life.
•Behavioral Talk therapy can help you to face your fears. Discussing your problems with a trusted person can help you to begin to overcome those fears and take control of your life.
What is the difference between a Counselor, a Therapist, Psychologist, and Psychiatrist?
A counselor is a person who is a master level licensed clinician who has completed a counseling focused program. They are trained to assess, diagnose, and treat numerous issues that people face. They cannot prescribe medication, however they work closey with physicians who can.
A Therapist is a person who has a Master’s or doctoral level degree in a counseling field and a license from a Board of Behavioral Health. Both the degree and license take years to achieve, so rest assure that the person should experience in talk therapy. They can’t prescribe medications, however they work closely with physicians who can.
A Psychologist is a person who has their Ph.D. in a counseling related field. Psychologists have more training and schooling than a therapist. They provide counseling, support, perform psychological tests. Psychologists cannot prescribe medication but work closely with psychiatrists and physicians if prescribed medication becomes necessary.
Psychiatrists are physicians who had to do a residency in the area they specialized, ie child psychology, neuropsychology. They can prescribe medication (prozac, ativan). Some provide talk therapy. Some will prescribe and provide both.
Secret Signs of Hidden Depression
People who suffer from secret or concealed depression usually do not want to acknowledge how serious their feelings are. They often put on a “happy face” for others so they do not feel judged. Click HERE to find out what the six signs of concealed depression are.
Depression is a mood disorder that causes a constant feeling of sadness, hopelessness, anger, and loss of interest in everyday life for a long period of time. The exact cause of depression is unknown, however, many researchers believe that depression is caused by chemical imbalances in the brain. Norepinephrine, seratonin and dopamine are neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. It is believed that there is an increased risk for developing depression if there is a family history of the illness. However, people who do not have a family history of depression can still develop this mood disorder.
About 19 million Americans battle depression annually. Depression is estimated to contribute to half of all suicides. About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life. Depression affects people of all races, incomes, ages, and ethnic and religious backgrounds, but it is three to five times more common in the elderly than in young people.
“Some types of depression seem to run in families”
Causes, incidence, and risk factors:
Certain personality traits such as low self-esteem, physical or sexual abuse, financial issues, and the death of a loved one can often times trigger depression in some people. While it has long been believed that depression caused people to misuse alcohol and drugs in an attempt to make themselves feel better (self-medication), it is now thought that substance abuse can actually cause depression. Some illnesses such as heart disease, cancer, and certain medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness or other risks.
There is no single cause of major depression. Psychological, biological and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological, medical illness.
A number of factors can play a role in depression:
- Life events or situations, such as: Breaking up with a significant other, illness or death in the family, or parents divorcing (for adolescents)
- Repetitive traumatic calls
- Childhood events, such as abuse or neglect
- Divorce, death of a friend or relative, or loss of a job (for adults)
- Social isolation (common in the elderly)
- Medical conditions such as hypothyroidism (underactive thyroid), medications (such as sedatives and high blood pressure medications), cancer, major illness, or prolonged pain
- Sleeping problems, Sleep deprivation
- Alcohol or drug abuse
- Agitation, restlessness, and irritability
- Dramatic change in appetite, often with weight gain or loss
- Extreme difficulty concentrating
- Fatigue and lack of energy
- Feelings of hopelessness and helplessness
- Feelings of worthlessness, self-hate, and inappropriate guilt
- Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such as sex)
- Thoughts of death or suicide
- Trouble sleeping or excessive sleeping
- Depression can appear as anger and discouragement, rather than as feelings of hopelessness and helplessness. Use of alcohol or illegal substances may be more likely to occur.
- Even Medicines that you take for other problems could cause or worsen depression, check with your doctor.
- Medicines that you take for other problems could cause or worsen depression. You may need to change them. DO NOT change or stop taking any of your medications without consulting your doctor.
- People who are so severely depressed that they are unable to function, or who are suicidal and cannot be safely cared for in the community may need to be treated in a psychiatric hospital.
- Most people benefit from antidepressant drug therapy, along with psychotherapy. As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.
- Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.
- Take medications correctly and learn how to manage side effects.
- Learn to watch for early signs that depression is becoming worse and know how to react when it does.
- Try to exercise more, seek out other activities that bring you pleasure, and maintain good sleep habits.
- Avoid alcohol and illegal drugs. These substances can make the depression worse over time, and may also impair your judgment about suicide.
- When struggling with your depression, talk to someone you trust about how you are feeling. Try to be around people who are caring and positive.
- Try volunteering or getting involved in group activities.
“therapy teaches depressed people ways of fighting negative thoughts”
Types of help (See also Types of Counseling)
- Cognitive behavioral therapy teaches depressed people ways of fighting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
- Psychotherapy can help someone with depression understand the issues that may be behind their behaviors, thoughts, and feelings.
- Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for a recommendation.
You can take a personal assessment here.
What is anxiety?
Anxiety can come from any situation or thought that makes you feel frustrated, angry, or during a time you feel you have no control of the situation. Anxiety is a feeling of apprehension, nervousness, or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.
Having anxiety is a normal part of life. However, too much is harmful. It can be debilitating and get in the way of everyday life. Continued high levels of anxiety can set you up for general poor health, as well as physical and psychological illnesses like infection, heart disease, and depression. It can lead to unhealthy behaviors to help self medicate like overeating and abuse of alcohol or drugs.
What are the symptoms?
- Abdominal pain (this may be the only symptom of anxiety, especially in a child)
- Diarrhea or frequent need to urinate
- Dry mouth or difficulty swallowing
- Muscle tension
- Rapid breathing
- Rapid or irregular heart rate
- Twitching or trembling
- Sometimes other symptoms occur with anxiety:
- Decreased concentration
- Irritability, including loss of your temper
- Sexual problems
- Sleeping difficulties, including nightmares
More severe symptoms that may need immediate treatment:
- You have crushing chest pain, especially with shortness of breath, dizziness, or sweating.
- These symptoms might be caused by a heart attack, which can also cause feelings of anxiety.
- You have thoughts of suicide.
- Call your health care provider if you have dizziness, rapid breathing, or a racing heartbeat for the first time, or if it is worse than usual.
- You are unable to work or function properly at home because of anxiety or other symptoms.
- You do not know the source or cause of your anxiety.
- You have a sudden feeling of panic.
- You have an uncontrollable fear — for example, of getting infected and sick if you are out, or a fear of heights.
- Your anxiety is triggered by the memory of a traumatic event (See PTSD).
- You have tried self care for several weeks without success, or you feel that your anxiety will not go away without professional help.
- Changes to you environment or day to day life
- Both positive and negative changes can cause anxiety
- Relationship issues
- Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug.
Such drugs include:
- ADHD medications, especially amphetamines
- Benzodiazepines (during withdrawal)
- Bronchodilators (for asthma and certain other breathing disorders)
- Cold remedies
- Diet pills
- Thyroid medications
- A poor diet — for example, low levels of vitamin B12 — can also contribute to stress or anxiety. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may cause anxiety or stress-like symptoms. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.
The most effective solution is to find and address the source of your stress or anxiety. This can be difficult, because the cause of the anxiety may not be conscious. A first step is to take an inventory of what you think might be making you “stressed out,” trying to be as honest with yourself as possible:
- What do you worry about most?
- Is something constantly on your mind?
- Is there something that you fear will happen?
- Does anything in particular make you sad or depressed?
- Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxietyin these situations?
Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that you need to relieve anxiety.
Contacting on of the Peer Support Team members is always an option. Also, most communities also have support groups and hotlines that can help. Social workers, psychologists, and psychiatrists can be very effective in helping you reduce anxiety through therapy or medication.
Also, find healthy lifestyle choices to help you cope with the stress and anxiety. For example:
- Eat a well-balanced, healthy diet. Don’t overeat.
- Exercise regularly.
- Find self-help books at your local library or bookstore.
- Get enough sleep.
- Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.
- Limit caffeine and alcohol.
- Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.
- Pick up a hobby that you used to enjoy.
What to expect your doctor to ask:
- When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular, like an event in your life or a circumstance that scares you?
- Do you have physical symptoms along with your feelings of anxiety? What are they?
- Does anything make your anxiety better?
- Does anything make your anxiety worse?
- What medications are you taking?
- Do you use alcohol or drugs?
Anxiety and Distress
Use the following personal assessments to determine your risk for anxiety and distress.
What is resiliency?
One of the most important aspects of a firefighter’s life and mental health is resiliency. Resilience is often defined as one’s ability to bounce back from setbacks and to properly adapt to stressful situations. Resiliency is so important to us all because no one is immune to stress whether it’s daily irritants or major life-altering events.
Building resilience takes time. In order to help improve resiliency make sure to get enough sleep, exercise, and practice on thought awareness. Being more optimistic and seeing the glass half full in the long run will help change the way you think about negative or stressful events. If we improve the health and happiness in our individuals and workforce as a whole, then we will produce a higher performance overall.
Building resiliency is important for the following reasons:
- It protects against heart disease (the #1 killer of firefighters!)
- Potentially increase life expectancy by up to a decade
- Inoculates against daily hassles and life altering events
- Improves job satisfaction and productivity
- Boosts your immune response
- You’re at lower risk for injuries and pain, including headaches
- Lowers risk of alcohol and dependency
Four pillars of resilience:
- Mental toughness
- Social connectivity
- Mind body “muscle memory”
- sparking positive emotions
Tactical breathing is used to gain control over physical and psychological responses to stress. Through practice one can gain control over heart rate, oxygen intake and emotions to increase concentration in various situation. Please see the link below for more information.
In apartment complexes and commercial strip malls across the country, we have issues with line placement through narrow or obstructed paths. These can be caused by parked cars, short setbacks, parking barriers, planters, shrubs, etc. With this in mind, one option available is to pass these obstacles before the deployment of the hose. This is what I like to call “The Delayed Triple Split.” This maneuver allows for the entire hose bundle (on a triple layer) to be deployed after passing through any obstructions or obstacles on the pathway to the building. A few considerations go into this deployment process; they are as follows:
– Placement for the aerial at buildings. The best practice is to have the first arriving aerial’s turntable at the center of the building to access the entire length of the building.
– Placement for the next engine company to bring water or supply a “booster back-up.”
– The width of the average car is approximately six to seven and a half (6′ – 7.5′) feet.
– The width of the average parking space is seven and a half to nine (7.5′ – 9′) feet.
– When spotting the hose cross-lays, use an object in the same area on the truck to act as a reference point, i.e. Piston Intake Valve, wheel well, strobe light, etc.
– The objective could be met with only two firefighters involved.
– Find the average length of bedded hose. The average car is about fourteen to eighteen (14′ – 18′) feet long. You need to find how many folds in the cross-lay are needed to reach the sidewalk, which is approximately twenty (20′) feet from the apparatus.
– The Nozzle Firefighter and Driver/Backup Firefighter go in opposite directions (Triple Split) with the loop and nozzle. This allows for short setback deployments.
– When choosing which way to separate the triple layer on the walkway, consider the need for the loop to advance with the building, not against.
– When Backup/Driver is pulling the loop section of the Triple Layer to the opposite side of the fire building, keep pulling it until the fifty (50’) foot coupling is at the entry to the breezeway/recessed area. This will allow the Nozzleman to walk in a straight path to the entry point and keep all remaining 100’ of hose in usable position in the yard.
– On the return trip to the pump panel or relocating to the front door for Doorman position, the last parts of the hose is placed onto the sidewalk/walk space to allow for clearance once the hose gets charged.
– The 50’ coupling is brought to the front door, with the accordion style layout in the open area between the stairs and building.
– If the 2nd-floor apartment is the apartment, take the nozzle and 50’ coupling to the top of the landing. This will further prove the need for the Backup/Driver to pull the looped section far enough to align the 50’ coupling with the base of the stairs.
With these steps, the training evolution was completed in approximately 1 minute from the time the parking brake was pulled. This is an easy way to allow for the needless pulling of the Triple Layer in a straight line, causing multiple steps to place in proper position.
The key to this process, as with any new training elements, is getting out and practicing. Finding those landmarks on the truck, the direction of the loop placement, and placement of the final layout in the yard or on the landing are the fundamentals to making this stretch successful. Unfortunately, many things in these types of properties will reach up and grab anything on the hose layout to hinder the progress. Couplings get caught on the edge of parking blocks, hoses get pulled under tires, etc. By moving the stretch to the fire building side of the obstructions, the layout will transition smoother with fewer locations for Murphy’s Law to apply.
– Joel Richardson