Firefighters have been around since bucket brigades started in the 1600s, so after 400 plus years it might be a good idea to focus on how we as a society can help protect from and possibly prevent PTSD from even happening in the first place. So until that happens, I might not let this subject rest.
Why has so little research been done to gain an understanding of trauma and firefighting?
I am going to venture to think that one challenge to research could be engaging such a large population in research that will actually convey a general understanding. How can you compare volunteers to career firefighters or career firefighters to contract firefighters overseas in terms of what you see and what you deal with, you simply can’t. After that, there is a whole other layer to compare in regards to the environment the station is in, the frequency of calls and intensity of calls. We just aren’t comparing apples to apples.
I combed through articles and research where scholars are attempting to study and figure this out, but the research is extremely limited and very few studies have actually been done. Some studies lead to dead ends. However, some of the research leads to actual evidence that makes some sense and is worth investigating further.
What does the research say that is helpful?
One very interesting point stands out as I rifle through the limited research; gallows humor plays a large role in a firefighter’s ability to manage and overcome trauma. Having witnessed interactions of firefighters in day rooms, humor is intertwined into almost all conversations. There is more banter, friendly interrogations, sarcastic comments and jokes involving everyone and their mother heard between firefighters than in almost any other workplace I have stepped foot in. This banter back and forth encourages and fosters positive relationships with one another. This all relates back to one of my original proposals that protective factors are built into fire departments to protect you all from the negative effects of trauma.
To gain a better understanding of trauma in firefighters, a study was conducted on 128 firefighters in an urban environment. The research ranked coping mechanisms identified by all the firefighters in the study and “found most useful among the sample were the use of humor followed by support from coworkers, family support, exercise, and kitchen table discussion at the firehouse.” (1).
The form of humor that has been most effective in coping with trauma is gallows humor. Gallows humor can be best defined as “dark humor or crass joking. It is humor that treats serious, frightening, or painful subject matter in a light or satirical way, and is used in response to incidents that elicit an emotional response from firefighters or would elicit an emotional response from the average bystander” (1). This is where you find ways to use humor when dealing with an intense or horrible situation because it helps to do three things: offset the stress that you feel, distance yourself from the reality of a traumatic call and it increases camaraderie in the station.
What role does the fire department play?
Not all negative responses to trauma can be avoided through humor and other protective factors. The fact is, you all are dealing with some of the most critical and gruesome moments in a person’s life. Your response can be the difference between a person living and dying. Whether or not you did all you could, there will be times that you don’t immediately bounce back from an incident.
Before assuming a horrifying incident is to blame for experiencing symptoms of PTSD, there are other aspects to also consider. It would be important for leadership within fire departments to first look at the organizational structure of the department to determine if it is playing a negative role. Increased work tension or stress within the organizational makeup of a fire station can be detrimental to firefighters and other emergency service personnel. In a research study published in 2015 by Josh Rinker (2), it was identified that “the day-to-day functioning of fire and EMS companies can contribute to poor mental health functioning if the resources available do not correspond with the needs of their staff.” (2) If the day-to-day is not functioning efficiently or effectively, it could increase the risk for mental health issues to arise for firefighters.
It would be interesting if Rinker’s 2015 conclusions lead to new studies that were conducted in well-functioning fire departments compared to those where firefighters are overworked, underpaid and had lower morale. Would we see that stations with better morale and more team camaraderie have fewer issues related to mental health than those that have poor morale and where firefighters or working in less than ideal conditions?
So where do we go from here?
Station Pride wouldn’t be Station Pride if we didn’t find a way to tackle an issue head-on. So we turn to you for feedback in a survey. Participating in this easy and confidential survey will help us begin to lay some groundwork to figuring out how we can move forward.
Alvarado, G. E. (2013). Gallows Humor as a Resiliency Factor Among Urban Firefighters with Specific Implications on Prevalence Rates of PTSD. Azusa: Azusa Pacific University.
Rinker, J. (2015). The relationship between emotional intelligence and Firefighters and Emergency Medical Personnel. Chicago: ProQuest Dissertations & Theses Global.
It is estimated (here) that 50% of marriages in the fire service industry lead to divorce. That statistic is pretty high. The dream of being in a relationship with a firefighter sounds pretty glamorous. Sharing a bed with this tough, good looking, risk taker firefighter appears pretty amazing until reality sets in that is. The reality of that life is quite the opposite and that firefighter is now replaced with a body pillow because you spend more nights sleeping at the station than you do at home and when you are home you are most likely exhausted because of interrupted sleep or haunted by calls. Not quite as glamorous after all.
What makes so many marriages fail?
There is a lot that can cause a marriage to break up and being a firefighter adds a whole new layer of potential issues. Picture this, you come home from a long 48 hour shift at the fire station and hear your partner’s question, ‘How was work?”. Your past 48 hours have been pretty brutal with calls. If you are being honest, you don’t really want to answer this question because work absolutely sucked and it was absolutely everything that cannot be explained to someone that wasn’t there. So you answer with the word, “fine” and just want to find your bed or recliner and collapse in it for a bit or throw yourself into a hobby to try to forget about it all. You know the word “fine” never means fine and often leaves your partner feeling neglected or left out of your life. This response can have some pretty hefty consequences when it comes to building and maintaining your relationships outside of the station.
How do you find a way to talk to those that you love about the work that you love?
Let’s face it, there are just some calls that you can’t talk to your partner about if they weren’t there and sometimes you probably shouldn’t talk to them about it. It actually isn’t healthy for your partner to be aware of every call because it can cause sleepless nights worrying about situations that are out of their control. Sometimes it is best that they don’t know everything but they do need to know some things. They need to be a part of your life outside of the home.
Your life as a firefighter is not just a career; it is a lifestyle so if you don’t find a way to incorporate your partner into that lifestyle it could lead to problems. So how do you include them in your firefighter life but also limit it at the same time? It is more about finding ways to connect instead of just finding better ways to communicate. Being able to connect to your partner is vital.
You need to find what you can talk to your partner about. Ask yourself what parts of your day can you talk about without making it just sound like sunshine and roses? Your partner will know if you are only giving them the good parts of your day. You can talk about a routine call and pull out some detail of significance that can help your partner feel connected to what you do.
What if I don’t want to talk about my day?
You can tell them you had a pretty horrific call and you feel pretty crappy and can’t bring yourself to talk about it right now. Let them know that you care enough to inform them that something is bothering you but that you just need some time to move past it. Here is a quick statement you can make, “I had a pretty rough call last night, we talked it through a lot at the station and right now I just want to try to forget about it and be thankful that I am home spending time with my family.” Sometimes you may want to talk to about it though, so take advantage of those times and talk to your partner about what is on your mind and how you are feeling.
Bottom line though, those bad calls are going to happen, the sleepless nights are going to happen, and your work is not going to change. On the upside though, by nature you are problem solvers, fixers, doers and risk takers and you can bring this into your personal life. So let’s look at what you can do to make your relationships at home just as strong as the ones with the firefighters at the station.
It’s about connection, not just communication.
Find new ways to connect when you do have time together. Instead of looking at ways to communicate about everything, find better ways to connect with your partner. Connecting with one another will lead to better communication in the long run.
You also spend a lot of time apart so take advantage of that and let your partner know you are thinking about them when you can. Start small, just text your partner and let them know you are thinking about them while you are at work. It doesn’t need to be this long conversation because they should understand that you are busy and that might not be possible. However, if you have the chance to let them know you are thinking about them, do it. Keeping connected as much as possible goes a long way.
Not only is it important to let your partner know you are thinking about them when you aren’t together but spend quality time together when you are together. Schedule date nights at least once a month and get away for a few hours together to recharge and reconnect. Learn something new or take a class together. Learning together helps couples to connect. So find a cooking class, or go zip lining, or take a work out class together. Find something that you haven’t done before and learn it together.
It is important for your relationships outside of work to be healthy to keep your mind focused when you are at work. The fact is your work and the bad calls won’t change. The potential for strain on a relationship is there but you have the ability to take control of your relationships and connect with your loved ones. So find new ways to connect but also understand that you are only one half of the problem and one half of the solution. If your partner is not open to connecting with new ways or things just feel like they are too far gone, then it might be time to seek out some help from a marriage counselor. A counselor can help look at your relationship from an outside perspective to see what might be causing the strain.
You don’t have to be one of the marriages that lead to divorce. Start with connecting and go from there.
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As though getting a solid night sleep wasn’t challenging enough for you while on shift, now we have proof that firefighters are at greater risk of suffering from some type of sleep disorders that makes it even worse. The result of a study on 7,000 firefighters nationwide was released in 2015 reporting that 37% of firefighters suffer from some sleep disorders such as Circadian Rhythm Sleep-Wake Disorder, sleep apnea and chronic sleep restriction (Journal of Clinical Sleep Medicine, 2015).
Let’s look at what some of these sleep disorders look like for your body. Circadian Rhythm Sleep-Wake Disorder means your body clock is constantly out of whack because your sleep/awake cycle is forever changing as the calls come in and as your work shift changes. Your body lives in this constant cycle where it knows that it needs to be alert the second that a call comes in, even if you are sleeping.
Sleep apnea is where your breath is pausing while you are sleeping, this can happen for seconds or minutes at a time. You stop breathing while you are sleeping and then your body recognizes what is happening and jolts you out of it through a loud snort or choking sound, so you start breathing again. After that, you continue to breathe as normal until the next time it happens throughout the course of your sleep cycle. Even though this can occur on average of 30 times a night, you generally don’t even register that you’re choked into breathing again. If you are sharing a bed or sleeping space with someone, they are probably more aware that it is happening than you are.
Just as someone in your sleeping space is probably aware if you suffer from sleep apnea, they are also probably very aware if you are snoring. Snoring is actually a sign that you might be suffering from sleep apnea because snoring can indicate that there is an obstruction of the airway and the air has to squeeze by to get in and out. The 2015 study mentioned above identified that 28.4% of firefighters have sleep apnea. That is a pretty high number compared to the 5% of the US population that has it (Statistic Brain Research Institute, 2016). It’s pretty safe to say that some attention needs to be given in this area for firefighters.
Chronic sleep restriction is just as it sounds; your sleep is restricted due to the nature of the job. You tend not to get the full amount of sleep needed in one stint of time for your body to go through the process of repair because you are consistently being awoken to respond to an emergency. Adults need on average of 8 hours of sleep a day to fully repair the body. How often does it happen that you get 8 hours of solid sleep, without interruption?
So how do you know if you have a sleep disorder?
It might be time to figure out if you have a sleep disorder. Do you wake up feeling groggy or with a sore throat like you were snoring all night long? Maybe you suffer from a sleep disorder and don’t even know it. You can take this self-assessment here and see what your results are: http://www.usc.edu/programs/cwfl/assets/pdf/sleep_test.pdf or you could just ask anyone at the station, and they will probably tell you just how badly you snore, that is if they can hear you over their snoring.
What do I do about it?
Just because you might suffer from one of these sleep disorders, doesn’t necessarily mean you are going to have to sleep with one of those machines over your mouth and nose that makes you sound like Darth Vader when he is breathing, there are other treatments available and some you can even do on your own. I am going to give you a few options to try, but you should still see a doctor to dig a little deeper into the problem.
If you have a few extra pounds hanging around from the winter, or maybe even last winter, work on losing them. Not only does that help with your sleep apnea but it reduces your risk for heart disease too. So try just 30 minutes of exercise a day, this exercise does not include throwing on your gear and blazing your way into a burning building. You need actual planned cardio; your body will thank you.
Another option can be to change the position you sleep, try not to sleep on your back. There are plenty of new memory foam pillows out there now that can help you sleep in positions to support your head and neck for better breathing. So get online and order one, well maybe order two, one for the station and one for those occasional nights at home in your bed.
Sometimes your mind can get in the way of letting you fall asleep and stay asleep, and this can lead to sleep disorders. Meditation can help; I’m not saying you need to sit on a pillow with your legs crossed chanting umms. Meditation is as simple as finding a quiet space for 10-15 minutes and focusing on your breathing. Once you are in a space, find a comfortable way to sit. Close your eyes and take deep breaths in and out, focus on each breath you take. Focus on the feeling of the air coming into your lungs and out of your lungs. Breathe in for a count of ten and then exhale for a count of ten, emptying your mind of any thoughts except for the feeling of air entering and exiting your lungs. Just try it for 5 minutes and work your way up to more time. Once you are getting the hang of it, there are so many resources online if you search for Meditation or Mindfulness that can guide you even further.
If you think that you might have a sleep disorder, you should still schedule an appointment with your doctor to make sure there isn’t something worse going on. They can also help offer other methods of treatment. Failing to sleep soundly can be the beginning of even greater issues such as heart disease, obesity, a weakened immune system, memory loss and increased risk of death. You owe it to yourself, the firefighters at your station and your loved ones to take care of yourself.
We recently published an article that identified some of the protective factors that help reduce the risk of Post-Traumatic Stress Disorder (PTSD) in career firefighters (here) but what about the risk of PTSD with those of you that are volunteer firefighters?
The National Fire Protection Association reported that there were “approximately 1,140,750 firefighters in the U.S. in 2013. Of the total number of firefighters 354,600 (31%) were career firefighters and 786,150 (69%) were volunteer firefighters.” (NFPA, 2014).
That is a huge number of you that volunteer day in and day out to interrupt your normal life at work or home at a moment’s notice and jump at the call to help your community. How do you go from responding to a call one minute and then immediately go back to whatever it was you were doing before you raced to the fire station? Unless you found this magic on/off switch on your body somewhere, (if you did, you should patent that right away), you can’t just shut it all off and go back to your life as it was right before a difficult call.
Many small town America fire departments can sometimes barely afford the equipment you need just to function let alone fund the support you would need following a horrific call.
This one hits home for me because I can remember like it was yesterday hearing my father’s pager go off in the next room, alerting not only him but the entire family that there was a crisis in our small town that needing rescuing. I can still hear the front door slam shut and hear his footsteps pound the sidewalk as he started to run the block down the hill to the volunteer fire station. Each time that pager went off, the men that volunteered for our small town quickly tossed off their hat of being a construction worker, farmer, banker, and ran to put on a helmet and gear. You always knew that our volunteer fire department was out there saving the day when you saw all the haphazardly parked cars and trucks belonging to our firefighters scattered along the street downtown. They got to the station as fast as possibly, never knowing what crisis was awaiting them, never knowing if they were rushing to help a neighbor, a friend or even a family member.
So, you put your life on the line as a volunteer, and your community would feel your absence if you weren’t there, right? Why is there such limited information out there on how this drastically impacts your mental well-being?
It appears that there has been a total of two, that’s right two studies on the effects of trauma on volunteer firefighters. It took a grad student in Ontario, Canada to publish one of them in 2010. Brad Campbell, a Seguin Township resident, a graduate of the School of Social Work at Laurentian University, conducted a two-year study of nine volunteer firefighters to help figure out how big of a problem this really is. His thesis can’t even be found online to see what this 95-page book says because it is probably tucked away on some dusty library shelf in Ontario. The big take away from his two-year study was this: volunteer firefighting psychological trauma remains overlooked.
I don’t think that comes as a surprise to most of you. If you are interested in reading the super short article about that, you can find it here.
Sometimes it doesn’t just stop at PTSD either.
The effects of PTSD can lead to even bigger and more permanent problems, such as taking your own life.
The Firefighter Behavioral Health Alliance (FBHA) is currently tracking the number of suicides each year for all firefighters, both volunteer, and career. Last year alone there were 112 suicides. Since the FBHA started tracking this information in 2012, there has been a total of 754 suicides.
We are talking about 754 avoidable firefighter deaths. Many of these suicides could have been prevented if there was help readily available, easily accessible, and perhaps even required. You can find more of this research at FBHA.
The reality here?
A volunteer firefighter has an increased chance of struggling with PTSD. It could be assumed that the volunteer has an even greater chance than that of a career firefighter because the protective factors are not in place as they are with career firefighters.
Now imagine responding to call where a teenager has been ejected from a vehicle, you are first one scene, and the teen is a mangled corpse. You place her human remains into a body bag, finish the call, and return home to wash the blood off your clothes just in time to enjoy dinner with your family and the 6:00 news.
This scenario, which is common among volunteer firefighters, highlights the need for intervention. Encourage your volunteer fire department to take the initiative for all their members. PTSD support should be a priority for every department.
PTSD isn’t about what’s wrong with you, it’s about what happened to you.
There are resources out there for volunteers. The National Volunteer Fire Council (NVFC) has teamed up with the American Addictions Center (AAC) to offer you and your family a free and confidential helpline. You can call 1-888-731-FIRE 24 hours a day, seven days a week and 365 days a year. The person that answers the phone knows what you are going through, has been there, and has the resources to help you. You can also access more help, training, and resources for not only you but your entire department by visiting http://www.nvfc.org/.
There are a lot of you out there. Each and every one of you deserves to be taken care of just as you take care of your friends, your neighbors, members of your community, and complete strangers.
At the end of the day, this isn’t a new problem. PTSD is an issue that has existed since the dawn of firefighting and other traumatic events. The psychological impacts just haven’t been fully considered until recently. It seems; however, there is a stronger focus on career firefighters while less of an open and verbal concern for volunteers.
You answer the call to help others at a moment’s notice, and many of you may believe that since you are there to help others, you can’t reach out for help yourself. You don’t have to be a statistic; you can get the help you need. Talk to someone, talk to anyone, your life is just as valuable as the person you are rescuing when the alarm goes off.
PTSD is real, and it needs everyone’s attention.
Just mentioning the words Post Traumatic Stress Disorder or PTSD probably has you running for the hills right now but trust me, it doesn’t have to be a scary subject. Every firefighter in this world is willing to take on any risk to save another person’s life. Sometimes that risk means witnessing or engaging in a crisis that would be unthinkable for the average Joe on the street to handle. You jump in on someone’s worst day of his or her life and at times risk your life for the sake of theirs. With that said, sad to say it, but that means you have witnessed a traumatic event. When you witness a traumatic event, it puts you at risk for developing PTSD. It puts you at greater risk to develop PTSD when you continuously witness traumatic events. It probably sounds a lot like your day-to-day life as a firefighter, endlessly witnessing trauma.
There is such limited information out there to let you know what the stats say about PTSD amongst firefighters. The most consistent, predicted number out there says that about 37% of firefighters show signs or symptoms of PTSD. You would think that number would be higher since it is pretty safe to say that 100% of you witness at least one traumatic event throughout the course of your career. You’re probably laughing right now because that number is probably way higher than one.
Whether it was by choice or by chance, the way that a firehouse is set up, and the way that your schedule works is a protective factor that reduces your risk to develop PTSD. Protective factors are a fancy way of saying that there is something in place that helps you reduce the risk of developing PTSD. Psychologists, actually let’s call them head docs; they had to develop a fancy way to say it that sounded smart. It looks better in our field when we sound smart.
So let’s look at what these protective factors are and how you can rely on them to process through any traumatic event that you might come across. Because let’s face it, the next alarm that goes off could lead you right into someone’s worst day and your next call might be the one that is hard to forget. Your next call might be the one that plays over and over in your mind. Your next call might be the one that wakes you up at night in a pool of sweat. You never know what the next call is.
So what about these protective factors makes the risk of PTSD lower for firefighters? The fact that you live in the firehouse with the same people that are going through the same trauma with you, that in itself allows you to process events in a healthy way. You are side by side with the same people day in and day out, and they are someone with whom you can relate. You eat, sleep, shower, and who knows what else goes on in there but regardless, you do this with one another. If you were to experience an incident and then immediately return home to your family, it would make it harder to process it fully and effectively because they didn’t live the incident with you. The other protective factor is your schedule, as much as your wife, girlfriend, partner, might hate your schedule, it is a protective factor. When you work these long hours, it means that your support system is right there with you and that helps.
I know many of you think that you are invincible but even though you aren’t the average Joe, you still breathe and bleed just as they do. So just because these protective factors are in place, doesn’t mean you are invincible to developing PTSD. You should know the warning signs and talk to someone about it. Really quick. Here are some down and dirty signs to look for: If you are experiencing panic attacks, feeling numb towards emotions, difficulty concentrating, frequent nightmares, feeling extra stress or anxiousness, flashbacks to the event that feel real, or even memory loss, you might need to find someone to talk to about it. These are just some quick signs that should trigger you to dig a little deeper and see if everything is alright.
So turning to someone for help doesn’t mean you are weak, it means you are human. If you think things don’t feel right, you should listen to your body and talk to someone. At the end of the day, the world needs you and needs you to take care of yourself.