What makes us fit for duty? Training.
What training are we referring to? Tasks used to perform our job. Whether it be a technical rescue, hazmat knowledge, ARFF, district familiarization or countless other avenues, as firefighters we are called upon to know an extremely wide range of skills to perform our duties and go home at the end of our shifts.
While this knowledge is part of the necessary tools needed to perform, almost half of our brothers and sisters who pay the ultimate price do so because of overexertion. When called upon to fight fires, it takes an enormous amount of physical exertion to do our job, yet we aren’t physically training for the arduous tasks we will probably encounter.
That’s where Firefit Firefighter Fitness Trainer comes in. This machine mimics the most strenuous of fireground activities in a compact unit that will fit in the corner of most fire station truck rooms. In some cases, departments are replacing the cumbersome entrance exam equipment with Firefit. It’s turn key, requires virtually no set up and is modeled after the CPAT, with a couple of exceptions of course. Just drag the machine from the truck room to the station apron, or use it inside if you have the space for it.
Firefit was created and tested by Randy Johnson, a 14 yr firefighter in the Texas Panhandle, 13 of those as a career firefighter. His personal results while doing a six-week testing program were nothing short of phenomenal. Starting with his heart rate, Day 1 resting heart rate was 66, working HR in the 180’s and recovery time to resting was 14 minutes. His body fat was 22%. Weight was 202. After six weeks using Firefit as his only training, and only on duty for a total usage of 15 times, his HR was in the 150’s during the workout; recovery time dropped to 4.5 minutes! Randy lost 7 lbs, gained back 2 (probably muscle), and lost 4% bodyfat.
While these results are amazing in themselves, the reason for the creation of Firefit, according to Randy, is to reduce the number of names we put on the wall in Colorado Springs and Emmitsburg every September and October, respectively. After all, isn’t that the goal and why we train to be the best at what we do?
The article, PTSD, are we selling a lie, has quite a few great points and hits on so much that is true for the fire service. I could not agree more with the following quote: “We as firefighters hold greater respect and dignity in the public eye than nearly any profession on earth, and the reason is simple, we are there when you need us. It is time for the fire service to move beyond education of PTSD and psychological wellness in the fire service, and to shift its focus towards preventative measures that begin at the recruitment process and build from a foundation of personnel who are prepared for the task that lies before them, who are prepared to show up and perform, fully aware that no one else is coming if we fail.” This is the heart of the problem for those in the fire service. We are called to help folks in crisis, and as a result, we feel that we must always be prepared to be the helpers.
In as much, we fear that if we have any sort of weakness, we will be deemed unfit. However, where this article can harm more than benefit, and what causes me to cringe is the title and the following: “According to the Firefighter Behavioral Health Alliance (2016), PTSD and its underlying consequences have taken the lives of at least 131 firefighters and EMS workers in 2016 alone (Dill, 2016), and that’s only in the United States.” When we attribute every fire service suicide to PTSD and the underlying consequences of PTSD, we silence those who are suffering from other issues unrelated to PTSD and issues that fester if left untreated into a major crisis: Depression, alcoholism, divorce, family problems, health problems, etc.
PTSD is a huge consequence of the job and is an injury that if left untreated can be devastating. We absolutely must take measures to ensure that people who have PTSD know they are having normal reactions to extraordinary situations. Treatment is available, and treatment helps! However, it is not the only cause of fire service suicide and to say that it can be damaging. Public servants are human, and it is normal to have highs and lows in life. However, if the lows are not cared for, they can snowball. Firefighters afraid to share their struggles tend to use unhealthy coping mechanisms such as alcohol. However, like CO & HCN, depression and alcoholism can be toxic twins. Alcoholism leads to poor choices and poor health which just makes everything worse and can be deadly.
So attributing 100% of firefighter suicides to PTSD only will cause members who are struggling with other risk factors to suffer in silence and be ashamed to admit the issues they are facing. Like I said, the article hit the nail on the head when it recommended that we need to shift towards preventative measures. However, these are not always going to be built during the recruitment process. Of all the work I have done and research I have conducted, Dr. Thomas Joiner has come up with a model that explains suicide. His model has yet to be disproven and is 100% relatable to the fire service. First and Foremost, Stigma = Fear + Ignorance. The stigma behind suicide is directly related to the ignorance surrounding the causes. Fear is ok, but we must eliminate ignorance through education.
For example, science has proven that 95% of those who complete suicide had a mental disorder such as depression or alcoholism. What this tells me is, if we stop fearing treatment and learn how to admit that: “HEY, IT’S OK TO NOT BE OK!” then we will learn to ask for help when we need it, rather than suffer in the silence of our misery and continue to turn to other mechanisms.
Dr. Joiner’s theory is simple, while there are a lot of causes that lead to suicide: PTSD, Depression, Alcoholism, Divorce, Substance abuse, etc. , there is only one common final pathway that leads to suicide: Loneliness plus feeling like a burden will create a desire to die, and this desire translates into lethal behavior only in the presence of acquired capability or a learned fearlessness. Most firefighters do not realize that the job allows us to develop this fearlessness quicker than the general population. This next quote is directly from Dr. Joiner in 2011 at the NFFF suicide summit: “Put more directly, it may well be that firefighting in itself does not increase a firefighter’s risk for suicide and may, in fact, provide some protection. But when those protections, for whatever reason, are weakened, and other factors in the firefighter’s life serve to compound risk, the capacity to actually take that final action may be greater. Accordingly, it is not necessarily that firefighters die by suicide at greater rates than others but rather that factors known to affect anyone’s life can become all the more difficult for a firefighter if the bonds and perceptions that make the occupation so attractive and compelling are lessened or lost. This provides a salient framework from which to consider the roles that fire departments and fellow firefighters can play in prevention, intervention, and survivor support.”
So yes, PTSD is a huge problem, and members must learn that it is an injury, and treatment can help. We can not try to get through on our own. BUT!!! PTSD is not the only thing that causes us to take our lives. This article, without realizing so, is just another reason for somebody who so desperately needs help for their underlying problem that may or may not be work-related to suffer in silence because they fear their problem is not worthy of help.
So what can we do? We can encourage members to reach out for help. We can follow the amazing framework of the Illinois Firefighter Peer Support Team, http://www.ilffps.org/. Matt Olson, Executive Director, states: “I am reading this, and I think a problem with the PTSD awareness movement is it forgets that depression is a huge part of suicides. More importantly, if we look to PTSD as the “heroic” injury, it makes people with depression less likely to stand up and take care of themselves.” The ILFFPS team’s mission is to simply create a safe environment where folks can admit that they are not ok. Peer support is available 24/7 and as a result has the ability to lessen the loneliness factor of Dr. Joiner’s theory.
When peer supporters recognize that an individual needs more than just peer support, the team has access to their trained clinical team who possess the power to eliminate the burdensome component. Feeling as though one’s death is worth more than their life is almost always a misperception that requires treatment. A study by the American Association of Suicidology found that 78% of people who attempted suicide, had significant regret. This means, these people simply needed help for their underlying problems and felt powerless.
As stated by Chief Dan Degryse of the Chicago Fire Department, “Suicide is just one outcome for an individual that can manifest for some time before he or she reaches the decision to die by suicide.” Intervention is key to prevention and making it ok to say you’re not ok is the key to intervention. A seminal study was published in 1978 by Richard Seiden on 515 people who were restrained from jumping from the Golden Gate Bridge. Of those who received mental health treatment, 95% were still alive decades after the study or died of natural causes. Treatment works!
Spreading the message that the fire service must create a safe environment to admit when one is not ok and allow members to continue to serve while receiving assistance for their underlying issues is critical to prevention. Matt Olson and the ILFFPS are doing it right by spreading the message that it’s ok to not be ok and therapy helps. Sometimes just talking to a peer is enough and sometimes you need a little more help, but it’s ok to not be ok! And it’s ok for the reason that you are not ok to be something outside of the job.
Firefighters are human and susceptible to stress, depression, and anxiety just like every other human. “At any given time, around 5 percent of the U.S. population is experiencing major depressive disorder. The disorder involves sadness, insomnia, loss of energy, and the like, and it causes serious distress and affects people’s lives negatively. But in the majority of the cases, it does not involve psychosis, dementia, intoxication, or delirium” Joiner, 2009.
There is no weakness in admitting you’re not ok, only strength.
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.
Post Traumatic Stress Disorder (PTSD) in Firefighters is becoming a hot topic in the fire service. It’s not a difficult idea to wrap your head around, we all know it’s a constant struggle for some of our brothers and sisters. Managing the raw mortality of the general public is not for the faint of heart. Our experiences with risk, death, trauma, and merely bearing witness to the personal tragedies of others is just another Wednesday at the office. The first responder (Police, Fire, EMS) job experience cannot be matched in procedure, process, or practice in any other profession.
Firefighting began with neighbors helping neighbors, entire communities banding together for collective survival in bucket brigades and it has morphed into a massive complex industrial entity, quilted together in inconsistencies. The idea of neighbors helping neighbors remains the same, but the process has changed dramatically. Instead of entire communities standing up to shoulder the load, a select few are standing up, swearing-in, and accepting the life of experiencing all the tragedies and miracles for the sake of others. “So others may live.”
For the last ten years, there has been extensive research into military combat-related PTSD; it’s the majority of research that currently exists with PTSD. What doesn’t exist is extensive research into the propensity and prevalence of PTSD in Firefighters. In every instance of trying to understand firefighter PTSD the only example that can be referenced is combat and war, however, the comparison is not apples to apples. Firefighter PTSD can not and should not be compared to what soldiers experience in combat.
Combat-related PTSD occurs because of what soldiers experience and the tasks that he/she performs while they are deployed. The symptoms of combat-related PTSD generally surface when the soldier attempts to reintegrate into society. In short, a soldier leaves the safety of home, inserts into a combat zone; experiences and/or does awful things for a defined term of time (deployment); the soldier returns home and tries to carry on as if nothing happened. No other profession can compare or match the reality of taking another person’s life in combat while accepting the feeling of being hunted or targeted for death.
In a differing experience, Firefighters are nearly always and fairly consistently on the verge of experiencing, if not in the middle of mitigating, a traumatic event (whether there own or witnessing others). Firefighters live in society, and there is no reintegration unless you attempt to measure it after every shift. The exposure to traumatic incidents is spread across years and even decades, over one’s career.
For the first responder, the consistent exposure to traumatic events becomes a way of life. It’s that reality that begs the question; are firefighters ever “post” trauma?
Sure, there is a moment when the traumatic incident ends, followed by an inconsistent amount of unmeasurable time until there is another traumatic experience which will have its own “post” block of time. The repeated exposure to traumatic events creates layers of exposure like an onion, one layer on top of another. You may remember one specific traumatic incident for the rest of or life; it may be an awful memory, but it doesn’t always give you PTSD symptoms. It’s not fully known WHY some people get PTSD and others don’t. Again, PTSD isn’t about what’s wrong with you; it’s about what happened to you and how you’re able to process it. Clearly, we’re all different.
To complicate matters, after a while, all the traumatic experiences start to become relative to one another. The worst call you’ve ever experienced will always stick out until it is matched or topped by another call, leaving lesser, moderately traumatic situations to feel not so bad, because you’ve had worse. If you took the average resident of your community and had them bear witness to a traumatic car accident, that event is likely to be more traumatizing to them, because you’ve been exposed to worse or similar incidents.
As you can probably conclude, it’s not entirely simple to break down the prevalence of PTSD in Firefighters. There are several types of firefighters. Career, volunteer, wildland, airport, industrial, federal, shipboard, and more. Each segment of our profession has vastly differing experiences related to trauma. The airport firefighter could work his entire career without experiencing a traumatic event, while the career firefighter in a metropolitan environment could experience multiple traumatic experiences per week for an entire career.
To make things even more complex, volunteer firefighters in rural areas may experience a fair amount of traumatic experiences related to people they know personally, as opposed strangers, which adds another barrier to research. To further complicate the volunteer research challenge, volunteers lack the PTSD protective factors (social support, kitchen table discussions, access to EAP) available to career firefighters. Volunteers who respond to a traumatic event and then return home to their family brings it’s own dynamic that has the potential for marriage and family implications.
If you’ve made it this far, you might be feeling that you’re completely fine, as if nothing could possibly affect you, and you could be right. However, desensitization is the key theme here. Desensitization is the diminished emotional responsiveness to a negative or aversive stimulus after repeated exposure. This has long-term implications which could affect your social relationships outside of the fire department, including your family.
More research is needed in this area so we can begin to understand the bigger picture. With more research, we’re able to create better solutions for firefighters, their families, and the industry. Please take this short survey to help Station Pride gather the data needed to realize a global picture of the greater fire service. The more firefighters that take the survey, the clearer the picture. Please be as honest as possible.
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.
THE BIOLOGY OF SLEEP
Every person needs a different amount of sleep to awaken feeling refreshed. Individual sleep requirements are genetic and may be hereditary. Scientists consider six to 10 hours of sleep a normal range, with most people requiring 7.5 to 8.5 hours of sleep in a 24-hour period. At least four to five hours of uninterrupted core sleep is necessary to maintain minimum performance levels. Sleep requirements may change slightly with age and can be affected by general health. Illness, stress, and depression cause the body to require more sleep to heal and recuperate.
WHAT IS SLEEP DEPRIVATION?
Sleep deprivation occurs when a person does not get sufficient amounts of quality sleep. Work demands, family life, and lifestyle choices may cause a person to sleep fewer hours than his body needs to maintain wakefulness and energy levels. In the Fire Service most of us to Shift work and have to interrupt the body’s natural wake/sleep cycle. Over time deprivation of sleep can have both an acute and cumulative effect on our bodies and minds.
THE EFFECTS OF SLEEP DEPRIVATION
Sleep loss is cumulative and creates a sleep debt. Larger sleep debts require greater amounts of restorative sleep to return the body and mind to normal, rested levels. Sleep deprivation affects mental processes and intellectual abilities. It reduces performance on challenging tasks and negatively affects psychomotor skills. Mood, productivity, and communication skills suffer. Extended periods without sleep may cause hallucinations and paranoia. Lack of sleep may slow glucose metabolism by 30 to 40 percent and increase levels of the stress hormone cortisol. Sleep deprivation has also been linked to inadequate levels of the hormone leptin. Leptin signals the body to stop eating when it’s full. Decreased levels of leptin lead to increased carbohydrate cravings and eating.
“Physical and mental performances are not the only casualties of sleep deprivation. Even a minimal loss of sleep impacts general health. Chronic lack of sleep can contribute to serious health problems and even shortened lifespan. In a 1983 study at the University of Chicago, rats kept from sleeping became sick and died after two and a half weeks. Sleep-deprived rats that became ill but were then allowed to sleep, recuperated fully.”
Other effects of chronic sleep deprivation include:
• Adult-onset diabetes
•Menstrual and infertility problems
•Increased use of drugs and alcohol
•Impaired sexual function
•Less satisfaction in personal and domestic pursuits
•Increased appetite and weight gain
•Personality changes, particularly loss of humor and increased ill temper.
COUNTERMEASURES AND COPING STRATEGIES
“Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night”
Quality sleep is the primary weapon in the battle against sleep deprivation. Firefighters must take advantage of opportunities for sleep, both on and off duty. Sleeping areas at home and at the fire station should be quiet and dark, and the room temperature should be cool. A comfortable, good-quality mattress is a must. Invest in comfortable bedding and pillows as well. Good sleep habits are essential. Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night. Going to sleep and waking up at the same times every day, even on weekends, is important for maintaining the body’s natural rhythms.
Other tips for quality sleep include the following:
- Avoid eating, reading, and watching TV in bed.
- Restrict caffeine intake, and avoid caffeinated drinks at least six hours before bedtime.
- Eat healthful foods. Do not eat large meals within four to five hours of sleeping.
- Do not use alcohol to induce sleep. The effects of alcohol-induced drowsiness last only a few hours and cause poor-quality sleep.
- Avoid long-term use of over-the-counter sleeping pills. Habitual use can reduce effectiveness and lead to addiction.
- Reduce life stress as much as possible.
- Use relaxation techniques to relieve stress and invite sleep.
- Exercise, but not more than four hours before bedtime. For 24-hour shift workers, outdoor exercise during daylight hours can help the body maintain natural biological rhythms and increase sleep quality off-duty.
- Napping is an effective coping strategy that can be used in anticipation of a long night or during extended operations. Naps as short as 20 minutes can be effective. Two-hour naps during around-the-clock operations are highly restorative.
- Daytime sleep after a night shift is essential to staying well rested, but trying to sleep when the rest of the world is awake can be challenging at best. The shift worker must emphasize to friends and family the importance of restorative sleep. Go as far as having daytime sleep scheduled on the family calendar along with ballgames, school meetings, and other activities.
- Melatonin may help promote better sleep, particularly during the day. However, this supplement is not FDA-approved, and current research is contradictory on short-term and long-term effects.
- People who are regularly unable to sleep should consult their physicians to rule out underlying health problems. Doctors may also be able to prescribe medication to help with sleep. Sleep disorders can be aggravated by shift work. Shift workers with diagnosed sleep disorders need to work closely with their physicians to effectively manage their disorder.
A great insomnia program is available through Mindability. Please click on the link to learn more.
This article is provided as a service by FireStrong.org
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.